The Scourge of Tainted Heroin

The headline read “74 Overdoses in 72 Hours.” Within two weeks that number climbed to 118.

It was less than a year ago that a batch of tainted heroin caused a flurry of overdoses in Chicago. Paramedics required two to three doses of the heroin antidote Narcan to keep the victims alive during transport. Some would show up at the hospital with needles still stuck in their arms. At least a dozen didn’t make it.

Jacked-up Heroin?

Looking to distinguish themselves in a competitive market, some ruthless street drug entrepreneurs laced their heroin with fentanyl, a synthetic opioid used for extreme pain. The resultant product was an extreme version of heroin, jacked-up, unpredictable, and highly dangerous. Fentanyl is potent: 80 to 100 times stronger than morphine and roughly 40 to 50 times more potent than 100% pure pharmaceutical grade heroin.

About the same time as the overdoses were happening in Chicago, six died in New Jersey from similarly tainted heroin. Officials in the state claim that heroin has been responsible for 5,000 deaths since 2004.

More recently in Sacramento County, California health department workers declared an emergency after seeing 28 overdoses in a week linked to the prescription drug Norco also laced with fentanyl. Norco is the brand name for a mix of acetaminophen and the semi-synthetic opioid hydrocodone used to treat moderate pain.

The Power of Street Heroin

According to the DEA, the purity of street heroin has been on the rise in recent years – from 2005 to 2011 heroin purity increased by 42 percent. At the same time the price per milligram dropped. Purity of street heroin also varies depending, apparently, on where you get your information: According to articles in the Associated Press going back years, street heroin had been found to be “60 percent to 85 percent pure.” According to the DEA’s Heroin Domestic Monitor Program (HDMP), purity varies, often depending on country of origin, between 17 percent and 31 percent. Others sources make claims of even higher and lower purities. But one thing is certain: with the addition of fentanyl, a user can never know the exact potency of the heroin they’re using. This can turn an otherwise typical dose into a deadly one.

A Scourge of Overdoses Across the Country

Fentanyl-laced heroin was responsible for 50 deaths over six months in Bangor, Maine and took 60 more over a similar period in Philadelphia, Pennsylvania and 37 more in Maryland. More media reported deaths in New York, Connecticut, Michigan, South Dakota, Florida, and on and on. In 2006 alone there were more 2000 deaths nationwide attributable to this scourge of fentanyl-laced heroin.

Fentanyl works on the central nervous system, acting upon certain receptors in the brain. It quickly creates a tolerance to high doses; tolerance can develop over the course of days. Because it has greater potency than heroin, fentanyl can be highly addictive.

Tainted Cocaine

In 2009 the Associated Press ran a story reporting that nearly one-third of the cocaine in the United States was tainted with levamisole, a de-worming agent used by veterinarians on cows and horses. And it appears to be on the rise. Eighty percent of the cocaine in Britain is reportedly cut with levamisole. Levamisole in cocaine has been responsible for numerous deaths across the country. It’s also been related to two particularly nasty immunodeficiency conditions: agranulocytosis, which causes a severe depletion of white blood cells and leaves the body susceptible to infection, and neutropenia, another serious blood disorder of the white cells.

As compared to other cocaine cutting agents such as baking soda, caffeine, powdered milk, creatine, and sugars, levamisole is expensive. Why then would levamisole be used in cocaine? While levamisole is neither a stimulant nor local anesthetic, it contains a compound called aminorex which has amphetamine-like stimulation properties. Levamisole also increases the amount of dopamine receptors in the brain. This helps levamisole enhance the high of cocaine.

Cocaine overdoses are most often associated with heart attack and cardiac arrest, a condition exacerbated by levamisole. Cocaine is toxic to heart-muscle cells and is considered one of the worst recreational drugs for the cardiovascular system. Added contaminants only make matters worse: A study from the Netherlands1 found that “Adulterated cocaine was associated more frequently with reported adverse effects than unadulterated cocaine.

Fentanyl has also been found in cocaine: Last year in Manitoba, Canada two men overdosed, one of them fatally, from fentanyl-laced cocaine.

Along with heroin and cocaine other drugs found to have been tainted include ecstasy (MDMA), the painkiller Norco, amphetamines (the most impure illegal drug), and the asthma drug clenbuterol.

Are Drug Contamination Deaths Rising?

In 2014, opioid overdose deaths rose to a record high, increasing 14 percent in just one year. Between 2006 and 2010, there was a 45 percent spike in lethal overdoses; between 1999 and 2010 overdoses increased by 102 percent2. Considering the overall growth in heroin users though, these numbers should come as no surprise: Between 2007 and 2012 the number of heroin users ages 12 and up increased by nearly 80 percent3. And the rates continue to grow. This is the first generation since the mid-1960s to experience higher death rates than the generation before it.

Assessing the state of tainted drugs and their affects has proven to be hard to track and harder to predict. But according to the Substance Abuse and Mental Health Services Administration (SAMHSA), fentanyl related deaths are on the rise. One report stated that there were at least 700 fentanyl-related deaths from late 2013 to 2014 alone.

While no street drug is ever safe, additives and contaminants make them far worse – and far deadlier.

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  1. Brunt TM, Rigter S, Hoek J, et al. “An analysis of cocaine powder in the Netherlands: content and health hazards due to adulterants“.
  2. May 2009;104(5):798-805. Centers for Disease Control and Prevention: Substance Abuse and Mental Health Services Administration Survey

Are Drug Contamination Deaths on the Rise?