Substance use disorder (SUD) is a significant public health challenge in the United States. According to the 2021 National Survey on Drug Use and Health, an estimated 29.5 million individuals aged 12 and older had an alcohol use disorder, while 24 million had a drug use disorder. Beyond the direct health impacts of substance use, individuals with SUD may also face increased exposure to harmful environmental chemicals that can further compromise health. Drugs produced through clandestine and unregulated manufacturing processes can expose individuals to a range of contaminants, including cutting agents (fillers and additives), plasticizers (excipients), and pesticides. In addition, individuals with SUD often consume higher amounts of alcohol and tobacco, leading to increased exposure to plasticizers present in alcoholic beverages and polycyclic aromatic hydrocarbons (PAHs) generated through tobacco smoke.
A biomonitoring study of 200 overdose patients, led by Dr. Kurunthachalam Kannan found that urinary metabolites of PAHs were two to three times higher in individuals with SUD compared to levels reported for the general population. Similarly, urinary concentrations of bisphenol S (BPS) and bisphenol F (BPF) – chemicals commonly used as replacements for bisphenol A – were significantly higher in SUD patients than in the general population. Importantly, concentrations of environmental chemicals measured in urine samples were significantly correlated with concentrations of drugs measured in the same samples, suggesting that drug ingestion itself is a source of environmental chemical exposure. This study is the first to document elevated exposure to environmental toxicants among individuals with substance use disorder.
Dr. Kannan’s laboratory is externally funded by the U.S. Centers for Disease Control and Prevention to conduct biosurveillance of drug use among overdose patients.