Solimini Renata, Rotolo Maria C, Pellegrini Manuela, Minutillo Adele, Pacifici Roberta, Busardò Francesco P, Zaami Simona
National Centre on Addiction and Doping, Istituto Superiore di Sanita, V.le Regina Elena 299, 00161, Rome. Italy.
Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
Curr Pharm Biotechnol. 2017;18(7):524-530. doi: 10.2174/1389201018666170710184531.
Powdery drugs such as cocaine and heroin are frequently adulterated or diluted predominantly to obtain more doses and to increase the drug dealer's profits, but also to enhance, to modify or to oppose drug effects. The aim of this report is to provide an overview of the recent scientific literature on medicines as well as on new psychoactive substances, used as cutting agents (i.e. pharmacologically active adulterants) and on the related adverse health effects on consumers, possibly due to the synergistic effect of the adulterants laced with substances of abuse.
A literature search up to January 2017 was performed on MEDLINE, Scopus and Web of Science and reports and documents of international agencies or institutions were also searched.
Pharmacologically active substances such as: paracetamol, caffeine, dextromethorphan, clenbuterol for heroin; levamisole, phenacetine, lidocaine, hydroxyzine and diltiazem for cocaine; caffeine and phentermine for amphetamine, have been identified over the years. Furthermore, since cocaine and morphine (this latter as a precursor of heroin) are both extracted from natural products, some impurities and minor alkaloids can be present in the final preparation. In this context, it is worth considering that new psychoactive substances are also used as cutting agents.
The wide availability of illicit psychotropic drugs is the most serious hazard threatening consumers. Indeed emergency departments are often responsible in evaluating damages caused not only by the base substance, but also by other eventual compounds added to mimic or antagonize drug effects or simply dilute the drug amount, with a possible harmful synergic toxic action.
诸如可卡因和海洛因之类的粉末状毒品经常被掺假或稀释，主要目的是获取更多剂量并增加毒贩的利润，但也有增强、改变或对抗毒品效果的意图。本报告的目的是概述近期有关用作掺杂物（即具有药理活性的 adulterants）的药品以及新型精神活性物质的科学文献，以及其对消费者可能产生的相关健康不良影响，这可能是由于掺杂物与滥用物质的协同作用所致。
在 MEDLINE、Scopus 和科学网进行了截至 2017 年 1 月的文献检索，还检索了国际机构或组织的报告和文件。
多年来已鉴定出具有药理活性的物质，例如：用于海洛因的对乙酰氨基酚、咖啡因、右美沙芬、克伦特罗；用于可卡因的左旋咪唑、非那西丁、利多卡因、羟嗪和地尔硫䓬；用于苯丙胺的咖啡因和芬特明。此外，由于可卡因和吗啡（后者是海洛因的前体）均从天然产物中提取，最终制剂中可能存在一些杂质和次要生物碱。在这种情况下，值得考虑的是新型精神活性物质也被用作掺杂物。
非法精神药物的广泛可得性是威胁消费者的最严重危害。实际上，急诊科常常负责评估不仅由基础物质，而且由添加的其他最终化合物所造成的损害，这些化合物用于模拟或拮抗药物效果，或仅仅是稀释药物量，可能具有有害的协同毒性作用。
