Risk of Counterfeit and Laced Drugs
Results from the 2014 National Survey on Drug Use and Health found that approximately 27 million people aged 12 or older were current illicit drug users. That figure amounts to 1 in every 10 people having used illegal drugs in the past month. With a growing number of people buying and using drugs comes an increase in demand on the illicit drug market. With illegal drug manufacturing in full swing, it can be difficult or even impossible to know what exactly you’re getting.
Drug dealers and online drug retailers may cut, lace, or mix drugs with other substances or adulterants during the production process to increase bulk and dilute purity-keeping costs down and profits up.
Furthermore, some prescription drug users are buying their pills from disreputable online sources and unwittingly receiving fake drugs as a result.
When you purchase a drug from a dealer or from the Internet, it is difficult to know:
- How the drug was produced.
- Whether the drug was mixed with other substances or adulterants.
- The environment in which the drug was made.
- Whether the drug is contaminated.
This dangerous combination of unknowns adds up to enormous unpredictability in drug purity and composition, as well as the effects the substance will produce. Additionally, if you take drugs that are diluted or fake, you may take more to feel the desired effects, which increases your risk of overdose.
The popular party drug, "Molly," is marketed to consumers as pure ecstasy (MDMA). However, drugs such as Molly are often cut or laced with other substances. When one study looked at hair samples of nightclub/festival-attending young adults in New York City who reported lifetime Molly/MDMA/ecstasy use, they found that only half of the hair samples contained MDMA. Approximately 49%, however, tested positive for butylone and 10% tested positive for methylone, both of which are synthetic cathinones (or “bath salts”). The hair samples showed that 4 of 10 people who reported never having used bath salts or other novel psychoactive substances had, in fact, ingested them.
In the Netherlands, PMMA (paramethoxymethamphetamine)a very potent stimulant designer drug, was being sold under the guise of MDMA. Four people in the UK were thought to have died from taking the drugs (NIDA, 2016).
Harm Reduction: Drug Purity Testing Kits
Drug impurities are so common that some companies have created drug-testing kits. These kits allow users to test the purity of their drugs on their own. There are a range of kits available on the market, including:
- EZ Test.
The kits do not identify the various ingredients but rather proclaim to indicate the presence or absence of MDMA. The kits are still relatively new, and some argue they are dangerously unreliable. For example, Dr. Adam Winstock of the Global Drug Survey argues that testing kits are not suited to give a 100% accurate reading. Rebecca Murray of the University of Florida in Gainesville told New Scientist that the kits will “create a false sense of security.” The only truly reliable way to test drug purity is via lab testing.
Cutting Drugs with Other Substances
Below are some of the more commonly encountered cutting agents found in popularly abused drugs.
Cocaine may contain:
- Lidocaine: a local anesthetic with numbing qualities similar to cocaine but none of its stimulant effects.
- Phenacetin: an analgesic and antipyretic drug similar to acetaminophen; banned by the FDA in 1983 because it increased the risk of certain cancers.
- Levamisole: an anti-parasitic used on dogs and cattle.
Ecstasy may contain:
- PMMA or PMA: an illegal psychoactive chemical that can cause eath in high doses.
- Amphetamines: stimulants that produce effects that resemble those of ecstasy.
- Synthetic cathinones (including methylone and butylone): drugs that possess amphetamine-like properties.
Other adulterants such as lead, caffeine, and sugar are often added to various drugs. These substances are legal, cheap, and more readily available than other drugs.
Heroin may contain:
- Phenobarbital: a barbiturate sedative. Inclusion of large doses of this substance can cause severe and sometimes fatal adverse effects such as profound respiratory depression.
- Quinine: an antimalarial medication that can cause renal failure and visual disturbances. Mimics the “rush” felt by injecting heroin.
- Clenbuterol: a decongestant and bronchodilator used to manage reactive airway diseases; numerous toxicities (neural, cardiovascular, thyroid, etc.) in high doses.
- Scopolamine: an anticholinergic medication used to treat motion sickness. It is not easily detectable and can cause sleepiness and euphoria.
- Fentanyl: an extremely potent opioid painkiller.
Fentanyl: Rise of the Hidden Killer
One of the deadliest drug combinations is heroin and fentanyl. Fentanyl itself is an extremely powerful opioid — 80-100 times stronger than morphine and 25-50 times stronger than heroin.
Recently, emergency departments have seen a surge in the number of visits resulting from heroin cut with fentanyl. According to the Centers for Disease Control (CDC), in Florida, Maryland, Maine, Ohio, Philadelphia and Pennsylvania, public health departments have reported dramatic increases in fentanyl-related seizures and deaths. In 2013, there were 92 unintentional deaths involving fentanyl in Ohio. By 2014, that number rose to 514, representing nearly a 500% increase. In 2016, NIDA issued a warning because fake medications disguised as Norco, Percocet, and Xanax actually contained fentanyl.
The combination of heroin and fentanyl can cause people to stop breathing. The DEA reported that in other parts of the world, labs are manufacturing fentanyl and smuggling them into the U.S. via drug cartels.
Counterfeit Prescription Drugs
Fake or adulterated prescription pills pose a slew of dangers that are impossible to predict.
The World Health Organization (WHO) estimates that 1% of prescription medicines in developed countries are fake. Many counterfeit drugs are sold online, and the FDA warns buyers about the dangers of purchasing prescription medication over the Internet.
Although a website may look legitimate, you do not know where the drugs are coming from or in what conditions they are manufactured. The FDA cites an incident in which people ordered drugs like Ambien, Xanax, Lexapro, and Ativan over the Internet and instead received powerful anti-psychotics. As a result, a number of unsuspecting individuals needed emergency medical treatment.
Furthermore, WHO warns that fake drugs can be difficult to identify – which is the point. Fake drugs usually look like the actual product. The consumption of counterfeit drugs poses a number of health risks because they may contain the wrong ingredient or inaccurate amounts of the ingredients.
Counterfeit prescription drugs may be:
- Contaminated with adulterants.
- Packaged in a way that looks convincingly real.
- Much cheaper than normal.
- Made with the wrong ingredients.
Fake or adulterated prescription pills pose a slew of dangers that are impossible to predict.
Who’s at Risk?
Many people who may have purchased drugs in person, however, are now turning to the Internet as a place to buy their desired substances, and this can be risky as well. The Internet is introducing a new way to purchase drugs, and in a recent survey of 100,000 drug buyers, people felt that buying drugs online was safer than buying off the street. Other factors such as low purity product and variable product purity also contributed to their desire to buy online vs. on the street (GDS, 2015).
However, the online availability of a drug does not ensure its safety. Certain websites will sell drugs of questionable legality such as “research chemicals,” with varying ingredients and simply label it “not for human consumption.” Other websites will sell medications with supposed “cyber doctors” who will allow you to buy a drug after filling out a questionnaire.
Any time you take a drug in the absence of a legitimate prescription from a doctor, your health is at risk.
More recently, festivals and concerts have become epicenters of the problem. Individuals are taking drugs from friends or strangers without knowing what is in the drug, resulting in unwanted drug interactions. In fact, substance use and sales of adulterated drugs at music festivals has become such a widespread problem that this documentary was created to raise awareness of the issue.
It is nearly impossible to avoid the risk of impurities when purchasing recreational drugs off the street or off the Internet. For those who are abusing illicit drugs, the best means of avoiding potential harm is to get help to stop using. For information on treatment programs, call us at 1-888-744-0069Who Answers?.
If you are looking for prescription medications (and you have a legitimate prescription), make sure to get your medication from a reputable source, such as a trusted doctor. If you have to shop online, the FDA says that consumers should know how to distinguish between safe, legal sources and questionable websites and know how to buy real medicines safely.
The FDA recommends the following strategies to prevent buying impure or counterfeit drugs:
- Do not purchase prescriptions online without a legitimate prescription.
- Only visit state-licensed pharmacy websites.
- Make sure that the pharmacy is located in the United States.
- Don’t buy from websites that will sell you medications without a prescription.
- Do not buy from websites that use “cyber doctors” who will give a “prescription” after answering only an online questionnaire.
- Don’t give any personal information unless you are sure the site will keep your information private.*
- Use sites that have a licensed pharmacist to answer your questions.
* Be aware that some illegal sites may not protect your personal information such as your name, social security number, credit card information, or medical history. Take your time to protect yourself by looking for the National Association of Boards of Pharmacy’s (NABP) Verified Pharmacy Practice Sites (VIPPS) Seal on the website. The seal indicates that it is a safe Internet pharmacy and meets state licensure requirements.
If you or a loved one is dependent on recreational, prescription, and/or illicit drugs, consider treatment. Research shows that substance dependence is treatable.
Don't wait to get the help you deserve. You can lead a healthy life that does not include using any type of drug. Give us a call today to learn more about available recovery options and resources. We can help you find a program that will meet your needs.
- World Health Organization (WHO). (2016). Substandard, spurious, falsely labelled, falsified and counterfeit (SSFFC) medical products.
- Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50).
- National Institute on Drug Abuse (NIDA). (April 2016). Emerging Trends.
- Lynch, K. L., Dominy, S. S., Graf, J., & Kral, A. H. (2011). Detection of levamisole exposure in cocaine users by liquid chromatography-tandem mass spectrometry. Journal of analytical toxicology, 35(3), 176-178.
- Broséus, J., Gentile, N., & Esseiva, P. (2016). The cutting of cocaine and heroin: A critical review. Forensic science international, 262, 73-83
- CUT: a guide to adulterants, bulking agents and other contaminants found in illicit drugs. Centre for Public Health, Faculty of Health and Applied Social Sciences, Liverpool John Moores University, 2010.
- White House Office of National Drug Control Policy. (2004). The Price and Purity of Illicit Drugs: 1981 Through the Second Quarter of 2003.
- Best, D., Beswick, T., Gossop, M., Rees, S., Coomber, R., Witton, J., & Strang, J. (2004). From the deal to the needle: drug purchasing and preparation among heroin users in drug treatment in South London. Addiction Research & Theory, 12(6), 539-548.
- Park, Haeyoun & Bloch, Matthew. (2016). How the Epidemic of Drug Overdose Deaths Ripples Across America.. New York Times.
- Centers for Disease Control and Prevention (CDC). (2016). Increases in Drug and Opioid Overdose Deaths – United States, 2004- 2014.
- Centers for Disease Control and Prevention (CDC). (May 2016).Fentanyl Overdose Data.
- Coomber, R., & Maher, L. (2006). Street-level drug market activity in Sydney's primary heroin markets: Organization, adulteration practices, pricing, marketing and violence. Journal of Drug Issues, 36(3), 719-753.
- Palamar, J. J., Salomone, A., Vincenti, M., & Cleland, C. M. (2016). Detection of “bath salts” and other novel psychoactive substances in hair samples of ecstasy/MDMA/“Molly” users. Drug and alcohol dependence, 161, 200-205.
- Federal Drug Administration. (2011). The Possible Dangers of Buying Medicines over the Internet.
- Cole, C., Jones, L., McVeigh, J., Kicman, A., Syed, Q., & Bellis, M. (2011). Adulterants in illicit drugs: a review of empirical evidence. Drug testing and analysis, 3(2), 89-96.
- Codrea-Rado, Anna. (2016). How Do We Stop Drug Deaths At Festivals? Vice Magazine.
- Werb, D., Rowell, G., Guyatt, G., Kerr, T., Montaner, J., & Wood, E. (2011). Effect of drug law enforcement on drug market violence: A systematic review. International Journal of Drug Policy, 22(2), 87-94.
- Global Drug Survey (GDS). (2015). The Global Drug Survey 2015 findings: What did we learn from GDS2015? An overview of our key findings.
- Prosser, J. M., & Nelson, L. S. (2012). The toxicology of bath salts: a review of synthetic cathinones. Journal of Medical Toxicology, 8(1), 33-42.
- Global DrugSurvvey 2015 shows more people buying online than ever before. (June 2015). The Guardian.
- Ecstasy testing kits prove unreliable. (February 25, 2003). New Scientist.