The contribution of impurities to the acute morbidity of illegal drug use

Although emergency physicians treat many patients who use illegal drugs, little is known about the relative toxicities of the abused drug versus those that result from drug impurities and additives. Although case reports suggest significant contribution of contaminants to the morbidity and mortality of street drugs, most physicians' clinical experience and a comprehensive review of the clinical and forensic science literature demonstrate that impurities and additives play only a minor role in the majority of drug-related emergency department presentations. The strengths and weaknesses of several of the currently available drug abuse information data bases are reviewed, and qualitative information concerning the scope of contaminants that have been reported in preparations of cocaine, heroin, and phencyclidine is presented. More research is needed in this area, and a closer liaison between law enforcement, forensic scientists, and emergency physicians should be developed.