{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T03:54:32Z","timestamp":1792122872069,"version":"4.4.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T00:00:00Z","timestamp":1711670400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T00:00:00Z","timestamp":1711670400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The opioid overdose crisis is one of the worst public health crises ever to face the US and emerging evidence suggests its effects are compounded by the presence of drug adulterants. Here we report our efforts to characterize the adulterants present within the local fentanyl supply of San Diego County, obtained from undifferentiated drug samples seized by local law enforcement over the calendar year 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty-two participating local law enforcement agencies across San Diego submitted 4838 unknown individual illicit drug samples (total of 312\u00a0kg) to the San Diego County Sheriff\u2019s Department Regional Crime Laboratory for identification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Qualitative analysis of these samples via FTIR and GC-MS identified methamphetamine (38.7%), fentanyl (20.8%), diacetylmorphine (heroin) (10.2%), codeine (5.8%) and alprazolam (4.3%) as the most common illicit substances and the presence of 52 unique adulterants. The most common adulterants included 4-methylaminoantipyrine (4-MAAP) (10.9%), mannitol (9%), acetaminophen (8.5%), methamphetamine (4.2%), diacetylmorphine (heroin) (3.6%), tramadol (1.9%), and xylazine (1.7%). Several additional pharmacologically active adulterants and contaminants of interest were also identified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This analysis is vital for public health use and harm reduction efforts at the level of the individual consumer. Continued direct surveillance of the drug supply is necessary for the detection of potentially harmful adulterants that may pose serious threats to the public.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-024-18459-0","type":"journal-article","created":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T10:01:48Z","timestamp":1711706508000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Adulterants present in the San Diego county fentanyl supply: a laboratory analysis of seized law enforcement samples"],"prefix":"10.1186","volume":"24","author":[{"given":"Henrik","family":"Galust","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin A.","family":"Seltzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy R.","family":"Hardin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan A.","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff","family":"Salamat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard F.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Harmon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,29]]},"reference":[{"key":"18459_CR1","unstructured":"Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Accessed January 11, 2023. https:\/\/www.samhsa.gov\/data\/ Retrieved."},{"key":"18459_CR2","unstructured":"Ahmad FB, Cisewski JA, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2023. Accessed May 21, 2023. https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/drug-overdose-data.htm."},{"issue":"1","key":"18459_CR3","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/0033354919887741","volume":"135","author":"VM Singh","year":"2020","unstructured":"Singh VM, Browne T, Montgomery J. The emerging role of toxic adulterants in Street drugs in the US Illicit Opioid Crisis. Public Health Rep. 2020;135(1):6\u201310.","journal-title":"Public Health Rep"},{"key":"18459_CR4","doi-asserted-by":"crossref","unstructured":"Levine M, Meyn A, Krotulski A, Logan B, Amaducci A, Hughes A, Schwarz E, Pizon A, Wax P, Brent J, Manini. A. 71 adulteration of Illicit drugs in Emergency Department patients with Acute Opioid overdose: a Multicenter Cohort. Ann Emerg Med 78. S29. 1.","DOI":"10.1016\/j.annemergmed.2021.09.080"},{"key":"18459_CR5","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.15585\/mmwr.mm7037a4","volume":"70","author":"M Kariisa","year":"2021","unstructured":"Kariisa M, Patel P, Smith H, Bitting J. Notes from the field: xylazine detection and involvement in drug overdose deaths \u2014 United States, 2019. MMWR Morb Mortal Wkly Rep. 2021;70:1300\u20132.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"18459_CR6","unstructured":"Cole C, Jones L, McVeigh J, Kicman A, Syed Q, Bellis M. Adulterants in illicit drugs: a review of empirical evidence. Drug Test Anal."},{"key":"18459_CR7","first-page":"863","volume-title":"Neuropathology of drug addictions and substance misuse","author":"M Akhgari","year":"2016","unstructured":"Akhgari M, et al. Street level heroin, an overview on its components and adulterants. In: Preedy V, editor. Neuropathology of drug addictions and substance misuse. Volume 3, 1st ed. New York, NY: Elsevier; 2016. pp. 863\u201377.","edition":"1"},{"issue":"18","key":"18459_CR8","first-page":"2391","volume":"66","author":"M Helpern","year":"1966","unstructured":"Helpern M, Rho YM. Deaths from narcotism in New York City. Incidence, circumstances, and postmortem findings. N Y State J Med. 1966;66(18):2391\u2013408.","journal-title":"N Y State J Med"},{"issue":"2\u20133","key":"18459_CR9","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1016\/0379-0738(94)90228-3","volume":"64","author":"E Kaa","year":"1994","unstructured":"Kaa E. Impurities, adulterants and diluents of illicit heroin. Changes during a 12-year period. Forensic Sci Int. 1994;64(2\u20133):171\u20139.","journal-title":"Forensic Sci Int"},{"key":"18459_CR10","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1016\/j.forsciint.2016.02.033","volume":"262","author":"J Bros\u00e9us","year":"2016","unstructured":"Bros\u00e9us J, Gentile N, Esseiva P. The cutting of cocaine and heroin: a critical review. Forensic Sci Int. 2016;262:73\u201383.","journal-title":"Forensic Sci Int"},{"key":"18459_CR11","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1136\/injuryprev-2020-043968","volume":"27","author":"J Johnson","year":"2021","unstructured":"Johnson J, Pizzicato L, Johnson C, et al. Increasing presence of xylazine in heroin and\/or fentanyl deaths, Philadelphia, Pennsylvania, 2010\u20132019. Inj Prev. 2021;27:395\u20138.","journal-title":"Inj Prev"},{"key":"18459_CR12","unstructured":"Hamilton RJ, Perrone J, Hoffman R et al. A descriptive study of an epidemic of poisoning caused by heroin adulterated with scopolamine. J Toxicol Clin Toxicol."},{"issue":"5","key":"18459_CR13","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1016\/j.annemergmed.2008.04.026","volume":"52","author":"RS Hoffman","year":"2008","unstructured":"Hoffman RS, Kirrane BM, Marcus SM. Clenbuterol Study investigators. A descriptive study of an outbreak of clenbuterol-containing heroin. Ann Emerg Med. 2008;52(5):548\u201353.","journal-title":"Ann Emerg Med"},{"key":"18459_CR14","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/978-1-4939-8579-1_3","volume":"1810","author":"TA Brettell","year":"2018","unstructured":"Brettell TA, Lum BJ. Analysis of drugs of abuse by Gas Chromatography-Mass Spectrometry (GC-MS). Methods Mol Biol. 2018;1810:29\u201342.","journal-title":"Methods Mol Biol"},{"key":"18459_CR15","unstructured":"United States Census Bureau. QuickFacts San Diego County, California. Accessed December 17. 2022. https:\/\/www.census.gov\/quickfacts\/fact\/table\/sandiegocountycalifornia\/PST045221."},{"key":"18459_CR16","unstructured":"United States Attorney\u2019s Officer Southern District of California. Fentanyl Seizures at Border Continue to Spike, Making San Diego a National Epicenter for Fentanyl Trafficking; U.S. Attorney\u2019s Officer Prioritizes Prosecutions and Prevention Programs. Updated August 11, 2022. Accessed December 17, 2022. https:\/\/www.justice.gov\/usao-sdca\/pr\/fentanyl-seizures-border-continue-spike-making-san-diego-national-epicenter-fentanyl."},{"issue":"1","key":"18459_CR17","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1093\/jat\/bkac062","volume":"47","author":"JL Schumann","year":"2023","unstructured":"Schumann JL, Syrjanen R, Alford K, et al. Intoxications in an Australian Emergency Department Involving \u2018Nitazene\u2019 Benzylbenzimidazole Synthetic opioids (Etodesnitazene, Butonitazene and Protonitazene) [published correction appears in J Anal Toxicol. 2022]. J Anal Toxicol. 2023;47(1):e6\u20139.","journal-title":"J Anal Toxicol"},{"key":"18459_CR18","doi-asserted-by":"crossref","unstructured":"Bitting J, O\u2019Donnell J, Mattson CL. MMWR Morb Mortal Wkly Rep. 2022;71(39):1239\u201340. Published September 30, 2022. Notes from the Field: Overdose Deaths Involving Para-fluorofentanyl - United States, July 2020-June 2021.","DOI":"10.15585\/mmwr.mm7139a3"},{"issue":"34","key":"18459_CR19","first-page":"703","volume":"62","author":"Centers for Disease Control and Prevention (CDC)","year":"2013","unstructured":"Centers for Disease Control and Prevention (CDC). Acetyl fentanyl overdose fatalities\u2013Rhode Island, March-May 2013. MMWR Morb Mortal Wkly Rep. 2013;62(34):703\u20134.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"18459_CR20","doi-asserted-by":"publisher","first-page":"737","DOI":"10.15585\/mmwr.mm6834a2","volume":"68","author":"RM Gladden","year":"2019","unstructured":"Gladden RM, O\u2019Donnell J, Mattson CL, Seth P. Changes in opioid-involved overdose deaths by Opioid Type and Presence of benzodiazepines, Cocaine, and methamphetamine \u2014 25 States, July\u2013December 2017 to January\u2013June 2018. MMWR Morb Mortal Wkly Rep. 2019;68:737\u201344.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"1","key":"18459_CR21","doi-asserted-by":"publisher","first-page":"36","DOI":"10.23907\/2017.004","volume":"7","author":"HE Schueler","year":"2017","unstructured":"Schueler HE. Emerging synthetic fentanyl analogs. Acad Forensic Pathol. 2017;7(1):36\u201340.","journal-title":"Acad Forensic Pathol"},{"key":"18459_CR22","unstructured":"(22) Ccsa.ca. Canadian Centre on Substance Use and Addiction. Adulterants, contaminants, and co-occurring substances in drugs on the illegal market in Canada. 2020. Accessed January 17, 2023 https:\/\/www.ccsa.ca\/sites\/default\/files\/2020-04\/CCSA-CCENDU-Adulterants-Contaminants-Co-occurring-Substances-in-Drugs-Canada-Report-2020-en.pdf."},{"key":"18459_CR23","doi-asserted-by":"publisher","first-page":"109380","DOI":"10.1016\/j.drugalcdep.2022.109380","volume":"233","author":"J Friedman","year":"2022","unstructured":"Friedman J, Montero F, Bourgois P, et al. Xylazine spreads across the US: a growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend. 2022;233:109380.","journal-title":"Drug Alcohol Depend"},{"issue":"23","key":"18459_CR24","doi-asserted-by":"publisher","first-page":"14619","DOI":"10.3390\/ijms232314619","volume":"23","author":"A Di Trana","year":"2022","unstructured":"Di Trana A, Berardinelli D, Montanari E, et al. Molecular insights and clinical outcomes of drugs of abuse adulteration: New trends and New Psychoactive substances. Int J Mol Sci. 2022;23(23):14619. Published 2022 Nov 23.","journal-title":"Int J Mol Sci"},{"issue":"1","key":"18459_CR25","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s00213-004-2135-9","volume":"180","author":"JL Cornish","year":"2005","unstructured":"Cornish JL, Lontos JM, Clemens KJ, McGregor IS. Cocaine and heroin (\u2018speedball\u2019) self-administration: the involvement of nucleus accumbens dopamine and mu-opiate, but not delta-opiate receptors. Psychopharmacology. 2005;180(1):21\u201332.","journal-title":"Psychopharmacology"},{"key":"18459_CR26","doi-asserted-by":"publisher","first-page":"859563","DOI":"10.3389\/fphar.2022.859563","volume":"13","author":"HM Hazani","year":"2022","unstructured":"Hazani HM, Naina Mohamed I, Muzaimi M, et al. Goofballing of Opioid and Methamphetamine: the Science behind the Deadly Cocktail. Front Pharmacol. 2022;13:859563. Published 2022 Apr 7.","journal-title":"Front Pharmacol"},{"key":"18459_CR27","unstructured":"Prieto A, Mendez N, Urrutia F, Namm A. Drug adulterants and their effects on the health of users: A critical review. Inter-American Drug Abuse Control Comminision (CICAD). Accessed January 28, 2023 http:\/\/www.cicad.oas.org\/oid\/pubs\/Final%20ENG%20Drug%20adulterants%20and%20their%20effects%20on%20the%20health%20of%20users%20-%20a%20._.pdf."},{"key":"18459_CR28","doi-asserted-by":"publisher","first-page":"107625","DOI":"10.1016\/j.ypmed.2023.107625","volume":"176","author":"RA Rawson","year":"2023","unstructured":"Rawson RA, Erath TG, Clark HW. The fourth wave of the overdose crisis: examining the prominent role of psychomotor stimulants with and without fentanyl. Prev Med. 2023;176:107625.","journal-title":"Prev Med"},{"issue":"1","key":"18459_CR29","doi-asserted-by":"publisher","first-page":"e0","DOI":"10.1161\/CIRCEP.121.010273","volume":"15","author":"P Dominic","year":"2022","unstructured":"Dominic P, Ahmad J, Awwab H, et al. Stimulant drugs of abuse and Cardiac Arrhythmias. Circ Arrhythm Electrophysiol. 2022;15(1):e0.","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"18459_CR30","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.ajem.2022.06.017","volume":"59","author":"B Long","year":"2022","unstructured":"Long B, Chavez S, Gottlieb M, Montrief T, Brady WJ. Local anesthetic systemic toxicity: a narrative review for emergency clinicians. Am J Emerg Med. 2022;59:42\u20138.","journal-title":"Am J Emerg Med"},{"issue":"11","key":"18459_CR31","doi-asserted-by":"publisher","first-page":"758","DOI":"10.7326\/0003-4819-152-11-201006010-00026","volume":"152","author":"M Bradford","year":"2010","unstructured":"Bradford M, Rosenberg B, Moreno J, Dumyati G. Bilateral necrosis of earlobes and cheeks: another complication of cocaine contaminated with levamisole. Ann Intern Med. 2010;152(11):758\u20139.","journal-title":"Ann Intern Med"},{"issue":"3","key":"18459_CR32","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1007\/BF00508781","volume":"334","author":"E Schneider","year":"1986","unstructured":"Schneider E, Brune K. Opioid activity and distribution of fentanyl metabolites. Naunyn Schmiedebergs Arch Pharmacol. 1986;334(3):267\u201374.","journal-title":"Naunyn Schmiedebergs Arch Pharmacol"},{"issue":"4","key":"18459_CR33","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1093\/jat\/bkab032","volume":"46","author":"MM Vandeputte","year":"2022","unstructured":"Vandeputte MM, Krotulski AJ, Hulpia F, Van Calenbergh S, Stove CP. Phenethyl-4-ANPP: a marginally active byproduct suggesting a switch in Illicit Fentanyl Synthesis routes. J Anal Toxicol. 2022;46(4):350\u20137.","journal-title":"J Anal Toxicol"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-18459-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-024-18459-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-024-18459-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,29]],"date-time":"2024-03-29T10:02:24Z","timestamp":1711706544000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-024-18459-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,29]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["18459"],"URL":"https:\/\/doi.org\/10.1186\/s12889-024-18459-0","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3138105\/v1","asserted-by":"object"}]},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,29]]},"assertion":[{"value":"4 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"IRB approval for this study was not necessary as it did not include any interactions or interventions with human subjects or include any access to identifiable private information.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"923"}}