When drugs are manufactured and sold illicitly on the streets for recreational use and abuse, there are often issues with quality control. It can be difficult, if not downright impossible, to know exactly what is in these drugs.

Drug manufacturers and distributors often use other products to “cut” their products in order to stretch them and make them go further. This may be done to increase profit margins by “bulking them up,” making drugs weigh more, or giving them the appearance of having more product. Often, cutting agents are cheaper than the drug itself. These cutting agents can impact a drug’s purity, and individuals buying or taking them may not be able to tell that these drugs are not exactly what they are being marketed as.

What Are the Most Dangerous Cutting Agents?

Drugs like cocaine, heroin, methamphetamine, ecstasy, and cannabis may be cut with agents that are the same color and texture, or substances that are odorless, colorless, and tasteless. Sometimes these agents are relatively harmless, like powdered milk, flour, sugar, starch, or salt, and other times, these cutting agents can be dangerous and have unintended and potentially hazardous side effects. In some cases, substances may be added to drugs in order to enhance or complement the drug’s active properties.

Regardless of the reason for additives in illegal drugs, they contaminate the product. They result in a product of lower purity and quality, and they may lead to negative consequences.

Fentanyl and Other Dangerous Cutting Agents Used in Heroin

Heroin is an illicit drug that has no accepted medical use in the United States, meaning that it is classified as a Schedule I controlled substance by the Drug Enforcement Administration (DEA). It is distributed and marketed illegally, not through regulated channels.

Abuse and Side Effects of Fentanyl

As the United States suffers from an opioid epidemic, stemming from prescription opioid abuse, and tighter regulations are instituted around these narcotic medications, heroin abuse has increased dramatically in recent years. The DEA warns that rising heroin abuse has also led to a spike in heroin overdose deaths that may be in part due to a lack of purity in the drug.

A synthetic opioid that is 50-100 times more potent than morphine, fentanyl can be manufactured in clandestine laboratories and is therefore often cheaper and easier to obtain than the plant-based opiate heroin. Drug distributors may use fentanyl to cut heroin to make it go further for cheaper.

The Centers for Disease Control and Prevention (CDC) warns that fentanyl is appearing more and more often in seized drug submissions, from just 56 reports testing positive for fentanyl in 2010 in Ohio to 4,009 in 2015, for example. Since fentanyl is so much more potent than heroin, already a powerful opiate, the risk for overdose rises exponentially when fentanyl is used as a cutting agent. Per the Washington Post, nearly 4,000 Americans died from a fentanyl-related overdose in 2016, a 600-percent increase from the number of fentanyl-involved fatal overdoses in 2014.

Other potentially toxic substances that may be used to cut heroin include:

  • Rat poison
  • Laundry detergent
  • Caffeine
  • Talcum powder

These adulterants may cause blockages in veins or arteries as they may not be as easily dissolved or broken down as heroin is when the drug is injected. They may also increase the risk for cardiac arrest, heart conditions, infections of the heart tissue, brain blockages, liver damage, and overdose.

Hazardous Substances Found in Cocaine

Cocaine purity is relatively low; CNN reports that in 2010 it was around 45 percent. This means that 55 percent of what is found in cocaine is not actually the active substance derived from the coca plant.

Cocaine has been cut with many agents over the years to bulk it up and stretch the product, making it less expensive for drug distributors and cartels, but potentially more toxic and hazardous to those buying and using the drug. Examples of dangerous cutting agents used in cocaine and their potential side effects are outlined below.

  • Phenactin: One of the primary agents used to cut cocaine, phenactin is a fine, white, crystal similar to cocaine in appearance that was used in analgesic medications in the US prior to 1983. The US National Library of Medicine (NLM) reports that it was taken off the market for its adverse side effects, including kidney damage, and it is generally considered to be a carcinogenic substance in humans.
  • Levamisole: The journal Mayo Clinic Proceedings publishes that in 2009 nearly 70 percent of all cocaine that made it into the US contained levamisole, a veterinary deworming agent. The substance was used to treat some forms of cancer in humans before it was pulled from the market in 2000 due to numerous adverse health effects. Levamisole-tainted cocaine has been known to cause skin necrosis and literally rot the flesh of a person’s face.
  • Amphetamine/methamphetamine: As they are additional stimulant drugs, when methamphetamine or amphetamine is added to cocaine, the risk for overdose goes up drastically.
  • Procaine/lidocaine: Topical anesthetic drugs, lidocaine and procaine can potentially increase the potency of cocaine, leading to cardiac arrest and/or overdose.
  • Acetaminophen: Large doses of acetaminophen, an over-the-counter analgesic, can lead to liver failure, especially when mixed with cocaine and/or alcohol.
  • Dextrose, sucrose, or lactose: Sugars are often added to cocaine, which can result in unstable blood sugar levels, blood clots, and nasal irritation.
  • Lead: This toxic substance increases the risk of cancer and other negative health side effects. When it is added to cocaine, lead can cause gastrointestinal upset, anemia, renal failure, seizures, and coma.
  • Caffeine: Another stimulant, caffeine may make cocaine more addictive than it already is and increase all of the potential side effects associated with its abuse.
  • Fentanyl: Like heroin, fentanyl is an extremely potent drug that can raise the risk for overdose and additional adverse side effects when added to cocaine.

Molly and Purity of Ecstasy

Ecstasy is a man made synthetic drug manufactured in illicit laboratories as MDMA. Molly is a more recent form of the club drug ecstasy that has been being marketed as a supposedly “pure” version of the drug. It is often anything but pure.

The National Institute on Drug Abuse (NIDA) publishes that Molly may actually be cocaine, methamphetamine, ketamine, synthetic cathinones (or “bath salts”), or over-the-counter cough medicine. As it’s a synthetic drug, CNN warns that individuals may never truly know what is in Molly.

Only 13 percent of the drug seized in New York between 2011 and 2015 actually contained any MDMA. Instead the drug often contained other synthetic, and potentially toxic chemicals, such as MDPV, methylone, MePP, 4-MEC, and pentedrone. All of these substances are psychoactive and can have variable and unpredictable side effects, making them dangerous cutting agents.

Ecstasy and other synthetic drugs are highly hazardous and volatile. A person may never know what is actually contained in them, raising the risk for overdose, addiction, and a multitude of other adverse health effects.

Pure Ecstasy and Popping Molly

Harm Reduction for Drug Safety

Additives and adulterants are commonly mixed into illicit drugs either to cut and stretch the product or to increase the mind-altering aspects of the substance. Many of the cutting agents used are toxic and can lead to additional side effects and risk factors on top of the negative effects the drug already has.

Harm Reduction for Drug Safety

Cutting agents can increase a drug’s potency and lead to an increased threat for a possible drug overdose. They can also lead to both short-term and long-term health risks, and increase the potential addictive nature of a drug.

Drugs that are sold on the street have no checks and balances for quality control; therefore, a person can never be sure that the product they are getting actually contains a pure dose of the drug. In addition, there can be significant variability between batches from the same supplier. There is no way to be sure that drugs do not contain potentially toxic substances in them.

A harm reduction program is one that focuses on trying to minimize the potential consequences of illicit drug abuse without necessarily eliminating the drug use altogether, the United Nations Office on Drugs and Crime (UNODC) explains. In some cases, programs will test individuals’ drug supplies, determining exactly what is in a particular batch. This can help users dose appropriately and prevent overdose from unknown substances. For example, people who buy what they think is heroin may discover that it is actually fentanyl. As a result, they may opt against using that batch altogether.