Substance Abuse in WV - West Virginia State Medical Association

Scientific Article | Special IssueThe Face of Hillbilly Heroin and Other Images ofNarcotic AbuseRachel Lagos, DORadiology Resident, West Virginia University HospitalsMichael Hogan, MDAssociate Professor of Radiology, West VirginiaUniversity School of MedicineKarthikram Raghuram, MDAssociate Professor of Radiology, West VirginiaUniversity School of MedicineAbstractThe nationally recognized popularityof recreational intranasal oxycodoneabuse among rural Appalachians isapparent to West Virginian healthcareproviders. Three recent cases of narcoticinducedinjury at WVU Ruby MemorialHospital demonstrate the facial bonenecrosis associated with “hillbilly heroin”abuse as well as other imaging featuresof narcotic-induced intracranial ischemia.This paper shows how diagnostic imagingmay facilitate clinical evaluation ofpatients with narcotic abuse.IntroductionThe West Virginia PrescriptionDrug Abuse Quitline reports thatfatal drug overdoses increasinglyoccur in rural areas. West Virginiansown the greatest increase, a 550%increase in fatal drug overdoses. 1Suspecting, recognizing and treatingnarcotic abuse, including prescriptionnarcotic abuse, is a growing priorityamong local health care providers.The US Department of Health andHuman Services compiles a nationalsurvey on drug use and health. 2 Thestatistical data portray the “typical”drug abuser. Most illicit drug usersare sixteen to twenty-five years-oldswith a multi-ethnic background anda full-time job. Men and womenhave similar rates of nonmedicaluse of pain relievers, stimulants andmethamphetamine. Diagnostic crosssectionalimages acquired at WestVirginia University Ruby MemorialHospital illustrate their problems.The Face of Hillbilly HeroinThe first report on “hillbillyheroin” written by Greg Stonein 2001 credits a pharmaceuticalrepresentative for this epigramconnoting the regional popularityof “a potentially lethal” and “highlyabused painkiller”, oxycodone. 3 Theheroin-quality high of this syntheticopiate prescription painkiller earnsnotoriety locally and throughoutthe United States as an addictionoften affecting impoverishedrural Appalachians. 4,5,6 Regionalpredilection for this addiction isdue in large part to its availabilitythrough Medicaid prescriptioncoverage. Recent narcotic indictmentsreport that a single 80-milligramoxycodone tablet can sell for $120on the street.” 7 Although theSchedule II controlled substance ismanufactured as a sustained-releaseformula, intranasal use of a crushedoxycodone tablet foils the sustainedreleasemechanism and affords moreintense and instantaneous opiateeffects. These include a lessenedsensation of pain, dreamy euphoria,pinpoint pupils and respiratorydepression. A patient with chronicrecreational oxycodone abuse maypresent with nasal congestion.A twenty-three-year-old man witha history of intranasal oxycodoneImages A and B.Bony defects of the nasal septum and hard palate from intranasal oxycodone.ObjectivesThe following article conveys the information necessary to suspect, diagnose and assess the complications ofintranasal oxycodone abuse. There is discussion of three recent cases of narcotic-induced cranial and brain injuries. Crosssectionalneuroimaging demonstrates the severity of physical injury in these cases. In addition, the article summarizesradiological findings of narcotic-induced physical injury to multiple organ systems.34 West Virginia Medical Journal