March 18, 2022: What adulterants are found in blood of OD patients?


The American College of Medical Toxicology (ACMT) had its' annual meeting last week (virtually). I thought you may enjoy a synopsis on some of the more interesting abstracts. The following abstract described a study in which discarded blood samples from OD patients were tested for adulterants.

Adulterants are present in drugs for one of three reasonsillicit manufacturing, added for synergistic effects, or added for bulking. They may represent local practices that differ from place to place even if the drugs originate from the same source.

Three areas (California/Oregon (west); Michigan/Missouri(central); Pennsylvania, New York, New Jersey (east)) were sampled over three time periods. More than 900 novel psychoactive drugs and adulterants were tested in 378 blood samples.

The following adulterants were found in the following percentage of samples. Potential side effects (SE) from the adulterant are noted:

• Quinine 26% of samples (increased over time) SE-1A antiarrhythmic with n/v/cinchonism, thrombocytopenia, hypoglycemia

• Local Acting Anesthetics 23% of samples SE-arrhythmia

• Levamisol 23% of samples (not only in cocaine)-rare in the west, in 23% of samples in the east, and 30% in central. SE-avascular necrosis

• Phenacetin 20% (decreased over time) SE-renal failure

• Diphenhydramine 15% (increased over time) SE-anticholinergic, Cardiac sodium channel blocker

• Hydroxyzine 11% somnolence

It appears that variation in adulterants exists in regions over time. Patterns change. We much remember not to assume that we know which adulterants are present in our region. 

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Professor Emeritus
Department of Medicine VUMC

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