Adulterants and substitutes

The presence of an adulterant in an already inherently toxic street drug leaves both the user and the emergency physician with a harsh predicament. Both may be in the dark as to the true nature of the active ingredients, or as to the clinical effects produced by these substances or combinations of substances. This creates a diagnostic and therapeutic dilemma for the treating physician, as he or she wrestles with the often contradictory clinical signals and the inescapable possibility that prescribed therapy may interact adversely with the compounds already exerting their effects. The only defense we have is an open and constantly probing thought process, which maintains an awareness of the current street drug culture, and then channels this information into the clinical decision process.