Adulterants in crack cocaine in Brazil

Abstract Introduction Brazil is the world’s biggest consumer of crack cocaine, and dependence is a major public health issue. This is the first study to investigate the prevalence of potentially harmful adulterants present in hair samples from Brazilian patients with crack cocaine dependence. Method We evaluated adulterants in hair samples extracted by convenience from 100 patients admitted at the 48 hour-observation unit of Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), Brazil’s largest center for addiction treatment. A cross-sectional analysis was performed with the data obtained. Results Adulterants were found in 97% of the analyzed hair samples. The most prevalent adulterant was lidocaine (92%), followed by phenacetin (69%) and levamisole (31%). Conclusion Adulterants were widely prevalent in hair samples from crack users treated at CRATOD: at least one adulterant was present in virtually all the hair samples collected. This points to a need to monitor adverse effects in the clinical setting in order to provide this high-risk group of patients with prompt and effective care related to the acute and chronic complications associated with these adulterants.

摘要
引言：巴西是全球最大的快克可卡因（crack cocaine）消费国，可卡因依赖已成为突出的公共卫生问题。本研究为首个针对巴西快克可卡因依赖患者毛发样本中潜在有害掺假物质（adulterants）检出情况的调查研究。
方法：本研究通过便利抽样法（convenience sampling），选取巴西最大的成瘾治疗中心——酒精、烟草及其他药物依赖参考中心（Centro de Referência de Álcool, Tabaco e Outras Drogas，简称CRATOD）48小时观察病房收治的100名患者，对其毛发样本中的掺假物质进行检测，并对所得数据开展横断面分析（cross-sectional analysis）。
结果：本次分析的毛发样本中，97%检出了掺假物质。检出率最高的掺假物质为利多卡因（lidocaine），占比92%；其次为非那西丁（phenacetin），占比69%；左旋咪唑（levamisole）占比31%。
结论：CRATOD收治的快克使用者毛发样本中掺假物质检出率极高，几乎所有采集的毛发样本均至少含有一种掺假物质。这提示临床需对该高危人群加强不良反应监测，以便为其提供针对上述掺假物质相关急慢性并发症的及时有效诊疗服务。