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In March 2015, the Virginia Department of Health (VDH) was alerted by the Virginia Poison Center of a 6-patient cluster treated for severe clinical presentations after using heroin. Patients' symptoms were atypical for heroin use, and concern existed that patients were exposed to heroin that had been adulterated with or replaced by another substance.

Collaborative Public Health Investigation of Clenbuterol-Adulterated Heroin Outbreak—Richmond, Virginia, March-April 2015