Toxicology International (Formerly Indian Journal of Toxicology)

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Adulteration in the Drug of Abuse:An Autopsy Study on the Prevalence and its Role in Natural Death


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1 National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang 50586, Kuala Lumpur, Malaysia
     

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Introduction: The number of natural deaths among drug abuser is increasing in number at our centre. We aim to study the prevalence of adulterants and their role in natural deaths. Methods: This was a retrospective study of all autopsy cases with positive toxicology results from the year 2014-2016 at the Forensic Medicine Department of Hospital Kuala Lumpur. Cases that died at the ward, resuscitated, decomposed and were excluded. Data for this study were retrieved from the autopsy reports which include the toxicology report. The positive toxicology cases were then categorised into morphine group, amphetamine group and methadone group. The prevalence and relatedness using statistical analysis were computed. Results and Discussion: Morphine (18.36%) was the highest prevalent drug of abuse detected from the post-mortem cases. The commonest adulterant seen in our study was chloroquine followed by paracetamol and lidocaine. A significant difference obtained in cross tabulation between respective adulterant and drug of abuse, X2 (1, N = 80) = 14.159, p < 0.05 (CI – 95%) which proves that chloroquine was preferred adulterant in all the drug groups especially in morphine group. The highest number of chloroquine was seen in cases with lung infection and perforated gastric ulcer. Lidocaine was present in the highest number in death related to the heart pathology. Conclusion: Adulterants in the drug of abuse is becoming common, with chloroquine leading the list followed by lidocaine at our centre. The effect of adulterants is not negligible. It has a role in the development of natural disease and even deaths.


Keywords

Adulterants, Drug of Abuse, Post-mortem.
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  • National Drug Agency: Drug Information. Home Ministry Malaysia; 2016.

  • Kaye S, Darke S, Duflou J, McKetin R. Methamphetaminerelated fatalities in Australia: Demographics, circumstances, toxicology and major organ pathology. Addiction. 2008; 103:1353–60. PMid: 18855825. https://doi.org/10.1111/j.1360-0443.2008.02231.x

  • Bartu A, Freeman NC, Gawthorne GS, Codde JP, Holman CD. Mortality in a cohort of opiate and amphetamine users in Perth, Western Australia. Addiction. 2004; 99:53–60. PMid: 14678062. https://doi.org/10.1111/j.1360-0443.2004.00602.x

  • Chemistry Department Malaysia. 2018. http://www.kimia.gov.my

  • Andreasen MF, Lindholst C, Kaa E. Adulterants and diluents in heroin, amphetamine, and cocaine found on the illicit drug market in Aarhus, Denmark. The Open Forensic Science Journal. 2009; 2:16–20. https://doi.org/10.2174/1874402800902010016

  • Akhgari M, Moradi F, Ziarati P. The texture of psychoactive illicit drugs in Iran: Adulteration with lead and other active pharmaceutical ingredients. Journal of Psychoactive Drugs. 2018; 50(5):451–9. PMid: 30130472. https://doi.org/10.1080/02791072.2018.1508791

  • Akhgari M, Etemadi-Aleagha A, Jokar F. Street level heroin, an overview on its components and adulterants. Neuropathology of Drug Addictions and Substance Misuse. 2016; 1:867–77. https://doi.org/10.1016/B978-0-12-800213-1.00081-X

  • Masoodi M, Zali MR, Ehsani-Ardakani MJ, MohammadAlizadeh AH, Aiassofi K, Aghazadeh R, Shavakhi A, Somi MH, Antikchi MH, Yazdani S. Abdominal pain due to lead-contaminated opium: A new source of inorganic lead poisoning in Iran. Archives of Iranian Medicine. 2006; 9:72–5.

  • Verheij J, van Nieuwkerk CMJ, Jarbandhan SVA, Mulder CJJ, Bloemena E. Hepatic morphopathologic findings of lead poisoning in a drug addict: A case report. Journal of Gastrointestinal & Liver Diseases. 2009; 18:225–7.

  • Dunbar NM, Harruff RC. Necrotizing fasciitis: Manifestations, microbiology and connection with black tar heroin. Journal of Forensic Sciences. 2007; 52:920–3. PMid: 17524065. https://doi.org/10.1111/j.1556-4029.2007.00452.x

  • Kalka-Moll WM, Aurbach U, Schaumann R, Schwarz R, Seifert H. Wound botulism in injection drug users. Emerging Infectious Diseases. 2007; 13:942–3. PMid: 17582887 PMCid: PMC2792833. https://doi.org/10.3201/eid1306.061336

  • Furst RT. The re-engineering of heroin: An emerging heroin “cutting” trend in New York City. Addiction Research & Theory. 2000; 8:357–79. https://doi.org/10.3109/16066350009009521

  • Will you have Gastric ulcer with Quinine - from FDA reports - eHealthMe. 2018 Jun. https://www.ehealthme.com/ds/quinine/gastric-ulcer/

  • Adeniyi OS, Makinde OV, Friday ET, Olaleye SB. Effects of quinine on gastric ulcer healing in Wistar rats. J Complement Integr Med. 2017; 29;14. PMid: 28665790. https://doi.org/10.1515/jcim-2016-0132

  • Chaudron-Thozet H, Girard J, David JJ. Analysis of heroin seized in France. Bulletin on Narcotics. 1992; 44:29–33.

  • Bernardo NP, Siqueria MEPB, de Paiva MJN, Maia PP. Caffeine and other adulterants in seizures of street cocaine in Brazil. International Journal of Drug Policy. 2003; 14:331–4. https://doi.org/10.1016/S0955-3959(03)00083-5

  • Decorte T. Quality control by cocaine users: Underdeveloped harm reduction strategies. European Addiction Research. 2001; 7:161–75. PMid: 11752847. https://doi.org/10.1159/000050737

  • Hine LK, Laird N, Hewitt P, Chalmers TC. Metaanalytic evidence against prophylactic use of lidocaine in acute myocardial infarction. Arch Intern Med. 1989; 149:2694–8. PMid: 2688587. https://doi.org/10.1001/archinte.149.12.2694

  • Haigney MC, Lakatta EG, Stern MD, Silverman HS. Sodium channel blockade reduces hypoxic sodium loading and sodium-dependent calcium loading. Circulation. 1994; 90:391–9. PMid: 8026023. https://doi.org/10.1161/01.CIR.90.1.391


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  • Adulteration in the Drug of Abuse:An Autopsy Study on the Prevalence and its Role in Natural Death

Abstract Views: 351  |  PDF Views: 5

Authors

A. H. Hasmi
National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang 50586, Kuala Lumpur, Malaysia
P. S. Lai
National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang 50586, Kuala Lumpur, Malaysia
M. S. Mahmood
National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang 50586, Kuala Lumpur, Malaysia
K. Subramaniam
National Institute of Forensic Medicine, Hospital Kuala Lumpur, Jalan Pahang 50586, Kuala Lumpur, Malaysia

Abstract


Introduction: The number of natural deaths among drug abuser is increasing in number at our centre. We aim to study the prevalence of adulterants and their role in natural deaths. Methods: This was a retrospective study of all autopsy cases with positive toxicology results from the year 2014-2016 at the Forensic Medicine Department of Hospital Kuala Lumpur. Cases that died at the ward, resuscitated, decomposed and were excluded. Data for this study were retrieved from the autopsy reports which include the toxicology report. The positive toxicology cases were then categorised into morphine group, amphetamine group and methadone group. The prevalence and relatedness using statistical analysis were computed. Results and Discussion: Morphine (18.36%) was the highest prevalent drug of abuse detected from the post-mortem cases. The commonest adulterant seen in our study was chloroquine followed by paracetamol and lidocaine. A significant difference obtained in cross tabulation between respective adulterant and drug of abuse, X2 (1, N = 80) = 14.159, p < 0.05 (CI – 95%) which proves that chloroquine was preferred adulterant in all the drug groups especially in morphine group. The highest number of chloroquine was seen in cases with lung infection and perforated gastric ulcer. Lidocaine was present in the highest number in death related to the heart pathology. Conclusion: Adulterants in the drug of abuse is becoming common, with chloroquine leading the list followed by lidocaine at our centre. The effect of adulterants is not negligible. It has a role in the development of natural disease and even deaths.


Keywords


Adulterants, Drug of Abuse, Post-mortem.

References





DOI: https://doi.org/10.18311/ti%2F2018%2Fv25i2%2F21736