{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:55:35Z","timestamp":1785768935015,"version":"3.56.0"},"reference-count":89,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T00:00:00Z","timestamp":1669161600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Project \u201cImplementation of the identification and study of the effects of NPS: Development of a multicenter research to enhance the database of the National drug Addiction Observatory and the Early Warning System\u201d"},{"name":"project: \u201cNational Early Warning System on Drugs (SNAP)\u201d by the Italian Department of Antidrug policies"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Adulteration is a well-known practice of drug manufacturers at different stages of drug production. The intentional addition of active ingredients to adulterate the primary drug may enhance or mask pharmacological effects or may produce more potent drugs to increase the number of available doses and the dealer\u2019s profit. Adulterants found in different drugs change over time in response to different factors. A systematic literature search in PubMed and Scopus databases and official international organizations\u2019 websites according to PRISMA guidelines was performed. A total of 724 studies were initially screened, with 145 articles from PubMed and 462 from Scopus excluded according to the criteria described in the Method Section. The remaining 117 records were further assessed for eligibility to exclude articles without sufficient data. Finally, 79 studies were classified as \u201cnon-biological\u201d (n = 35) or \u201cbiological\u201d (n = 35 case reports; n = 9 case series) according to the samples investigated. Although the seized samples analyses revealed the presence of well-established adulterants such as levamisole for cocaine or paracetamol\/acetaminophen for heroin, the reported data disclosed new adulteration practices, such as the use of NPS as cutting agents for classic drugs of abuse and other NPS. For example, heroin adulterated with synthetic cannabinoids or cocaine adulterated with fentanyl\/fentalogues raised particular concern. Notably, adulterants play a role in some adverse effects commonly associated with the primary drug, such as levamisole-adulterated cocaine that may induce vasculitis via an autoimmune process. It is essential to constantly monitor adulterants due to their changing availability that may threaten drug consumers\u2019 health.<\/jats:p>","DOI":"10.3390\/ijms232314619","type":"journal-article","created":{"date-parts":[[2022,11,23]],"date-time":"2022-11-23T09:50:52Z","timestamp":1669197052000},"page":"14619","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances"],"prefix":"10.3390","volume":"23","author":[{"given":"Annagiulia","family":"Di Trana","sequence":"first","affiliation":[{"name":"Department of Excellence of Biomedical Science and Public Health, University \u201cPolitecnica delle Marche\u201d of Ancona, Via Tronto 71, 60124 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diletta","family":"Berardinelli","sequence":"additional","affiliation":[{"name":"Department of Excellence of Biomedical Science and Public Health, University \u201cPolitecnica delle Marche\u201d of Ancona, Via Tronto 71, 60124 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0044-1714","authenticated-orcid":false,"given":"Eva","family":"Montanari","sequence":"additional","affiliation":[{"name":"Department of Excellence of Biomedical Science and Public Health, University \u201cPolitecnica delle Marche\u201d of Ancona, Via Tronto 71, 60124 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1748-5628","authenticated-orcid":false,"given":"Paolo","family":"Berretta","sequence":"additional","affiliation":[{"name":"National Centre on Addiction and Doping, Istituto Superiore di Sanit\u00e0, 00161 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Basile","sequence":"additional","affiliation":[{"name":"IRCCS Orthopedic Institute Galeazzi, 20157 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2137-4645","authenticated-orcid":false,"given":"Marilyn A.","family":"Huestis","sequence":"additional","affiliation":[{"name":"Institute of Emerging Health Professions, Thomas Jefferson University, 1020 Walnut St., Philadelphia, PA 19144, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco Paolo","family":"Busard\u00f2","sequence":"additional","affiliation":[{"name":"Department of Excellence of Biomedical Science and Public Health, University \u201cPolitecnica delle Marche\u201d of Ancona, Via Tronto 71, 60124 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,23]]},"reference":[{"key":"ref_1","unstructured":"United Nations Office on Drugs and Crime (UNODC) (2022). 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