- 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.