Correspondence

Lead Poisoning Due to Adulterated Marijuana

N Engl J Med 2008; 358:1641-1642April 10, 2008

Article

To the Editor:

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 (population, approximately 650,000) with classic signs and symptoms of lead intoxication. Twenty of these patients were admitted to our hospital (University Hospital Leipzig), 16 on an emergency basis (Table 1Table 1Clinical and Laboratory Characteristics of 16 Patients with 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.1

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 Δ 9-tetrahydrocannabinol by means of high-pressure liquid chromatography. One package contained obvious lead particles (Figure 1Figure 1Typical Street-Size Bag of Marijuana.); this strongly indicated that the lead was deliberately added to the package rather than inadvertently incorporated into the marijuana plants from contaminated soil. At this point, we involved the police, and a full criminal investigation was begun. 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 (>25 μg per deciliter), and some of these persons had dangerous levels of lead (>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. In the material that was obtained, the lead content on average was 10% by weight, which translates into a profit increase of approximately €1,000 ($1,500.00) per kilogram of marijuana. Lead particles smoked in a joint, which can have a core temperature of 1200°C,2 are very effectively absorbed in the respiratory tract. The medical community, including pediatricians,3 should consider adulterated marijuana as a potential source of lead intoxication.

Franziska Busse, M.D.
Leyla Omidi, M.D.
Alexander Leichtle, M.D.
University Hospital Leipzig, D-04103 Leipzig, Germany

Michael Windgassen, M.D.
Dialysis Center Grimma, 04668 Grimma, Germany

Eyleen Kluge, M.D.
Michael Stumvoll, M.D.
University Hospital Leipzig, D-04103 Leipzig, Germany
michael.stumvoll@medizin.uni-leipzig.de

3 References

1. 1

   Garcia RC, Snodgrass WR. Lead toxicity and chelation therapy. Am J Health Syst Pharm 2007;64:45-53
   CrossRef | Web of Science | Medline

2. 2

   Baker RR. Temperature distribution inside a burning cigarette. Nature 1974;247:405-406
   CrossRef

3. 3

   Needleman HL, Schell A, Bellinger D, Leviton A, Allred EN. The long-term effects of exposure to low doses of lead in childhood: an 11-year follow-up report. N Engl J Med 1990;322:83-88
   Full Text | Web of Science | Medline

Citing Articles (6)

Citing Articles

1. 1

   Kambiz Soltaninejad, Andreas Flückiger, Shahin Shadnia. (2011) Opium addiction and lead poisoning. Journal of Substance Use 16:3, 208-212
   CrossRef

2. 2

   Claire Cole, Lisa Jones, Jim McVeigh, Andrew Kicman, Qutub Syed, Mark Bellis. (2011) Adulterants in illicit drugs: a review of empirical evidence. Drug Testing and Analysis 3:2, 89-96
   CrossRef

3. 3

   Leonid Izikson, Erika Nornhold, Jayasri G Iyer, Paul Nghiem, Nathalie C Zeitouni. (2011) Merkel cell carcinoma associated with HIV: review of 14 patients. AIDS 25:1, 119-121
   CrossRef

4. 4

   Timothy J. Wiegand. (2010) Adulterated Cocaine and Lessons Learned from the Jake Walk Blues. Journal of Medical Toxicology 6:1, 63-66
   CrossRef

5. 5

   P. Lee, J. R. Greenfield, L. V. Campbell. (2009) Managing young people with Type 1 diabetes in a ‘rave’ new world: metabolic complications of substance abuse in Type 1 diabetes. Diabetic Medicine 26:4, 328-333
   CrossRef

6. 6

   Bastiaan J. Venhuis, Dries de Kaste. (2008) Sildenafil analogs used for adulterating marihuana. Forensic Science International 182:1-3, e23-e24
   CrossRef