What You Don’t Know Can Kill You

At the end of November, public officials in Alberta, Canada released a health warning about tainted cocaine. In 7 cases, cocaine users developed a condition called agranulocytosis, which impedes the immune system’s ability to fight infections. The medical officials attributed the problem to the presence of the antibiotic Levamisole, which is used to treat worm infestations, in the users’ cocaine. Without a properly functioning immune system, any type of infection could progress quickly, becoming severe and potentially fatal.

The situation in Alberta is only one instance of a problem that is so common that the culture that surrounds illicit drug use and sales has developed terminology for it; “cutting” a substance involves adulterating it with a less expensive material so that the dealer can have a larger amount of the substance to sell. Most of the time, dealers use legal and relatively harmless substances like sugars or baking soda. But, in some cases, these substances are not available, and the dealer uses another powdered substance that may be much more dangerous. In rare instances, dealers have intentionally laced a substance with poison in an attempt to seek revenge on unsuspecting people, which is called a “ten cent pistol.” Certainly, most dealers are unlikely to go to this extreme because they want their customers alive and seeking more; but dealing illegal drugs can be profitable for those who are willing to take the risk, and many dealers are tempted by the possibility of increasing their profit margins, even if it means adulterating or replacing a substance with something cheaper, no matter what it is.

What substances are most likely to be “cut”?

Any substance in powder form that comes from an unknown or unregulated source may have been “cut.” This includes cocaine and heroin.

What substances are used to “cut” the illegal substances?

Dealers may use legal substances like inositol, dextrose, mannitol (all sugars), lactose (sugar in milk), baking soda, or caffeine to adulterate their supplies of illicit substances. But some turn to any type of white, powdered substance to complete the task.

Are there any other examples like the Alberta case?

In 1991, a hospital in Spain reported 5 cases of scopolamine poisoning after users sniffed adulterated cocaine. Scopolamine is a strong substance derived from plants. In miniscule doses, it may benefit people who suffer from motion sickness. However, overdoses (which can happen if the user exceeds a few hundred micrograms in a short time) can result in elevated body temperature, delusions, and even death.

Another famous case occurred in 1979 when two fentanyl analogues were sold as substitutes for heroin to many unsuspecting users. Drug analogues are substances that result from chemical changes to the structure of a base drug; in these cases, the analogues were called “China White” and “New Heroin.” Dealers sold them as a replacement for heroin, and they resulted in numerous overdoses and deaths as well as multiple cases of a syndrome that closely resembled Parkinson’s disease.

In addition to heroin and cocaine, many club drugs are sold with additives or have other substances substituted for the one that the buyer thinks they are purchasing. Administering any type of substance (even prescribed medicines and over-the-counter drugs) carries risks, but it is even more dangerous to trust an unknown source that does not have your best interest at heart. If you or someone you know experiences unusual symptoms after administering a drug from an unknown source, seeking immediate medical attention could mean the difference between life and death.