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

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.