HWN Suggests

The Emerging Role of Toxic Adulterants in Street Drugs in the US Illicit Opioid Crisis

To date, efforts to respond to the opioid crisis have focused primarily on limiting opioid prescriptions and reducing the supply of illicitly manufactured fentanyl. However, our analysis of trends in the United States and other regions of the world suggests that increased emphasis should be placed on the presence of toxic adulterants and other dangerous pharmacologically active components in street drugs. Mounting evidence suggests that overdoses, severe health consequences, and even death can occur as a result of the toxic and potentially synergistic effects of multiple toxic adulterants in combination with illicitly manufactured drugs of abuse.

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Articles of Interest

Adulterants, Contaminants and Co-occurring Substances in Drugs on the Illegal Market in Canada

The inherent risks of substance use are significantly increased for drugs procured on the illegal market, where there is no quality control and drug contents are unpredictable. Drug adulteration — the presence of substances in addition to the expected one — increases the risk of accidental poisoning and other harms because people who use drugs do not know what substances they are using or how much.

Beyond Fentanyl: How Drug Adulterants/Cutting Agents are Contributing to Overdose, Chronic Health Problems, and Affecting Naloxone Administration

Drug adulterants/cutting agents are rampant in today’s street drug supply. These are synthetic compounds that may cause a myriad of health problems for people who use substances. These cutting agents have an impact on the administration of naloxone (Narcan) for overdose reversal and treatment for opioid use disorder and other substance use disorders. This information can be useful to professionals in health and criminal justice fields, as the awareness of individual types of adulterants/cutting agents and their health consequences can inform initiatives to prevent these problems from growing.

Levamisole—a Toxic Adulterant in Illicit Drug Preparations: a Review

Since the early 2000's, levamisole has been frequently used as an adulterating agent in illicit street drugs, especially cocaine, fentanyl, and heroin. Although its prevalence has varied over time and geographically, levamisole has been detected in up to 79% of the street supply of cocaine at levels up to 74% by weight.

The health threat of new synthetic opioids as adulterants of classic drugs of abuse

Practices of drug adulteration have been substantially evolving over the years: a significant trend has been observed in the last decade indicating a decline in the average purity of most drugs. Although the most frequent adulterants of common street drugs have long been well known, the rise of synthetic opioids has inevitably entailed gaps in knowledge in terms of the substances being used and their composition, which constitutes an even greater threat to public health.

What’s Going On With Tranq?

Xylazine is coursing through the illicit drug supply. Here’s what it does—and why it’s not the main concern.

Xylazine: An Increasingly Frequent Adulterant in Fentanyl Street Drugs

Xylazine's effects include sedation, analgesia, and muscle relaxation; it also can cause hypotension and bradycardia. Opioid-induced sedation could have extended duration when xylazine is added to fentanyl. Intoxication or overdose with xylazine is not reversed by naloxone. Because the life-threatening effects of xylazine–fentanyl overdoses likely are attributable to fentanyl, naloxone remains the reversal agent of choice. Xylazine use also has been associated with open skin ulcerations and chronic skin wounds that can occur regardless of route of administration (i.e., oral, inhaled, or injected) and can appear at sites of entry or in locations distant from sites of entry.