ABSTRACT
Adulterants may be defined as any substance or organism found in illicit drugs at the point of purchase other than the active ingredient. The presence of adulterants can increase the risk of morbidity and mortality. PWIDs often have abscesses, sores or open wounds, which may be infected with Staphylococcus aureus, group A streptococci and meticillin-resistant Staphylococcus aureus (MRSA). Cases of botulism and tetanus have occurred in PWIDs. In Europe, in 2012, several anthrax cases were recorded from drugs such as heroin contaminated with anthrax spores. Problems can occur whether the drug is injected, smoked or snorted, and users may present with severe soft-tissue infections, sepsis, signs/symptoms of inhalational anthrax or haemorrhagic meningitis.
