The Emerging Role of Toxic Adulterants in Street Drugs in the US Illicit Opioid Crisis

Singh, Vanila; Browne, Thom; Montgomery, Joshua

doi:10.1177/0033354919887741

Cited by 59 publications

(60 citation statements)

References 14 publications

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“…An illicitly purchased product may not contain the desired or marketed active ingredient. Instead, it may be adulterated, contain an entirely different product, or have other nondisclosed ingredients 32–34 . Such ingredients could also induce pharmacokinetic drug interactions or accentuate pharmacodynamic responses.…”

Section: Risks Involving Variable Drug Concentrationsmentioning

confidence: 99%

“…Beginning in the 2000s, levamisole and phenacetin appeared more frequently 35 . By 2010, levamisole, phenacetin, aminopyrine, metamizole (or dipyrone), diltiazem, and xylazine became the predominant cutting agents in heroin and cocaine 32 …”

Section: Product Adulteration Enrichment and Substitutionmentioning

confidence: 99%

“…Heroin and cocaine samples from Vermont and Kentucky were tested to determine whether adulterants found abroad are also appearing in the United States, as well as to evaluate their role in the US opioid overdose epidemic. Among 13 heroin and cocaine samples, 69% contained ≥5 adulterant compounds 32,34 . Nine or more adulterants were identified in 15% of all samples.…”

Section: Product Adulteration Enrichment and Substitutionmentioning

confidence: 99%

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Inherent Dangers of Using Non–US Food and Drug Administration–Approved Substances of Abuse

White

Browne

Nafziger

2021

The Journal of Clinical Pharma

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Use of US Food and Drug Administration–approved substances of abuse has innate risks due to pharmacologic and pharmacokinetic properties of the medications, but the risk when using nonapproved drug products is much greater. Unbeknownst to the user, the dose of active ingredients in substances of abuse can vary substantially between different products because of manufacturing practices or improper storage. Even naturally occurring substances of abuse can have extensive dosage variability because of effects of the growing season and conditions, or differences in harvesting, storage, or manufacture of the finished products. Many illicit substances are adulterated, to make up for intentional underdosing or to enhance the effect of the intended active ingredient. These adulterants can be dangerous and produce direct cardiovascular, neurologic, hematologic, or dermatologic reactions or obscure adverse effects. Finally, an illicit substance can be contaminated or substituted for another one during its manufacture, leading to differences in adverse events, adverse event severity, or the drug interaction profile. Substances can be contaminated with microbes that induce infections or heavy metals that can damage organs or cause cancer. This milieu of undisclosed substances can also induce drug interactions. For reasons that are discussed, individuals who use substances of abuse are at increased risk of morbidity or mortality if they develop coronavirus disease 2019. Health professionals who treat patients with acute, urgent events associated with substances of abuse, or those treating the chronic manifestations of addiction, need to appreciate the complex and variable composition of substances of abuse and their potential health effects.

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Section: Risks Involving Variable Drug Concentrationsmentioning

confidence: 99%

Section: Product Adulteration Enrichment and Substitutionmentioning

confidence: 99%

Section: Product Adulteration Enrichment and Substitutionmentioning

confidence: 99%

See 1 more Smart Citation

Inherent Dangers of Using Non–US Food and Drug Administration–Approved Substances of Abuse

White

Browne

Nafziger

2021

The Journal of Clinical Pharma

Self Cite

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“…The analysis of those substances also provides information regarding the prevalence of drug consumption including NPS arriving on the market and allows the monitoring of a potential altered substance presenting risks. Indeed, evidence also suggests the potential synergistic effect of certain toxic adulterants associated with the illicit drugs leading to overdoses, severe health consequences, and even deaths (Solimini et al, 2017 ; Singh et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

High-Throughput Qualitative and Quantitative Drug Checking by MALDI HRMS

Joye

Widmer

Mégevand³

et al. 2020

Front. Chem.

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“…8 Non-pharmaceutical fentanyl products that have been chemically altered into new products are often created in unregulated, clandestine laboratories and can be tainted with toxic adulterants. 8,9 Alarmingly, some legitimate laboratories have been found to also be manufacturing illicit fentanyl analogues in addition to their legitimate manufacture of pharmaceutical grade medication. 3 Often, these products have been manipulated to increase potency, some hundreds to thousands of times more potent than licit fentanyl, resulting in more addicting and potentially lethal substances.…”

mentioning

confidence: 99%

<p>Fentalogues</p>

Persico¹,

Wegrzyn²,

Fudin³

et al. 2020

JPR

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The ongoing media maelstrom regarding opioids and classification of an "opioid crisis" during the initial decade of this millennium has stirred awareness, outrage and action among regulatory and other government agencies, professional clinician organizations, community pharmacy policies, legislators, patient advocacy groups, anti-opioid advocate groups, and others. However, mass media reports often skew or misdirect the aggregate facts in a possible effort to abridge or sensationalize stories. 1 Discernable distinctions, for example, are rarely drawn between licit pharmaceutical fentanyl, illicit fentanyl analogues, and certain highly potent analogues approved only for ungulates. The omission of this information has resulted in distorted public information that has far reaching consequences in medicine and policy development, as it leads to misunderstanding and misinterpretation of the facts by politicians, lay people and many clinicians. 2 It is particularly relevant today, as pharmaceutical fentanyl is often an essential drug for intubation regularly required for ventilation procedures in declining patients that may succumb to novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). These distinctions are critical in the shifting landscape of the opioid crisis as prescriptions for opioids decrease yet overdose deaths remain alarmingly prevalent and continue to rise.Licit fentanyl was first synthesized in the 1950s via manipulation of another phenylpiperidine, meperidine, in an effort to develop a novel analgesic agent and laying the groundwork for pharmaceutical fentanyl and multiple analogues. Only a small percentage of those analogues are actually approved for medical use. 2 The remainder are dangerously potent with high binding affinity to opioid receptors and rapid entry to the CNS. These characteristics make them particularly hazardous when added to other illicit substances such as heroin, unbeknownst to the end-user with potentially deadly consequences. 3 Illicit fentanyl has had a dramatically increasing impact on opioid overdose deaths in the US over the past decade. According to provisional data from the 2018 Centers for Disease Control and Prevention, over half of the opioid-related overdose deaths in 2018 involved non-methadone synthetic opioids; the most common of which was illicitly manufactured fentanyl. 4 Perhaps more telling are the annual data released by the New Hampshire Department of Justice, with the most recent of which indicating that less than 7% of 2019 opioid overdose deaths in the state were due to prescription opioids. 5 These illicit opioids have affected the landscape of opioid abuse to the extent that the Drug Enforcement Agency (DEA) chose to emergently schedule all fentanyl-related substances (FRS) to schedule I as of February 2018.

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The Emerging Role of Toxic Adulterants in Street Drugs in the US Illicit Opioid Crisis

Cited by 59 publications

References 14 publications

Inherent Dangers of Using Non–US Food and Drug Administration–Approved Substances of Abuse

Inherent Dangers of Using Non–US Food and Drug Administration–Approved Substances of Abuse

High-Throughput Qualitative and Quantitative Drug Checking by MALDI HRMS

<p>Fentalogues</p>

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