Quinine as Drug Adulterant, And Malaria Transmission

To the Editor.— Malaria transmission by contaminated injection equipment is a well-documented phenomenon among heroin users in the United States.1An epidemic of falciparum malaria among heroin addicts in New York City began during the 1930s and persisted for nearly ten years, and there were more than 200 documented deaths. During the course of this epidemic, crime laboratories began to detect quinine as a common diluent or adulterant of confiscated heroin,2,3and by 1943, no further cases of needle-induced malaria were reported in the United States until the recent outbreaks associated with heroin-using Vietnam returnees (R.R. Roberto, et al, unpublished data).4 These outbreaks have been confined almost exclusively to California, where more than 50 cases have been reported since December 1970, and where, as we learned during the epidemiologic investigations, recently confiscated heroin when analyzed rarely has been found adulterated with quinine.*In contrast, only three induced