What Drugs Are Cut with Fentanyl?: Know the Risks

Dealers often cut their drugs with fentanyl to enhance their potency and increase their profits; however, this can have life-threatening consequences. Fentanyl is incredibly powerful and dangerous, roughly 50 times more potent than heroin and 100 times more potent than morphine, which is why it is responsible for so many drug overdoses across the country.1

According to the National Forensic Laboratory Information System, the presence of both prescription and illegal fentanyl in drugs tested in labs increased 1,000% from 2014 to 2017.1 It’s important to know what drugs are commonly cut with fentanyl, as well as the answer to the question, why are drugs cut with fentanyl?

In this article:

Fentanyl and Its Properties

Fentanyl has two forms: a synthetic opioid medication prescribed to treat severe, break-through pain such as cancer pain and illicitly manufactured or street fentanyl, made in labs.

Fentanyl as an Analgesic

Fentanyl, or its brands, Actiq, Duragesic, and Sublimaze, is prescribed after surgeries to help patients manage severe pain. It may also be used to treat individuals who have chronic pain and have become tolerant to weaker opioids, such as oxycodone.2

A unique quality of fentanyl is that it is utilized for chronic pain associated with all forms of cancer and persistent pain stemming from noncancerous maladies.3

When prescribed by a doctor to manage pain, it can be administered as a shot, a patch, or even as lozenges.2 Both dosage and the method of delivery play roles in the onset of action (i.e., pain relief):3

  • If administered intravenously, effects may be felt within 1-2 minutes.
  • If administered through intranasal sprays or sublingually, effects may be felt within 5-10 minutes.
  • If administered via a vis buccal transmucosal, effects may be felt within 10-15 minutes.
  • If administered through a patch, effects may not peak or plateau until 8-16 hours after application.

Fentanyl as an Illicit Drug

Most of the recent fentanyl overdoses are due to the illegal manufacturing of fentanyl created in labs. Consequently, the way it is distributed is not regulated (i.e., powder, put into droppers or nasal sprays, dropped onto blotter paper, or made into pills that look similar to prescription opioids).2

When fentanyl is manufactured in a lab [i.e., illicitly manufactured fentanyl (IMF)], it, along with other opioids, is considered to be a novel synthetic opioid (NSO).4 This group of synthetic opioids, in particular, has caused a spike in overdose deaths and is often “marketed” as stand-alone products when in actuality, they are adulterations or counterfeit representations of heroin or other prescription medications.4

Why Are Drugs Cut with Fentanyl?

One of the reasons drugs are cut with illicit fentanyl is because it’s cheap. When drugs like cocaine, heroin, MDMA, or methamphetamine, are cut with fentanyl, very little fentanyl is needed to produce a high.2

Independent of the inherent dangers of mixing substances, taking other substances cut with fentanyl is dangerous because those receiving the fentanyl-laced substance likely are unaware that they are using fentanyl, which increases the risk of overdose.2

To put this into perspective, 1 kg of illegal fentanyl can be used to manufacture hundreds of thousands of counterfeit prescription pills, which then translates to estimates of tens of millions of dollars made by traffickers.5

Common Drugs Cut with Fentanyl

Drugs that are commonly cut with fentanyl, a deadly opioid, may include:2,6-16

  • Methamphetamine: Methamphetamine is a Schedule II stimulant that is cut with fentanyl in Super Labs, often by the Mexican cartel, and then sold to the United States cheaply increasing the profit margin. Both of these substances are potent on their own, but together, could produce life-threatening effects.
  • Heroin: Heroin is an illegal opioid that can cause a surge of pleasure or euphoria and is often cut with fentanyl so that the supply itself can go further—using heroin that’s been cut with fentanyl increases the risk of overdose.
  • MDMA: MDMA (ecstasy), which is commonly cut with fentanly, is synthetically made and is chemically similar to both hallucinogens and stimulants insomuch that it increases experiences of pleasure, emotional warmth, energy, and distortions in sensory and time perception. Additionally, it causes changes in mood and perception, such as decreasing your situational awareness. People who take MDMA often do so at raves, dance parties, and music festivals, which can already be dangerous on its own due to the risk of hyperthermia and extreme dehydration, but add fentanyl to the mix and the risk increases significantly.
  • Cocaine: Cocaine is a Schedule II stimulant drug that can cause heart attack, stroke, and even sudden death in those who use it. Cocaine is often cut with fentanyl, unbeknownst to the person buying and using the cocaine, which can have devastating effects.
  • Counterfeit Xanax: Fentanyl is often pressed into a pill and made to look like prescription Xanax bars. Some people may attempt to buy Xanax on the street if they are unable to get it through their doctor, for one reason or another.
  • Counterfeit opioid painkillers: Dealers will also press fentanyl into pills that are intended to resemble opioid painkillers, such as OxyContin, Vicodin, and Percocet. Many people, especially teenagers, may be tempted to buy counterfeit prescription painkillers due to the inability to get prescriptions from doctors.
  • Counterfeit Adderall: As with the counterfeit pills above, fentanyl has now been detected in street Adderall, a prescription stimulant used to treat the symptoms of attention-deficit/hyperactivity disorder (ADHD).
  • Marijuana: Reports have shown that illegal marijuana (as opposed to the marijuana bought in dispensaries in states where it is legal) may be laced with fentanyl.

Signs Your Drugs Have Been Cut with Fentanyl

You can’t tell if a drug has been cut with fentanyl just by looking at it. The best way to tell if your drugs have been cut with fentanyl is to use a fentanyl test strip (FTS) to test for the presence of this synthetic opioid. Harm reduction organizations and syringe exchange programs often distribute fentanyl test strips for free. You can also buy them online through third-party distributors.

Otherwise, once you have used a drug like heroin or cocaine, if it was cut with fentanyl, you may experience the effects of an overdose. Signs and symptoms of a fentanyl overdose may include:1,2

  • Stupor
  • Pinpoint pupils
  • Slowed or stopped breathing
  • Slowed or stopped heartbeat
  • Cold, clammy skin
  • Blue skin or lips
  • Coma

When breathing stops or significantly slows down, this can lead to hypoxia, or a lack of oxygen reaching the brain. Hypoxia can cause serious and life-threatening outcomes, including irreversible brain damage or death.2

Finding Rehab for Drug Addiction

Because of its incredible potency compared to its other opioid variants, fentanyl addiction can form quickly whether you intentionally used it or if it was mixed with your drugs without your knowledge.1

One of the best ways to prevent an overdose, whether it is on fentanyl or another drug, is to stop using drugs. However, if you are addicted to drugs, you may need professional treatment to help overcome your substance addiction. There are many types of addiction treatment, including:

  • Inpatient rehab: You reside at the facility for the duration of your treatment program, which typically ranges from 30-90 days. You receive a combination of treatment modalities, such as individual therapy, group counseling, family therapy, psychoeducation, addiction treatment medications, peer support groups, and aftercare planning.
  • Partial hospitalization: The most intensive form of outpatient care, you receive several hours of therapy per day, for five to seven days per week. It’s a good option for those who need a high level of care but can’t commit to residing somewhere.
  • Intensive outpatient: A step down from a partial hospitalization program, an intensive outpatient program involves a few hours of therapy per day, for three to five days per week. It may be used as the first point of contact for addiction treatment or as a form of aftercare after completing an inpatient program.
  • Standard outpatient: The least intensive option, you attend therapy one or two days per week. This option may be beneficial for those with a mild addiction and strong motivation to quit.

However, there are many barriers to quality care that keep individuals from receiving much-needed addiction treatment, such as:

  • Lack of insurance
  • Cost of rehab
  • Lack of specialized care in their area
  • Lack of culturally responsive treatment professionals
  • Stigma
  • Lack of reliable transportation
  • Childcare or eldercare responsibilities

Bridging the Gap

These barriers, though a reality, can be mitigated by certain strategies. For example, if cost is a barrier for you or you don’t have insurance, you may want to look into low-cost or free rehabs that are funded by the state and federal government. State-funded rehabs provide addiction treatment to people who otherwise may not be able to afford it.

Other rehabs may offer sliding scale fees, which only charge you what you can reasonably afford based on your income. And others yet will work with you to create a financing plan in which you break the cost of rehab up into smaller, monthly payments.

If there are no free rehabs in your area or they are all full, you can also apply to a rehab scholarship—these scholarships cover the cost of addiction treatment to prevent financial hardship. These scholarships are offered by individual rehabs as well as organizations like the Substance Abuse and Mental Health Services Administration (SAMHSA).

If you are looking for a treatment program for yourself or someone else, you can browse our treatment directory, where you can learn which programs offer financing options as well as what insurance plans they accept.

You can also call our helpline at 800-662-4357 to find treatment for an addiction to fentanyl, cocaine, heroin, meth, or any other substances.

Resources

  1. Department of Justice, Drug Enforcement Administration. (2020). Fentanyl.
  2. National Institute on Drug Abuse. (2021). What is Fentanyl?
  3. Stanley, T.H. (2014). The Fentanyl Story. The Journal of Pain, 15(12), 1215-1226.
  4. Prekupec, M., Mansky, P.A., & Baumann, M.H. (2017). Misuse of Novel Synthetic Opioids: A Deadly New Trend. Journal of Addiction Medicine, 11(4), 256-265.
  5. Peterson, A.B., Gladden, R.M., Delcher, C., Spies, E., Garcia-Williams, A., Wang, Y., Halpin, J., Zibbell, J., McCarty, C.L., DeFiore-Hyrmer, J., DiOrio, M., & Goldberg, B.A. (2016). Increases in Fentanyl-Related Overdose Deaths – Florida and Ohio, 2013-2015. Morbidity and Mortality Weekly Reports, 65(33), 844-849.
  6. U.S. Department of Justice, Drug Enforcement Agency. (2018). 2018 National Drug Threat Assessment.
  7. U.S. Department of Justice, Drug Enforcement Agency. (2021). Lists of: Scheduling Actions, Controlled Substances, Regulated Chemicals.
  8. National Institute on Drug Abuse. (2019). What is Methamphetamine?
  9. National Institute on Drug Abuse. (2021). What is Heroin?
  10. National Institute on Drug Abuse. (2020). What is MDMA?
  11. National Institute on Drug Abuse. (2018). What are Prescription CNS Depressants?
  12. National Institute on Drug Abuse. (2021). What are Prescription Opioids?
  13. National Institute on Drug Abuse. (2018). What are Prescription Stimulants?
  14. National Institute on Drug Abuse. (2019). What is Marijuana?
  15. U.S. Department of Justice, Drug Enforcement Agency. (2021). DEA Warns of Methamphetamine and Fentanyl Drug Market Built by Aftermath of COVID-19 in New York.
  16. Trujillo, K.A., Smith, M.L., & Guaderrama, M.M. (2011). Powerful Behavioral Interactions Between Methamphetamine and Morphine. Pharmacology, Biochemistry, and Behavior, 99(3), 451-458.
  17. Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). Detoxification and Substance Abuse Treatment.

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