Toxicity due to adulteration of psychotropic substances

Toxicity due to adulteration of psychotropic substances:Identify Adulteration Prevalence , Characterize Adulterants, Explore User Behaviors .
Assess Toxicity Profiles: Investigate the toxicological profiles of both the primary psychoactive substances and the adulterants, including their short-term and long-term effects on health.
Evaluate Testing Methods: Assess the effectiveness and accuracy of drug testing methods, including technologies used to identify adulterants in real-time.

1. Toxicity due to adulteration of psychotropic substances: A Systematic review and Meta analysis National Forensic Sciences University Institute of Research and Development School of Pharmacy Guide: Dr. Jasmin Kubavat Assistant professor Presented By: Mahima Raj M. Pharm (Forensic Pharmacy)

2. Contents INTRODUCTION AIMS AND OBJECTIVE PLAN OF WORK LITERATURE REVIEW BACKGROUND STUDY BIBLIOGRAPHY

3. INTRODUCTION Psychotropic substances, also known as psychoactive substances or drugs, are chemicals that affect the central nervous system and can alter an individual's mental state, mood, cognition, and behavior. These substances can have a wide range of effects, including stimulating, sedative, hallucinogenic, or mood-altering properties. Psychotropic substances are used for various purposes, such as medical treatment, recreation, religious or spiritual rituals, or as a means of self-medication.[1] Adulteration of psychotropic substances is a serious concern because it can lead to significant health risks. Adulteration typically involves adding impurities, contaminants, or other substances to a drug, which can make it more dangerous or potent. This is particularly problematic with illegal substances because they are not subject to regulatory oversight, quality control, or purity standards. Adulteration of psychotropic substances is a serious concern because it can lead to significant health risks. Adulteration typically involves adding impurities, contaminants, or other substances to a drug, which can make it more dangerous or potent. This is particularly problematic with illegal substances because they are not subject to regulatory oversight, quality control, or purity standards. Adulteration can result in toxic effects ranging from mild discomfort to severe illness or death. The addition of unknown chemicals can cause allergic reactions, organ damage, psychosis, and other severe health consequences. subject to regulatory oversight, quality control, or purity standards.[2]

4. CLASSIFICATION OF PSYCHOTROPIC DRUGS

5. AIMS AND OBJECTIVE A study on psychotropic substance toxicity and adulteration aims to investigate and understand the potential harm associated with the use of these substances, particularly when they are adulterated with other compounds. Such a study serves various objectives to contribute to public health and safety. OBJECTIVES Identify Adulteration Prevalence , Characterize Adulterants, Explore User Behaviors . Assess Toxicity Profiles: Investigate the toxicological profiles of both the primary psychoactive substances and the adulterants, including their short-term and long-term effects on health. Evaluate Testing Methods: Assess the effectiveness and accuracy of drug testing methods, including technologies used to identify adulterants in real-time.

6. Plan of Work Step 1: Literature Review Tools: Pubmed , Google Scholar, CTRI, Cochrane library, Clinical trials.gov Specific search by using keywords – Psychotropic drugs, antipsychotropic drugs,Psycotropic drug adultration , Toxicity due to adultration in psychotopic drugs. Step 2: Sortening /selection of study on the basis of Inclusion criteria: Toxicity, Adverse effect, Identification of adultrant . Step 3: Data extraction Step 4: Analysis and interpretation of study outcomes by using forest plot. Expected Outcomes: To identify which drug or compound are used in the adultration and technique/method to find out the adultrant to overcome the toxicity caused due to the adultration . Collect information of toxicity due to the adultration in the psychotropic agents.

7. Background study and Literature Review

8. Drug Adulterants Toxicity Reference Cocaine Levamisole,phenacetin , caffeine,lidocaine chronic cocaine user admitted with ulcers on extremities Morelato M. et al. 2019 Fentanyl Methoxyacetylfentanyl , phenyl fentanyl,codeine ; methacryl fentanyl,caffeine hypersalivation ; palpitations; nausea; dissociative state; Krauss S.T. et al. 2019 Heroin Ocfentanil ,caffeine , paracetamol space disorientation, confused; pupils constricted/symmetrical; slurring speech, saliva drooling; wide-based gait, staggering/stumbling; unable to perform a tandem walk; Phillips R. et al. 2021  Opium Lead , acetaminophen , chloroquine , tramadol   tachycardia, flushing, dry mucous membranes, mydriasis Akhgari M. et al. 2018 Morphine Codeine , thebaine , papaverine , noscapine , heroin, oxycodone,acetylcodeine , fentanyl , alprazolam nausea; acute/severe abdominal pain; vomiting; pleuritic chest pain; Clinical: severe hypochromic-microcytic anemia; Peck Y. et al. 2019 Amphetamine MDMA,cocaine , methylphenidate,lignocaine ulceration, acute/chronic inflammation, fibrotic stroma , vessels permeated by inflammatory cells Braz A. et al. 2021 MDMA Caffeine, lidocaine intraparenchymal hemmorrhage Culshaw P.N. et al. 2019

9. BIBLIOGRAPHY Dinis -Oliveira RJ. Metabolism and metabolomics of opiates: A long way of forensic implications to unravel. Journal of Forensic and Legal Medicine. 2019 Feb [1] Corazza O, Prilutskaya M. Handbook of Novel Psychoactive Substances: What Clinicians Should Know About NPS. London: Routledge (2018). Victorri-Vigneau C, Gérardin M, Rousselet M, Guerlais M, Grall-Bronnec M, Jolliet P, et al. An update on zolpidem abuse and dependence. J Addict Dis. (2014) 33:15–23. doi : 10.1080/10550887.2014 Csete J, Elliott R. Consumer protection in drug policy: The human rights case for safe supply as an element of harm reduction. International Journal of Drug Policy. 2021 May 1;91:102976. Sabe M, Dorsaz O, Huguelet P, Kaiser S. Toxicity of psychotropic drugs in patients with COVID-19: A systematic review. Gen Hosp Psychiatry. 2021 May-Jun;70:1-9. doi : 10.1016/j.genhosppsych.2021.02.006. Epub 2021 Feb 18.. Damba JJ, Bodenstein K, Lavin P, Drury J, Sekhon H, Renoux C, Trinh E, Rej S, Greenway KT. Psychotropic Drugs and Adverse Kidney Effects: A Systematic Review of the Past Decade of Research. CNS Drugs. 2022 Oct;36(10):1049-1077. doi : 10.1007/s40263-022-00952-y. Epub 2022 Sep 26. Andrade C. Psychotropic Drugs With Long Half-Lives: Implications for Drug Discontinuation, Occasional Missed Doses, Dosing Interval, and Pregnancy Planning. J Clin Psychiatry. 2022 Aug 1;83(4):22f14593. doi : 10.4088/JCP.22f14593. PMID: 35921503.