{"id":176100,"date":"2021-08-25T06:50:16","date_gmt":"2021-08-25T10:50:16","guid":{"rendered":"https:\/\/today.uconn.edu\/?p=176100"},"modified":"2021-08-16T13:59:43","modified_gmt":"2021-08-16T17:59:43","slug":"rat-poison-is-just-one-of-the-potentially-dangerous-substances-likely-to-be-mixed-into-illicit-drugs","status":"publish","type":"post","link":"https:\/\/today.uconn.edu\/2021\/08\/rat-poison-is-just-one-of-the-potentially-dangerous-substances-likely-to-be-mixed-into-illicit-drugs\/","title":{"rendered":"Rat Poison is Just One of the Potentially Dangerous Substances Likely to Be Mixed Into Illicit Drugs"},"content":{"rendered":"

Over 150 people in Illinois started\u00a0bleeding uncontrollably<\/a>\u00a0after using\u00a0synthetic cannabis-based products<\/a>\u00a0\u2013 including fake marijuana, Spice and K2 \u2013 that contained the rat poison brodifacoum in March and April 2018. By the end of July 2021, these banned products were still being sold in\u00a010 states and the District of Columbia<\/a>, resulting in hundreds of severe bleeds and several deaths.<\/p>\n

Illicit drug use was responsible for\u00a0an estimated 166,613 deaths worldwide in 2017 due to overdose<\/a>. The increased risk of disease and injury associated with illicit drug use caused an\u00a0additional estimated 585,348 premature deaths<\/a>. And it\u2019s impossible to tease out whether people were harmed by the drugs themselves or by the myriad impurities added to them.<\/p>\n

I am a\u00a0clinical pharmacologist<\/a>\u00a0and guest editor for a\u00a0special supplement<\/a>\u00a0in the Journal of Clinical Pharmacology on commonly abused substances. I also\u00a0recently surveyed the research<\/a>\u00a0on what\u2019s known about illicit drug adulteration. The research is clear: Adding impurities to, or adulterating, illicit drugs is a longstanding and widespread practice with harmful consequences.<\/p>\n

You Seldom Get What You Pay For<\/strong><\/p>\n

Drugmakers\u00a0include other ingredients for a few reasons<\/a>, whether to cut costs by bulking up their product with cheaper nonactive ingredients or to achieve particular effects by adding other drugs to mask poor product quality or imitate the desired effect of the drug itself.<\/p>\n

Prior to the 2000s, drugs including cocaine and heroin were being \u201ccut,\u201d or diluted, with\u00a0inactive ingredients like sugars<\/a>\u00a0to enlarge supply and increase profits. Since then, buyers of cocaine and heroin products frequently receive a cocktail of adulterants that mimic the product\u2019s intended effects or mask side effects due to poor quality.<\/p>\n

For example, the active ingredient of ecstasy, MDMA, is what produces the product\u2019s intended effects. However, a 2004 study assessing ecstasy tablets from drug seizures at raves found that\u00a020% of the products contained no MDMA<\/a>, and dosage varied widely in products that did. Cheaper and more dangerous\u00a0stimulants and psychedelics<\/a>\u00a0like\u00a0synthetic bath salts<\/a>\u00a0and LSD are frequently swapped for MDMA without alerting the buyer.<\/p>\n

Drugs Added to Intensify Effects<\/strong><\/p>\n

Over 70% of cocaine products<\/a>\u00a0contain\u00a0levamisole<\/a>, a drug for worm infections that increases the intensity and duration of stimulant effects. It was\u00a0banned in the U.S. in 1999<\/a>\u00a0because it\u00a0suppresses red and white blood cell production<\/a>\u00a0and increases the risk of life-threatening infections and anemia. These side effects are seen at doses over 150 milligrams, and\u00a035% of seized cocaine products in the U.S.<\/a>\u00a0exceed that level.<\/p>\n

Other additives are commonly added to cocaine to intensify effects.\u00a0Aminorex<\/a>, a stimulant and appetite suppressant, was\u00a0withdrawn by the FDA in 1972<\/a>\u00a0after it caused a number of\u00a0pulmonary hypertension<\/a>\u00a0cases that resulted in heart failure and death. Similarly,\u00a0caffeine<\/a>\u00a0is\u00a0frequently added<\/a>\u00a0to intensify the adrenaline rush. While safe when taken alone in lower doses, higher doses of caffeine in combination with other stimulants can induce\u00a0seizures and heart rhythm problems<\/a>.<\/p>\n

For heroin,\u00a0veterinary anesthetic xylazine<\/a>\u00a0is commonly added to intensify its relaxing effect. And\u00a0fentanyl is increasingly being used as a substitute<\/a>. Because fentanyl is\u00a050 times more potent<\/a>\u00a0than heroin, a smaller amount of total product can produce similar effects. But adding even just a slightly larger amount of fentanyl than expected can easily result in an overdose.<\/p>\n

Covering Up Adulteration and Poor Manufacturing Quality<\/strong><\/p>\n

Manufacturers also add impurities to compensate for lost effects due to adulteration. Anesthetics like\u00a0lidocaine and benzocaine<\/a>\u00a0are added to adulterated products to reproduce the tingling sensation on the gums or tongue that drug dealers look for to assess cocaine quality. While these anesthetics are FDA approved, they can cause seizures and heart rhythm problems with the wrong dose.<\/p>\n

A similar technique is used for heroin. Manufacturers commonly add\u00a0malaria drug quinine<\/a>\u00a0to mimic heroin\u2019s bitter taste and the initial drop in blood pressure when it\u2019s administered.<\/p>\n

Poor heroin production also creates a lot of impurities that can cause\u00a0severe chills and pain at the injection site<\/a>. To get around these side effects, manufacturers frequently add antihistamines like Benadryl and pain relievers like Tylenol. The pain reliever metamizole, which was recalled in 1977 for health risks, is sometimes used instead of Tylenol.<\/p>\n

The Double-Edged Sword of Field Testing<\/strong><\/p>\n

Adulterants can lead to dangerous side effects. But because additives aren\u2019t disclosed to the buyer and most of them have been banned by the FDA, clinicians might not recognize or even suspect that an adulterant is the cause of a patient\u2019s symptoms.<\/p>\n

While consumer-based methods to test for drug impurities may help, they aren\u2019t foolproof. Volunteers at music festivals in the 2010s offered\u00a0MDMA purity testing<\/a>\u00a0so attendees could decide whether they wanted to use the drugs they had. If they were injured, attendees could alert emergency personnel about potential adulterants they were exposed to. Unfortunately, over 40% of the adulterated samples were missed by those field testing kits and discovered days later only with sophisticated laboratory equipment.<\/p>\n

With illicit drugs, the difference between what you believe you are buying and what is actually in the product can be the difference between life and death. If you are suffering from drug addiction,\u00a0resources are available<\/a>\u00a0to help you manage your addiction and achieve sobriety.<\/p>\n

 <\/p>\n

Originally published in The Conversation<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

The difference between what you think you’re buying and what is actually in the product can be the difference between life and death<\/p>\n","protected":false},"author":68,"featured_media":176101,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_crdt_document":"","wds_primary_category":0,"wds_primary_series":0,"wds_primary_attribution":0,"footnotes":""},"categories":[2231,1864,2235],"tags":[],"magazine-issues":[],"coauthors":[1902],"class_list":["post-176100","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-well-being","category-pharm","category-today-homepage"],"pp_statuses_selecting_workflow":false,"pp_workflow_action":"current","pp_status_selection":"publish","acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-05-11 05:36:45","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/posts\/176100","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/users\/68"}],"replies":[{"embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/comments?post=176100"}],"version-history":[{"count":1,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/posts\/176100\/revisions"}],"predecessor-version":[{"id":176102,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/posts\/176100\/revisions\/176102"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/media\/176101"}],"wp:attachment":[{"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/media?parent=176100"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/categories?post=176100"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/tags?post=176100"},{"taxonomy":"magazine-issue","embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/magazine-issues?post=176100"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/today.uconn.edu\/wp-rest\/wp\/v2\/coauthors?post=176100"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}