Adulterants in illicit drugs: A review of empirical evidence

Claire Cole, Lisa Jones, Jim McVeigh, Andrew Kicman, Qutubuddin Syed, Mark Bellis

Research output: Contribution to journalReview articlepeer-review

116 Citations (Scopus)

Abstract

Widespread public perception is that illicit drugs contain substances that are a serious risk to health, even though adulterants are often not considered in clinical or forensic toxicology. This review attempts to present an evidence-based overview of adulterants in illicit drugs, and their associated toxicity. Adulterants are deliberately added to increase bulk, enhance or mimic a pharmacological effect, or to facilitate drug delivery. Those present unintentionally are as a result of poor manufacturing techniques. From the reports gathered, adulterants are predominantly substances which are readily available, commonly being caffeine, procaine, paracetamol, and sugars. These are likely to have minimal impact on users' health at low dosages. Other adulterants, particularly in injectable drugs, have the potential to cause serious health issues, but the quantities reported, such as strychnine in heroin, are not life-threatening. The most commonly identified bacterial contaminants identified are Bacillus and Clostridium species. When death or serious illness due to adulteration occurs, circulation of information is particularly vital, such as in the USA regarding heroin and cocaine adulterated with fentanyl, and in Scotland recently regarding anthrax contaminated heroin. The complex interactions of supply, demand, and control of illicit drugs have a tangible impact on their adulteration. Continuing vigilance and the circulation of information is, therefore, desirable as a public health issue. As part of that strategy, analyses performed for adulterants needs to be encouraged, which are considerably limited in number and scope at the moment.

Original languageEnglish
Pages (from-to)89-96
Number of pages8
JournalDrug Testing and Analysis
Volume3
Issue number2
DOIs
Publication statusPublished - Feb 2011

Keywords

  • Adulteration
  • Contamination
  • Evidence
  • Illicit drugs

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