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Behrman AD. 
“Luck of the draw: common adulterants found in illicit drugs”. 
J Emerg Nurs. 2008 Feb 01;34(1):80-2.
One of the most notorious adulterations of an illicit drug in the United States occurred in the 1930s. The extract of Jamaica Ginger, a ‘‘patent medicine’’ with 85% ethanol, was illicit during Prohibition. Thousands of Americans presented to medical facilities with unusual muscle pain, ascending paralysis, and gait impairment with foot drop.1 Initially, the patients were diagnosed with polyneuritis. The patients had spinal cord damage and permanent spasticity in some cases.1 It was later determined to be related to an adulterant called triorthocresyl phosphate (TOCP) in Jamaica Ginger extracts. 1 Up to 50,000 Americans were affected.1 It is so well known that songs have been written about it including ‘‘The Jake Walk Blues’’ by the Allen Brothers. An adulterant is defined as an impurity or additive that is considered to have an undesirable effect or to dilute the active material so as to reduce its therapeutic or monetary value.2 Adulterants can be found in illicit drugs including heroin, cocaine, and ecstasy among others. The quality of the drug purchased may vary from week to week or even from day to day.
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