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A Musculoskeletal Syndrome in Intravenous Heroin Users: Association with Brown Heroin

ROBERT S. PASTAN, M.D.; STUART L. SILVERMAN, M.D.; and DON L. GOLDENBERG, M.D.
[+] Article and Author Information

Grant support: by the U.S. Public Health Service, National Institute of Arthritis, Metabolic and Digestive Disease, National Institutes of Health (AM-04599, Tl-AM-5285, and RR-533); the Massachusetts Chapter of the Arthritis Foundation; and the Arthritis Foundation. Stuart L. Silverman is a recipient of a Post-doctoral Fellowship from the Arthritis Foundation.

▸Requests for reprints should be addressed to Don L. Goldenberg, M.D; Department of Medicine, Boston City Hospital, 818 Harrison Ave.; Boston, MA 02118.


Boston, Massachusetts


Ann Intern Med. 1977;87(1):22-29. doi:10.7326/0003-4819-87-1-22
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During a recent 5-month period, 16 intravenous heroin users were hospitalized with a previously unrecognized complication of drug abuse. The characteristic symptoms were similar in all patients and included fever, paraspinal myalgias, and periarthritis. There was no evidence of bacterial infection, hepatitis, or drug abstinence as the cause of these musculoskeletal symptoms. Continued heroin use was associated with progressive musculoskeletal symptoms, while discontinuation of heroin use resulted in complete recovery. Antibiotics did not affect the outcome, and the syndrome was self-limited in all hospitalized patients. The pathogenesis of this syndrome is unknown but may be related to the heroin, which was described as brown by the patients, or an adulterant.

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