Longitudinal trends in cocaine seizures in North-East Italy (2015-2025): Increasing purity, changing adulterants, market expansion, and rising youth exposure (2026)

This study provides a longitudinal analysis of cocaine seizures in North-East Italy from 2015 to 2025, integrating forensic toxicological data and clinical indicators to characterize evolving market dynamics. A total of 6301 cocaine-containing samples were analyzed using validated GC-MS and GC-FID methods, enabling high-resolution monitoring of purity trends and adulteration profiles. Findings reveal a marked and sustained increase in cocaine potency, with mean concentrations rising from approximately 50% to 75%, and a progressive compression of the distribution toward high-purity values. Low-purity materials (<50%) nearly disappeared, while high-potency products (>80%) expanded sharply. Adulteration patterns shifted from widespread dilution to more selective combinations, including the increased use of pharmacologically active agents such as caffeine and procaine. Purity-adjusted dose-equivalent calculations indicate a doubling of the potential market impact between the first and last triennium, with a tenfold rise in high-potency dose equivalents. Parallel analyses of judicial cases involving minors show similar trajectories, suggesting increasing exposure among younger users. Questionnaire-based clinical data corroborate these trends, documenting a high prevalence of sympathomimetic adverse effects and a growing burden on addiction services. Overall, the findings depict a cocaine market characterized by evolving adulteration patterns and a greater capacity to generate acute and chronic harm. These results underscore the need for strengthened early-warning systems, integrated forensic–clinical monitoring, and targeted prevention strategies. [Author's abstract]
Highlights:
Mean cocaine purity in North-East Italy rose from 50 to 75% between 2015 and 2025.
Cutting patterns shifted mostly from levamisole to procaine/caffeine mixtures.
Total dose-equivalent availability doubled, with rising exposure among minors.