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
1. INTRODUCTION
2. AIMS AND OBJECTIVE
3. PLAN OF WORK
4. LITERATURE REVIEW
5. BACKGROUND STUDY
6. 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
1. 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]
2. CORAZZA O, PRILUTSKAYA M. HANDBOOK OF NOVEL PSYCHOACTIVE SUBSTANCES: WHAT CLINICIANS SHOULD KNOW ABOUT NPS.
LONDON: ROUTLEDGE (2018).
3. 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
4. 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.
5. 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..
6. 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.
7. 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.