The North Carolina Division of Public Health (NC DPH) currently is investigating 18 cases of illness potentially due to use of heroin mixed with clenbuterol. Reported cases are from four counties (Durham, Lee, Orange, and Wake). The source of the clenbuterol-contaminated heroin is suspected to be in Durham County.
Clenbuterol is a potent beta-agonist not approved for human use in the United States. In the current outbreak, cases have reported symptoms atypical for heroin use, including a rapid onset of heart palpitations, dizziness, anxiety, vomiting, fainting, hypotension, shock and severe muscle cramping.
NC DPH and the Carolinas Poison Center offer this guidance for clinicians.