Emergency department personnel often have to identify and treat the effects of illicit drugs and any other compounds added to mimic or antagonize the main drug effects. The consumed illicit drug may also be diluted with a range of substances, some of which could give rise to harmful synergic toxic actions. Cocaine and morphine (precursor of heroin) are extracted from natural products, impurities and minor alkaloids can be present in the final product.
Several countries worldwide analyze adulterants present in seized heroin and cocaine samples to trace the routes of trafficking and adulteration for forensic purposes. The identification of adulterants and the assessment of drug purity levels might offer opportunities for identifying potential health hazards. However, there is no standardized procedure for the type of analysis to be executed, nor is there a general database.
To set the stage for further national mapping, Simona Pichini, Istituto Superiore di Sanità, Rome, Italy, and colleagues systematically analyzed adulterants present in seized street drugs in Italy and compared their data to what has been reported in other countries. They analyzed recently seized drug samples from 2013 to 2016 obtained by the Carabinieri by gas chromatography-mass spectrometry (GC-MS). The finds are of a preliminary nature as they are only derived from one of the national police forces, and the quantitative purity data were frequently incomplete.
Comparable purity was found for street heroin in northern Italy. A significantly lower heroin purity found in Campania, agreed with street heroin recently seized in other European countries. The very few data on cocaine purity originating from Italy appeared uniform. Purity throughout Europe seems to be diverse.
The heroin adulterants were paracetamol and caffeine. Caffeine probably facilitates heroin vaporization. Methorphan was only detected in heroin samples from Italy, suggesting that it is an Italian phenomenon. Methorphan is a minor opium alkaloid of the morphinan series. It consists of a racemic mixture of dextromethorphan, an over-the-counter cough suppressant, as well as dissociative hallucinogen and levomethorphan, a potent opioid analgesic with no clinical application. Levamisole is the most abundant adulterant detected in cocaine samples seized in European countries.
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