Liverpool John Moores University, Centre for Public Health, Liverpool, United Kingdom.
Drug Test Anal. 2011 Feb;3(2):89-96. doi: 10.1002/dta.220. Epub 2010 Dec 29.
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.
普遍的公众认知是，非法毒品中含有对健康有严重风险的物质，尽管在临床或法医毒理学中通常不考虑掺杂剂。本综述试图对非法毒品中的掺杂剂及其相关毒性提出循证概述。掺杂剂是故意添加的，以增加体积、增强或模拟药理作用，或便于药物输送。那些非故意添加的是由于制造技术不佳造成的。从收集到的报告来看，掺杂剂主要是那些易于获得的物质，通常是咖啡因、普鲁卡因、对乙酰氨基酚和糖。这些物质在低剂量下对使用者的健康的影响可能很小。其他掺杂剂，特别是在注射用药物中，有可能导致严重的健康问题，但报告的数量，如海洛因中的士的宁，并不危及生命。最常被识别的细菌污染物是芽孢杆菌和梭状芽孢杆菌。当由于掺杂而导致死亡或严重疾病时，信息的传播尤为重要，例如在美国关于海洛因和可卡因中掺杂芬太尼，以及最近在苏格兰关于炭疽污染的海洛因。非法毒品的供应、需求和控制的复杂相互作用对其掺杂有明显影响。因此，作为一个公共卫生问题，持续的警惕和信息传播是可取的。作为该策略的一部分，需要鼓励对掺杂剂进行分析，目前这种分析在数量和范围上都相当有限。
