The composition of the street drugs heroin and cocaine has dramatically changed at alarming speeds across the globe. No longer are these street drugs cut with benign materials such as lactose but now cut with up to 17 or more pharmaceutically active and potentially toxic adulterants.

A drug user may buy cocaine today but may end up with a drug cocktail more dangerous then what was bought and assumed was cocaine. This has a profound effect on public health and safety as well as on the individual street drug users during the COVID-19 pandemic.

Selected by the Editor-in-Chief, Dr. Kenneth Blum as the Editor's Choice in the May 2021 issue of Current Psychopharmacology (CPSP), this work examined the alarming addition of multiple pharmaceutically active substances collectively referred to as "toxic adulterants" and their pathophysiological effects, especially on street drug using patients, in light of the COVID-19 pandemic.

Additional pharmaceutically active and potentially toxic compounds have been found in routine street drug seizures at startling amounts. These toxic adulterants include, but are not limited to, ethical pharmaceuticals such as cardiac medications, veterinary pharmaceuticals such as levamisole, industrial chemicals, fungicides, new psychoactive substances all of which have profound effects on the substance user health and COVID-19 risk.

"Never before in the history of addiction medicine have there been so many combinations of drugs and pharmacologically active compounds in a single dose of cocaine or heroin" Stated Dr. David M. Martin, Science Team Director of the project, he continued "Although the reason for this is unclear, it may be to create new product lines for an increasingly overcrowded street drug market and this trend seems to be continuing."

The report concluded that this dangerous new trend in world street drug supply is unprecedented and maybe the undetected cause of many psychostimulant and opioid overdose deaths. This is because many toxic adulterants are not routinely tested in post- mortem or street drug seizure cases. Public health and treatment officials need to know of this new dangerous trend evaluating and treating patients.

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