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Lacing is the act of entwining things together; we lace our shoelaces, we lace fabric, and now more and more we are seeing laced drugs. When a fabric is laced it is quite beautiful, but when it comes to drugs the definition isn’t quite so sweet.
Laced drugs are the leading cause of overdose deaths. This is because most people taking drugs won’t know that the drug is laced, making it so the person doesn’t know what they’re taking or the strength of the drug. This can result in underestimating the effects of the drugs, lead to addictive behavior, and in some cases can be fatal.
The Centers for Disease Control and Prevention estimated that more than 107,000 Americans died of drug overdoses in 2021. That’s a 15% increase from 2020, setting a new record in the nation’s tragic overdose epidemic. That translates to one overdose death in the U.S. every 5 minutes.
Out of this alarming number of overdose deaths last year, 71,000 overdoses were due to the drug being laced with fentanyl or other synthetic opioids. That’s a 23% increase in overdoses from 2020 to 2021 due to laced drugs.
What is a Laced Drug?
A drug is laced when two or more substances are mixed. The substance being “laced” with the other drug is called an adulterant or cutting agent.
The adulterant is the other drug meant to enhance the high such as methamphetamine, PCP, and fentanyl. In most cases, ingesting these adulterants will produce negative side effects.
Laced drugs are not a new concept. However, they are becoming an increasing concern with the rise of overdose deaths related to laced drugs and the U.S. opioid epidemic.
Why Are Drugs Being Laced?
Some experts believe that drugs are accidentally contaminated during processing. The same machines are used to package different types of drugs, so if the machine was not cleaned thoroughly traces of the previous drug may be found in the new batch.
While this may be true in some cases, it does not explain the dramatic increase of laced drugs across the U.S. A growing number of law enforcement agents believe that cartel leaders are cutting drugs with adulterants for their benefit. The most likely reason for lacing drugs is a cost-effective way to increase profitability.
Often “upper” drugs like cocaine are laced to enhance the potency of a lower-quality product, so it can be sold at a higher price. Customers can be fooled into thinking that the powerful effects are due to a high-quality product, increasing demand.
Lacing can also allow for less product to be used when making the drug, bringing down costs while being able to produce more. For example, if the drug is sold by weight the drug may be cut with other substances to add weight and gain more profit.
Some law enforcement agents argue that cartel leaders are using cocaine laced with opioids to expand the market of people addicted to drugs. By lacing drugs with highly addictive opioids like fentanyl, those who were once using cocaine occasionally are now using cocaine every day.
This method causes the drug users to develop a dependency and become loyal customers. However, this practice can produce a potentially deadly drug. Especially if the person taking the drug doesn’t know it is laced, they might be taking stronger drugs than they are used to and can be more likely to overdose.
Substances Drugs Can Be Laced With
Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and up to 100 times stronger than morphine. This means it is extremely dangerous if not used cautiously, for as little as two milligrams of fentanyl is a fatal dose for most people.
In severe cases, fentanyl may be prescribed. However, most fentanyl is sold illegally. This illegally used fentanyl typically comes as a powder or is made into a liquid, making it very easy to disguise or mix into other drugs without any evidence.
Due to its potency and how easy it is to hide in a variety of drugs, fentanyl has become the most common drug involved in overdose deaths in the United States. Drugs may be laced with a fatal amount of fentanyl but you wouldn’t be able to see, taste, or smell it. The overdose deaths involving synthetic opioids increased from 560 in 2020 to 834 in 2021, with 90% involving fentanyl.
Every day over 150 people die from fentanyl-related overdoses. According to the CDC, 2 out of 5 cocaine overdoses involved fentanyl in 2016, and in just one year the deaths related to fentanyl increased by 30% between 2020 and 2021.
In 2021 the Drug Enforcement Agency (DEA) released its first public health alert in six years, warning about the U.S. drug supply being laced with fatal substances. The DEA seized 9.5 million counterfeit pills, with the lab analysis showing that two out of five pills in the batch had been laced with a potentially lethal dose of fentanyl.
Carfentanil is a synthetic opioid that is 10,000 times more potent than morphine and 100 times more potent than fentanyl. The extreme potency of the drug is because carfentanil is used as a tranquilizing agent for large mammals like elephants. The fact a drug this strong is being laced with recreational drugs raises concern about overdose-related deaths, even among opioid-tolerant users.
Also known as “tranq”, xylazine is a non-opioid veterinary tranquilizer that has been linked to an increasing number of overdose deaths despite not being approved for human use. From 2015 to 2020, the percentage of overdose deaths that involved xylazine in Pennsylvania increased from 2% to 26%.
Xylazine is a central nervous system depressant that can cause drowsiness, slow breathing, and amnesia, and can bring the heart rate and blood pressure to dangerously low levels. Research has found that xylazine is typically added to opioids to lengthen the euphoric effects. Most overdose deaths linked to xylazine involved additional substances including cocaine, fentanyl, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids.
Other Drug Adulterants
Often drugs will be laced with another drug to enhance the effects for users. Whether the drug is knowingly or unknowingly laced, some adulterants include:
- 1. Heroin
- 2. LSD
- 3. Methamphetamine
- 4. PCP
- 5. Ketamine
- 6. Cocaine
- 7. Benzocaine
- 8. Lidocaine
- 9. Phenacetin
- 10. Chloroquine
- 11. Aspirin
Most Common Laced Drugs
Prescription Drug “Look-Alikes”
How to Tell If a Drug is Laced
Most of the time you can’t tell if a drug is laced just by looking at it. Sometimes there may be a stamp or a discoloration if you know what to look for, but when substances are mixed it can be almost impossible to distinguish.
Reagent testing kits
Often referred to as spot or colorimetric tests, a reagent test is done by applying liquid drops onto a small sample of the substance. A chemical interaction will identify the presence of the substances in the sample based on the color changes and corresponding codes.
Depending on the test, results can take as short as 30 seconds to identify substances including methamphetamine, opiates, MDMA, LSD, and cathinone (bath salts). These tests are available to the public through many distributors online and in-store and can be fairly inexpensive.
Fentanyl test strips
Fentanyl is not easily distinguished unless a fentanyl checking strip is used. To use the fentanyl checking strips, users must dissolve a small sample of the drug into some water and then insert the test strip. The indicator line will alert the user of any presence of fentanyl.
Strips are single-use and cost only about $1-2 per test. Fentanyl testing strips are easy to obtain and inexpensive so users can accurately read whether the substance contains fentanyl or not to promote safe use. In May of 2017, the California Department of Public Health paid for fentanyl checking strips to be distributed at syringe exchange programs and similar programs have been promoted in other states to promote safe use for those using drugs.
The Dangers of Laced Drugs
Most often, people who consume laced drugs do so unknowingly. If someone takes a drug without knowing what it is laced with, it can result in terminal damage or overdose.
Signs of Overdose
Being aware of the signs of an overdose can save a life. Some signs to look out for are:
- 1. Small, “pinpoint pupils”
- 2. Falling asleep or losing consciousness
- 3. Slow, weak, or stopping breathing
- 4. Choking or gurgling
- 5. Limp body
- 6. Cold/clammy skin
- 7. Discolored skin (especially in lips and nails)
- 8. Seizure
- 9. Muscle Rigidity
If you think someone is experiencing an overdose, call 911 immediately. If available and it is suspected to be fentanyl, administer naloxone. Try to keep the person awake and breathing, lay them on their side to prevent choking, and remain with the person until emergency assistance arrives.
Negative Effects of Laced Drugs
Laced drugs can cause negative effects physically, cognitively, and emotionally. The potential effects depend on the adulterant the drug is laced with, some of which may include:
Depleted dopamine levels, Increased sensitivity to pain, Damage to the frontal lobe, and decreased impulse control. The negative effects laced drugs have on the brain often lead to substance use disorder.
Substance Use Disorder
Laced drugs can be extremely addictive and lead to substance use disorder. Substance use disorder is a disease that affects a person’s brain and ability to control the use of drugs or alcohol. When you’ve developed a drug addiction, you may continue to use the substance despite the harm it causes.
The risk of addiction and how fast you become addicted will vary by substance. Substances with higher addictive qualities like opioids have a higher risk of causing addiction more quickly than others.
The more often you take the drug, the higher tolerance your body will develop to the drug. This means that over time you may need to take larger doses to feel the high. This is where it can become dangerous if the user assumes they need to take a larger dose, without realizing the drug is laced with another substance.
If someone develops a substance use disorder, they may begin to develop a dependency on the drug. A drug dependency is when the person feels they need the drug to feel good and may find it increasingly difficult to go without the drug.
Once someone has a substance use disorder, attempting to stop use may cause intense cravings or withdrawal symptoms. These withdrawal symptoms will range depending on the drug, frequency used, the person’s physical and psychological characteristics, and the withdrawal process used. Symptoms can include:
- 1. Irritability
- 2. Changing moods
- 3. Depression
- 4. Anxiety
- 5. Insomnia
- 6. Body aches and pains
- 7. Cravings
- 8. Fatigue
- 9. Hallucinations
- 10. Nausea.
Find Help for Substance Use Disorder
Whether the user knows the drugs are laced or not, they can be addictive and lead to substance use disorder. If you or a loved one has developed a substance use disorder, know that recovery is possible with the proper treatment.
Keep in mind that treatment is not a one-size-fits-all; it is important for the individual to have the proper tools for their specific situation and to feel supported along the way. Healthy Life Recovery offers various rehab programs with treatment services specific to the individual’s needs to overcome addiction and live a fulfilling life.
Medically Reviewed By:
Dr. Sanjai Thankachen
Dr. Sanjai Thankachen graduated from Adichunchanagiri Institute of Medicine in 2000. He completed his residency in psychiatry in 2008 at Creedmoor Psychiatric Center in New York. Dr. Thankachen is currently working with Pacific Neuropsychiatric Specialists in an outpatient practice, as well as working at multiple in-patient psychiatric and medical units bringing his patients the most advanced healthcare treatment in psychiatry. Dr. Thankachen sees patients with an array of disorders, including depression, bipolar illness, schizophrenia, anxiety, and dementia-related problems.
Edited for Clinical Accuracy By:
Sean Leonard is a board-certified psychiatric nurse practitioner. He received his master’s degree in adult geriatric primary care nurse practitioner from Walden University and a second postmaster specialty in psychiatry mental health nurse practitioner from Rocky Mountain University. Sean has experience working in various diverse settings, including an outpatient clinic, inpatient detox and rehab, psychiatric emergency, and dual diagnosis programs. His specialty areas include substance abuse, depression, anxiety, mood disorders, PTSD, ADHD, and OCD.
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