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Brunt TM, Rigter S, Hoek J, Vogels N, van Dijk P, Niesink RJ. 
“An analysis of cocaine powder in the Netherlands: content and health hazards due to adulterants”. 
Addiction. 2009 May 05;104(5):798-805.
AIMS: To report on trends in the content and adulterants present in street cocaine (powder) in the Netherlands and to describe the associated health hazards.

DESIGN AND PARTICIPANTS: Drug consumers handed in samples of cocaine powder from 1999 to 2007 for analysis. Reports were compiled of users' experiences with the samples received.

MEASUREMENTS AND ANALYSIS: Linear regression analysis was used to assess the trend in adulterated cocaine powder across the study period, and comparison of reported adverse effects of adulterated with those of unadulterated cocaine by Fisher's exact test.

FINDINGS: There has been a statistically significant upward trend in the occurrence of adulterated cocaine powder over the years. Adulterated cocaine was associated more frequently with reported adverse effects than unadulterated cocaine. Phenacetin, hydroxyzine and diltiazem appeared to be three adulterants contributing to these adverse effects. CONCLUSIONS: An increase in adulterants was detected in the analysed cocaine powder between 1999 and 2007. This increase is associated with relatively more adverse effects with cocaine use. The cardiac and hallucinatory effects that were reported more frequently are not understood clearly. Adverse effects are likely to be due to several factors, including interactions of adulterants with cocaine and the route of administration.
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