Cutting agents in cocaine: A temporal study of the period 2015–2017 in the Northern Region of Colombia

Application of dose‐addition analyses to characterize the abuse‐related effects of drug mixtures

“…Indeed, evidence suggests that ~70% of the cocaine supply being exported from Brazil is already adulterated with various psychoactive compounds, such as caffeine and levamisole (Lapachinske et al, 2015). Stimulants, in particular, are frequently mixed with caffeine, lidocaine, or levamisole (Arango‐Meriño et al, 2021; Brandt et al, 2010; Broséus et al, 2015; Davies et al, 2010; Fiorentin et al, 2019; Goh et al, 2008; Lapachinske et al, 2015; Seely et al, 2013; Spiller et al, 2011; Wolford et al, 2012; Zuba & Byrska, 2013), which serve as bulking agents, effectively reducing the amount of illicit drug per gram, while also contributing a mild stimulant or local anesthetic effect. Recently, it has become increasingly common for the mu‐opioid receptor agonist, fentanyl, to be used (intentionally or unintentionally) in combination with other illicit substances, including heroin, cocaine, and methamphetamine, which has contributed to an increase in overdose deaths (Biggar et al, 2021; Karch et al, 2021; Kariisa et al, 2019; LaRue et al, 2019).…”

“…In addition to the intentional use of drug mixtures (e.g., the cocaine + opioid, “speedball” mixtures), illicit drugs are often adulterated by distributers and/or dealers, likely in an attempt to increase profit. Psychoactive compounds, such as local anesthetics, levamisole, or caffeine, are often used to adulterate illicit stimulant preparations because they are inexpensive, legal, and can add bulk to the drug preparation while also contributing a mild stimulant‐like effect (Arango‐Meriño et al, 2021; Brandt et al, 2010; Broséus et al, 2015; Davies et al, 2010; Fiorentin et al, 2019; Goh et al, 2008; Lapachinske et al, 2015; Seely et al, 2013; Spiller et al, 2011; Wolford et al, 2012; Zuba & Byrska, 2013). Although relatively few studies have investigated interactions among illicit stimulants and common “adulterants”, emerging evidence suggests that these compounds may do more than simply increase profit margins.…”

“…Although relatively few studies have investigated interactions among illicit stimulants and common “adulterants”, emerging evidence suggests that these compounds may do more than simply increase profit margins. Two prominent examples of drugs that are often identified in cocaine preparations are levamisole, an anthelminthic agent, and caffeine, both of which have been identified in greater than 50% of cocaine samples seized in Brazil, prior to export, or in the United States (Arango‐Meriño et al, 2021; Lapachinske et al, 2015; Wolford et al, 2012). Due to their prominence in samples, it has been suggested that levamisole and caffeine are used as “adulterants” because they possess psychoactive properties that may mimic or enhance the abuse‐related effects of cocaine.…”

Diagnosis and management of the patient with contaminated illicit drug poisoning

“…There has been the increasing use of "adulterants" that are legal substances which are added to these illicit drugs. This process, called "cutting", is to either further enhance their effects or expand volume, both of which enhance the drug dealers' profits (3,4). Laboratory tests can confirm the most common illicit substances but often will not identify altered forms (5).…”