Quinine is a bitter tasting powder extracted from the bark of the cinchona tree of South America. Quinine, used in medicine, became popular as an antimalaria drug, and in the 1940’s drug pushers, concerned about their decreasing clientele from the epidemic of malaria sweeping the streets, added quinine to heroin. As a result of this new practice, the malaria outbreak in New York was reasonably controlled. The use of quinine in illicit preparations continues today, because quinine’s bitter taste prevents heroin buyers from being able to judge the quality of heroin sold as well as adds to the “rush” of the heroin injection.
Although quinine is a relatively toxic drug, it has a “good” reputation in the addict population. However, studies of “heroin overdose” deaths indicate that quinine is often one of the primary agents responsible for these deaths. Allergic reactions to the drug can lead to pulmonary death through overstimulation of the central nervous system. Tne incidence of these kinds of deaths has always been the greatest in those areas of the country where “cutting” heroin with quinine is most
Heroin or diacetylmorphine is a morphine alkaloid which is rapidly and almost completely broken down into morphine. A small fraction of a heroin dose is excreted as 6-monoacetylmorphine (6-MAM). Because 6-MAM is present in only very small concentrations for a short period of time, it is not reasonable to detect it in the urine samples of drug treatment patients. In these cases, the detection of quinine is often used to indicate the use of illicit heroin. In order to use quinine as a “marker” for heroin use, it is important to understand what quinine is and how it is detected. Quinine is also detectable for a longer period of time than morphine.
Quinine, it’s stereoscopic isomer quinidine and their metabolites are detected in urine by Thin Layer Chromatography (TLC). Urine extracts are spotted onto a TLC plate and developed in a solvent. Quinine is distinguished by three spots for the free drug as well as two metabolites. Each of these spots will give off a bright fluorescent color when exposed to ultraviolet light. Quinine/quinidine will also respond to the standard iodoplatinate reagent used to detect most alkaloidal drugs. The fact that there are three distinctive spots means that the identification of quinine is very specific and reliable. The limit of sensitivity for quinine in urine, utilizing TLC, is approximately 0.2mg/mL. Laboratory experience indicates that quinine nmy be detected as long as 4 to 5 days after intake.
However, the use of quinine as an indicator of illicit heroin abuse is complicated due to the fact that there are multiple sources for quinine other than illicit drug use. A positive urine sample for quinine can occur after intake of any source of quinine, whether that source be drugs “cut” with quinine or whether the source is some substance not drug abuse related.
Quinine is commonly associated with heroin in illicit drug preparations. Hence, a positive quinine test is often taken as an indication that drugs were used. If morphine is present, this assumption is reasonable. If both drugs are absent, the assumption is less valid. but not unreasonable. Quinine, however, may be present in medications and in tonic water, the most common source of non-drug related quinine. The consumption of 10oz. of tonic water can result in a quinine positive urine sample for a period of up to 96 hours (4 days) after intake.
There is a list of several compounds which contain quinine or quinidine below. Since many people are sensitive to quinine, it is almost always listed in the ingredients of products which contain it. Patients in drug treatment should be warned to avoid the use of products containing quinine or quinidine.
Common Products and Medications
|Common Name||Drug Name||Availability|
|Bromo-Quinine Cold Tabs||Quinine Hydrobromide||Over the counter|
|Cin Quin||Quinidine Sulfate||Prescription|
|Coco-Quinine||Quinine Sulfate||Over the counter|
|Coryza-A Tablets||Quinine Sulfate||Over the counter|
|Dura Quin||Quinidine Gluconate, USP||Prescription|
|Hospital Bitters||Quinine Sulfate||Unknown|
|Maso Quin||Quinidine Sulfate||Prescription|
|Myodyne||Quinine Sulfate||Over the counter|
|Quinaglute Dura Tabs||Qunidine Gluconate, USP||Prescription|
|Quine||Quinine Sulfate||Over the counter|
|Quinidex Extentabs||Quinidine Sulfate||Prescription|
|Quinidex I., A.||Quinidine Sulfate||Prescription|
|Quinidine M.B.||Quinidine Sulfate||Prescription|
|Special Formula #2||Quinine Sulfate||Unknown|
|Q-Vel||Quinine Sulfate||Over the counter|
|Quinatime||Quinidine Gluconate, USP||Prescription|
|Quin-Release||Quinidine Gluconate, USP||Prescription|
|Other products which contain various combinations of
quinine, quinidinem cinchonine and cinchonidine