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Street-Drug Contaminant causing Parkinsonism

The following information was submitted by the National Institute on Drug Abuse and the National Institute of Mental Health, and has been sent to state alcohol and drug abuse agencies and drug treatment programs.

Recently, a street-drug contaminant has appeared that can cause parkinsonism in drug abusers. The compound N-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) has been identified in underground laboratory preparations of a potent analog of meperidine (Demerol).

Over the past 8 years, sporadic outbreaks of MPTP-induced parkinsonism have occurred among drug abusers in California, Maryland, and Vancouver, British Columbia.

Two different synthetic methods were used by the underground chemists, and, in both instances, MPTP was present as a side product in the final drug preparation used or sold in conjunction with these outbreaks. The MPTP-containing powder, sometimes sold as a new "synthetic heroin," was dissolved in water and administered intravenously or taken by the intranasal route. This contaminant has been documented to produce irreversible chronic parkinson symptoms in drug abusers. Two deaths in Vancouver, British Columbia, have been attributed to use of this drug.

MPTP-induced parkinsonism in man is remarkably similar to idiopathic Parkinson's disease. All the major clinical features of Parkinson's disease are present: generalized slowing and difficulty moving, rigidity, resting tremor, flexed posture, and loss of postural reflexes. In addition, neurochemical abnormalities resembling those seen in patients with Parkinson's disease have been noted. These symptoms and signs subside temporarily after treatment with L-dopa or with bromocriptine, drugs used in treating Parkinson's disease. The neurotoxicity of MPTP has produced a severe, permanent parkinsonian syndrome in a number of drug abusers who continue to require treatment. Based on autopsy findings in one case, MPTP appears to destroy nerve cells in the substantia nigra, an area of the brain that plays a major role in controlling movement.

Since some cases of MPTP-induced parkinsonism have been misdiagnosed as catatonic schizophrenia, careful diagnostic evaluation and appropriate treatment are indicated.

While the instances of MPTP-induced parkinsonism have been limited to relatively few individuals, the possibility of far greater public health impact must be considered, because more drug-abusing individuals than those already identified have probably been exposed, and the effects of the drug appear to be cumulative and may not appear for several years.

Further studies of patients with MPTP-induced parkinsonism are currently under way at the National Institute of Mental Health.

If patients with suspected MPTP-induced parkinsonism are identified or if additional information is needed, contact Dorynne Czechowicz, M.D., Assistant Director for Medical and Clinical Affairs, Division of Prevention and Communications, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse, at (301) 443-6780.

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