Rising illicit drug Adulterants: Xylazine and levamisole

The increasing prevalence of xylazine and levamisole as adulterants in illicit drugs presents significant challenges for medical professionals. This review aims to provide an overview of the mechanisms of action, prevalence of adulteration, and detection methods for xylazine and levamisole. Clinical implications associated with xylazine and levamisole-contaminated drugs are also discussed. It provides a comprehensive examination of methodologies for analyzing these emerging contaminants, shedding light on the challenges faced by toxicology laboratories in accurately identifying and quantifying these substances. Various analytical techniques, including but not limited to GC–MS, HPLC-MS, and HPLC-MS/MS, are explored in detail, with a focus on their strengths and limitations. This serves as a valuable resource for clinicians seeking to navigate the complexities of analyzing xylazine and levamisole in illicit drug samples. It also contributes to the existing knowledge on illicit drug adulteration by xylazine and levamisole, providing insights that can inform public health interventions, law enforcement efforts, and treatment strategies aimed at mitigating the risks associated with contaminated substances.