Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


Drugs Of Abuse: What’s New (In) Drugs

  • The most prominent adulterant in cocaine is levamisole (found in 70% of seized cocaine in the US), which predisposes to agranulocytosis and necrotizing vasculitis.
  • Black tar heroin currently makes up about 2/3 of the US market and is frequently contaminated with clostridia.  Tetanus, wound botulism, and clostridial necrotizing fasciitis are risks.  Make sure all heroin users are up-to-date on tetanus immunizations.
  • Bath Salts primarily cause a stimulant toxidrome, and can involve fatal hyperthermia, rhabdomyolysis, and acute renal failure.  Treat with benzos and aggressive cooling as needed.
  • Synthetic cannabinoids (K12) can cause nausea, vomiting, syncope and seizures.  Treat with benzos as needed.  Of note, K12 does not show up on a standard drug screen, as it does not share key structural similarities to THC.