UMEM Educational Pearls

Category: Toxicology

Title: Cheese Heroin

Keywords: diphenhydramine, heroinI (PubMed Search)

Posted: 9/18/2008 by Fermin Barrueto, MD (Updated: 12/7/2019)
Click here to contact Fermin Barrueto, MD

 Cheese Heroin: a slang term for the combination of heroin with an over-the-counter antihistamine

  • The two are combined and forms a cheesy like powder that is different from pure heroin
  • A string of deaths were reported between 2005-2007 in Texas, many adolscents
  • This concoction is more often insufflated than smoked or injected
  • Combines opioid effect with the anticholinergic confusion and hallucinations
  • Scorpion was a heroin that was combined with scopolamine that had similiar effect

Treatment

  • Find the anticholinergic toxidrome, place the foley and supportive care are mainstays
  • Consider administration of physostigmine 1mg IV slowly over 2-5 minutes (call toxicologist)
  • The anticholinergic effects will linger much longer than the heroin effects ( <1hr)