Adulterated marijuana - source of lead poisoning
See this correspondence from Germany published this week in The New England Journal of Medicine. We are reproducing only parts but full text, tables, figures, authors and references are available free 1.
"As a consequence of strict regulations, lead intoxication has not occurred in Germany in recent decades. Recently, during a period of 3 to 4 months, 29 patients (16 to 33 years of age) were admitted to four different hospitals in the greater Leipzig area with classic signs and symptoms of lead intoxication. ......The patients presented with abdominal cramps, nausea, anemia of varying severity, and fatigue. Most patients had basophilic stippling* and a "Burton's line," ^ and some had neurologic symptoms. In other hospitals, one patient had severe encephalopathy with hallucinations and peripheral neuropathy with permanent extensor palsy in the forearm, and another patient underwent exploratory laparoscopy.
The diagnosis was quickly established, and chelation therapy was effective, but despite great efforts by health authorities and police, the source of lead could not be identified. After 8 weeks, we detected a common pattern: the patients were young, were unemployed or were students, had a history of smoking, and had body piercings. On questioning, all the patients eventually conceded that they were regular users of marijuana smoked in "joint" form or with the use of a water pipe. We recovered either half-used packages or aliquots of "home supplies" of marijuana from three patients, and we identified elemental lead by means of atomic absorptiometry and 9-tetrahydrocannabinol by means of high-pressure liquid chromatography. One package contained obvious lead particles; this strongly indicated that the lead was deliberately added to the package rather than inadvertently incorporated into the marijuana plants from contaminated soil. .....Health authorities immediately started an anonymous screening program for marijuana users. After 2 weeks, 145 persons had used this service. A total of 95 of these persons had blood lead levels that required treatment (more than 25 µg per deciliter), and some of these persons had dangerous levels of lead ( more than 80 µg per deciliter).
The current working hypothesis of the police is that because of its high specific gravity and inconspicuous grayish color, lead was used to increase the weight of street marijuana sold by the gram and thereby to maximize profits among dealers......Lead particles smoked in a joint, which can have a core temperature of 1200°C, are very effectively absorbed in the respiratory tract. The medical community, including pediatricians, should consider adulterated marijuana as a potential source of lead intoxication".
Addendum from icuroom.net:
* Basophillic Stippling is fine, medium or coarse blue granules with uniform distribution within the red cell and represents ribosomal RNA which is precipitated during staining. It is found in conditions such as thalassemia, hemoglobinopathies, sideroblastic anemias, heavy metal poisioning and pyrimidine-5'- nucleotidase deficiency.
^ Burton's line is a blue-purplish line on the gums seen in lead poisoning.
See image of Basophillic Stippling and Burton's line below.
Reference:
Lead Poisoning Due to Adulterated Marijuana, The New England Journal of Medicine, Volume 358:1641-1642, number 15, April 10 2008
