Drugs and cutting agents

It has always been the case that drugs such as Cocaine or Heroin are “cut” with other substances to produce more of the product to sell at a lesser strength. These so called ‘cutting agents’ fall into three types. Firstly there are Contaminants which refer to the by products that are also produced when the drug is initially manufactured.

Secondly there are Adulterants which refer to the pharmacological ingredients that are later added to give either synergistic or antagonistic effects.  Thirdly, there are Diluents which are inert substances added to illicit drugs to bulk out the drug and decrease the amount of active ingredient.

No one can ever be sure what the other substances are that have been used but it has generally been recognised that some of the agents added as Diluents have been talcum powder, bicarbonate of soda, glucose and even brick dust. Adulterants known to have been used are paracetamol – which has a similar burning point to heroin – and lidocaine (a mild anaesthetic) which is used due to it being a more powerful anaesthetic than cocaine, giving the impression that the drug is of a higher quality when testing it as it gives a numbing effect on the gums.

However, the most frequently used agent for cutting Cocaine is Levamisole which is an anthelminthic chemical used  specifically to treat infection in animals, such as cows, that have parasitic worms.  This has been used over the last 10 years as an additive in both Cocaine and Crack Cocaine. It is a white powder and similar in appearance to powder cocaine. Levamisole both bulks out the drug and will help to prolong the effect but it is really used to allow the dealer to increase his profit. None of the cutting agents used in the past have been shown to have large scale adverse medical reactions on people buying and using them but in the last few years that has changed.

The impact of the introduction of Fentanyl as a cutting agent

More recently a drug that was first developed in 1959 has come to the fore as a cutting agent, as it is really very cheap to produce but is extremely potent in very small quantities. That drug is Fentanyl and it is this that is solely accountable for the rapid increase in both overdoses and death among illegal drug users. Most of the volume of illegally used Fentanyl is made in labs in China and the drug route is then to America and on to Europe.

It is sold either as a powder, or dropped onto blotting paper, put in eye droppers and nasal sprays or made into pills that look like other prescription opioids.  Drug dealers will mix the Fentanyl with other drugs such as heroin and cocaine but it is now also being mixed with methamphetamine and MDMA.  So the drugs can be cut with anything to bulk them out but with the addition of a small dose of Fentanyl there will be a reaction similar to a much more powerful drug. 

The serious danger comes from the fact that as little as 2 mg of Fentanyl is medically estimated as a lethal dose in humans. In a recent survey in America, 42% of illegal counterfeit pills were found to contain Fentanyl of at least 2 mg per pill, with a small percentage of tested pills having up to 5.1 mg of the drug present.

What is Fentanyl?

Fentanyl is an extremely dangerous high strength synthetic piperidine opioid that was originally manufactured to be used as an analgesic which is for pain relief.  It is, unbelievably, approximately 100 times more potent than morphine and between 20 and 40 times more potent than heroin.  The fact that a small dose can send an individual into an overdose and the drug can be consumed without the individual even being aware that it may contain a lethal dose is, of course, of great concern. 

Overdose deaths in America primarily involving illicit manufactured Fentanyl rose over 55% recently. It is clear that Fentanyl is the primary driver of the increase in total drug overdose deaths.  Fentanyl has made its appearance in the UK over the last few years and is starting to be linked to the rise in opioid overdose deaths here.

Other dangerous synthetic opioids

Synthetic opioids are cheap to manufacture. New opioids are also now being produced which are similar in strength to Fentanyl. These are known as Nitazenes.  These are again considerably more potent than heroin. They are as dangerous as Fentanyl even in very small doses. They have been nicknamed the “Frankenstein Drug” due to their potency and risk of death if used.

Overdose

A drug overdose can occur when you take a drug such as heroin or cocaine and, unbeknown to yourself, the drug has been cut with a toxic amount of synthetic opioid. The combination of drugs overwhelm the body. The body’s central nervous system is affected which slows down breathing, blood pressure and heart rate and also reduces body temperature.  

Opioids fit into receptors that affect the drive to breathe. If someone is not breathing, or has difficulty breathing, the oxygen levels in the blood decrease and the lips and fingers turn blue. This is called Cyanosis.  This oxygen starvation in the body eventually stops other vital organs such as the heart and then the brain, leading to unconsciousness, coma and death.  With an opioid overdose, surviving or dying wholly depends on breathing and oxygen.

The importance of Naloxone

There is one medication that can be used to reverse the effects of an overdose and that is Naloxone. It can save a life if it is used quickly after someone has overdosed and before emergency medical help arrives. It is very important that if you have administered Naloxone to someone that you still call 999 for an ambulance, as the effects of Naloxone only last for about 20 to 40 minutes before the person goes back into overdose.

There are two ways to administer the drug, one is Prenoxad, which comes in a pre-filled syringe and this can be injected into someone’s thigh even through their clothing. The second is Nyxoid which comes as a nasal spray and you literally spray the drug into someone’s nostril.

It is now recommended that anyone using illegal drugs should carry Naloxone with them in either form and let others know that they have Naloxone with them. It is also preferable to use any drugs we are going to take with others. This will remove some of the risk that these new cutting agents pose to our health so that, should we unexpectedly go into an overdose, there is someone with us that can take actions to save our life.