Adulterants in heroin/cocaine: implications concerning heroin-associated nephropathy

Heroin-associated nephropathy (HAN) is a complication of the intravenous use of heroin or cocaine. It has been postulated that one of the substances used to adulterate these drugs may be responsible for the renal injury. We examined data provided by the Drug Enforcement Administration (DEA) concerning the laboratory analysis of 12 366 samples of heroin/cocaine. These street-grade drugs were analyzed for the presence of various adulterants or secondary substances. Eleven adulterants were identified with a frequency of occurrence that exceeded 5%. Quinine, mannitol, lactose and procaine were the non-narcotic compounds most commonly found. Other substances found included caffeine, inositol, lidocaine, starches, methapyrilene, sucrose, acetylprocaine and dextrose. No specific substance including heroin or cocaine has yet been definitely implicated as causative of HAN. These data suggest that further animal research is needed to determine the effects of repeated intravenous injections of each of these commonly found substances on the kidney.