Dr. Erin Miers is a clinical psychologist, she currently works at Dartmouth-Hitchcock Medical Center where she provides clinical services, consultation, supervision, and teaches at Geisel School of Medicine at Dartmouth University. She completed her doctorate in 2015 through California School of Professional Psychology in San Francisco. She has expertise in the areas of trauma, substance use disorder, HIV, and working with the LGBTQIA+ population. Her research interests include the impact of burnout on mental health providers, discrimination and internalized stigma generally but also specifically in people living with HIV.
Fentanyl-Laced Cocaine: How Opioids are Killing People with Cocaine Addiction
In response to a “deadly drug cocktail” hitting the street, authorities are issuing a warning about a seemingly-unlikely combination — cocaine laced with fentanyl.
This strange-but-dangerous pairing is killing people by the thousands, and the problem is getting exponentially worse. According to the National Institute on Drug Abuse, overdose deaths involving fentanyl-laced cocaine increased 23-fold between 2012 and 2016.
Deaths from opioid-induced overdoses have substantially risen over the last two decades. From 1999 to 2017, more than 702,000 people have lost their lives from an opioid overdose. In 2017 alone, opioid deaths made up more than 40,000 of the 70,237 total drug-related deaths. And now, individuals with cocaine addiction are finding opioids entering the cocaine supply chain.
Here, we will take a closer look at this terrifying trend — the scope of the problem, the contributing factors, and most importantly, some possible solutions that could potentially save tens of thousands of lives.
Getting and staying sober is very challenging, but with the right support network and tools, it's completely attainable.
First Things First — What You Need to Know about Fentanyl
“In terms of danger level, opioids are bad, heroin is worse and fentanyl is the worst. When these pills hit the street and you as an addict think you`re taking Oxy, and you take 10 pills, it’s very likely they could contain fentanyl, and just one of those pills could kill you.” ~ DEA Agent Tom Lenox
Fentanyl is an extremely-powerful opioid that is up to 100 times more powerful than morphine and at least 50 times stronger than pure heroin. Some of its chemical analogues, such as carfentanil, are 10,000 times stronger than pure morphine.
It has legitimate medical uses, typically given to patients suffering from cancer pain. Significantly, it does not block pain, but instead alters the user’s perception of that pain.
But unlike other opioid painkillers that come from the opium poppy plant, like morphine, oxycodone, and heroin, fentanyl is 100% synthetic, made entirely in a lab.
This is important, because that is precisely why criminal cartels manufacture illicit fentanyl in clandestine superlabs. Heroin production requires a tremendous outlay of resources, in terms of money, land, manpower, and time. The entire process takes months.
Fentanyl, on the other hand, only requires a properly-equipped lab, precursor chemicals, and someone with basic chemistry knowledge. A batch of illicit fentanyl can be made in less than 48 hours.
For drug cartels, it is a simple matter of economics. Fentanyl is twenty times more profitable than mere heroin. It costs cartels approximately $32,000 to manufacture one kilogram of fentanyl. But that kilogram can then be processed into one million pills, with an estimated street value of $20 million.
Where Does Illicit Fentanyl Come From?
“Fentanyl originally started mostly from China… We are also seeing precursor chemicals in Mexico and manufacturing labs begin to develop in Mexico.” ~ Jeff Sessions, former US Attorney General
Most of the counterfeit fentanyl in America comes from two countries – China and Mexico. 90% currently originates in clandestine Chinese labs, but Mexican drug cartels are increasingly switching to fentanyl production instead of marijuana or heroin cultivation.
How bad is the fentanyl smuggling threat?
According to the 2019 national Drug Threat Assessment, which was put out by the Drug Enforcement Administration, there were 56,530 forensic lab reports mentioning fentanyl in 2017. To put that in perspective, in 2013, there were only 934.
Because it shares a border with Mexico, Arizona is particularly geographically vulnerable to what locals call “Mexican Oxy”. Enormous amounts of fentanyl are flooding into the state:
- June 30, 2020: U.S. Customs and Border Protection agents seized 211,000 fentanyl tablets at the Nogales border crossing.
- June 11, 2020: Also in Nogales, agents confiscated nearly 300,000 pills laced with fentanyl.
- To put that in perspective, a total of 380,000 fentanyl pills were seized in the entire state of Arizona in ALL of 2018.
- January 23, 2020: The Phoenix Police Department led a raid that netted 170,000 fentanyl pills.
- January 31, 2019: CBP agents in Nogales found 254 pounds of fentanyl hidden in a secret compartment of a Mexican produce truck. This was the largest fentanyl bust in U.S. history.
Massachusetts Attorney General Maura Healey says, “For the cartels, it’s their drug of choice. They have figured out a way to make fentanyl more cheaply and easily than heroin and are manufacturing it at a record pace.”
The Centers for Disease Control and other governmental bodies understand the pressing need for greater awareness and rehabilitation resources. However, there is another problem facing drug users: fentanyl. The synthetic opioid can cause an overdose within minutes with a potency making it 50 to 100 times more potent than morphine.
The Result of Dangerous Contamination?
“It’s more of a contamination model, rather than one that is malicious or purposeful.”
~ Dr. Traci Green, PhD, Boston Medical Center
Some experts believe that drugs are being accidentally contaminated with fentanyl during processing. The same machines are usually used to package different drugs, so if they were not cleaned properly between production runs, it would partially explain why such dissimilar drugs are sometimes found together,
While that certainly may be true in many instances, it does not go far enough to cover the explosion of fentanyl-based drugs being found in virtually every corner of America.
Due to its strength, fentanyl is not only highly addictive but extremely dangerous. Some drug users seek it out purposefully to mix with a stimulant like cocaine. Taking the two together is an act known as “speedballing.” Others, on the other hand, may accidentally take fentanyl as many illicit dealers are now lacing their supplies with the drug.
Is COVID-19 to Blame?
“The coronavirus pandemic has resulted in a shortage of the supply of cocaine in our area. As a result, dealers are becoming desperate and greedy for profits, so we believe they may be deceiving their customers and selling them fentanyl, which is cheaper and more readily available.”
~ Tim Sini, District Attorney for Suffolk County, New York
The current upswing in overdose deaths is perhaps partially and indirectly caused by the coronavirus pandemic. With travel bans and stay-at-home orders in place, cocaine shortages are being reported, so cartels and dealers are attempting to pivot and get customers hooked on what is available.
Opioids are the most-abused class of illicit drugs and the most-profitable for the cartels, so this explanation does probably account for a portion of the recent trend. But again, it does not go far enough, because the spike in cocaine-fentanyl overdose deaths began years before the COVID-19 crisis.
Why Is Fentanyl-Laced Cocaine on the Rise?
No one knows for sure why fentanyl has suddenly been introduced to the cocaine supply, but there are a few theories. There has been an increasing demand for both methamphetamines, like cocaine, and opioids.
According to a survey by the U.S. Substance Abuse and Mental Health Services Administration, 2.4 million Americans started using opioids, methamphetamines, or other prescription stimulants such as Adderall in 2016. Overall, the total number of illicit prescription users was 13.6 million in the same year.
However, most cocaine users don’t want anything to do with fentanyl. This makes one idea that dealers are lacing their supplies to appease the majority fall apart. Instead, it seems more plausible that fentanyl is being marketed to cash upon the opioid epidemic. Given its strength, a person who starts taking cocaine laced with fentanyl can quickly develop an opioid use disorder. Unfortunately, if cocaine users are already struggling with a cocaine addiction, the risk of overdose increases exponentially.
Why are Drug Cartels Purposefully Mixing Cocaine and Fentanyl?
Ultimately, no one knows precisely why fentanyl is being added to cocaine. This can be notably perplexing given the immense fear the potent opioid caused in many of its users. Fentanyl is appearing in just as many overdoses with cocaine as it once did with morphine or heroin. Deaths from fentanyl-laced cocaine are now known as the “third wave” of the American opioid epidemic.
“Fentanyl is so cheap, and the drug cartels have great access to it. It is a tremendously effective filler because it’s highly addicting. If it doesn’t kill them, people get an intense reaction that creates addiction. It’s cheap, it has a strong high and it makes people come back for more.”
~ Emily Feinstein, J.D., The Center on Addiction
ABC News reports that as recently as 2012, there were very few cocaine deaths involving fentanyl. But by 2017, there were roughly 7000 fatal overdoses involving both types of drugs.
It is important to understand that this is usually not an accident. Drunk cartels mix in or even completely substitute this dangerous synthetic opioid for not only cocaine, but also heroin, marijuana, and prescription pills completely on purpose. And because it is virtually impossible to tell the difference between fentanyl and most other drugs without testing, this is almost always done without users’ knowledge.
Drugs cartels do this for several reasons.
For the cartels, profit is the only consideration. Because fentanyl is cheap and easily and quickly manufactured, it is a cost-effective way to boost profits. For example, it can be used to increase the potency of low-quality products, so they can be sold at a higher price.
It is also an inexpensive way to expand their client base, in a couple of different ways.
Fentanyl is so potent that unsuspecting drug customers can be fooled into thinking that the powerful effects are due to a high-quality product. That would increase word-of-mouth demand.
There is also the theory among some that the drug cartels are trying to create a new product, similar to cocaine-heroin “speedballs”. Rafael, a drug user interviewed by National Public Radio, says that because fentanyl is more powerful, it is also more addictive.
“It’s all about making them (drug users) need the product,” he opines.
The Danger of Fentanyl Overdose
“Sometimes, if people who occasionally use cocaine are not opioid users, they’re really at increased risk for an overdose because they’re what we call ‘opioid naive’ — they have no tolerance,”
~ Dr. Denise Paone, New York City Department of Health
In 2018, synthetics were involved in 2 out every 3 fatal opioid overdoses, accounting for over 31,000 lost lives. This was more than any other class of drug, and precisely why fentanyl is known as the “deadliest drug in America”.
That figure represents a 10% increase from 2017. Of special relevance, the state that experienced the largest year-over-year jump was Arizona. From 2017 to 2018, synthetic opioid deaths in Arizona increased by 93%.
A fatal dose of fentanyl is about the size of six grains of salt, roughly equivalent to a single grain of rice. of Between 2015 and 2017, the number of fentanyl deaths in Arizona tripled.
While all opioids have the potential to kill by slowing the central nervous system, fentanyl affects the CNS to a far greater degree than heroin or prescription painkillers, causing more serious and prolonged suppression of breathing.
There are three principal reasons why:
- Fentanyl is particularly fat-soluble, allowing it to enter the brain rapidly and quickly trigger an onset of effects. This means that users lacking in body fat are at elevated risk of overdose. This is relevant because two of the most-common side effects of long-term fentanyl abuse are severe weight loss and anorexia.
- Fentanyl users also retain high levels of carbon dioxide, thus dilating blood vessels and releasing even more fentanyl into the body.
- That retained carbon dioxide can trigger acidosis, thereby impairing how fentanyl bonds with inhibitory proteins. This in turn causes higher blood concentrations of fentanyl.
Fentanyl also causes less sedation than other opioids. This matters because symptoms such as extreme drowsiness, loss of consciousness, and unresponsiveness are early warning signs of an opioid overdose. Because they do not feel as sleepy as they normally would after taking painkillers or heroin, inexperienced or unknowing users mistakenly believe that it is safe to take more.
Counterfeit Drugs Lead to Real Dangers
“This used to be a relatively rare tragedy. Now with counterfeit drugs potentially made with more deadly and concentrated ingredients, the risk is dire. Please warn friends and family members using illegally-obtained drugs that even one pill or use can be deadly.”
~ Dr. John Dreyzehner, MD, Commissioner, Tennessee Department of Health
Without a laboratory analysis, it is virtually impossible for street-level drug users to know when their cocaine or heroin or Vicodin or Xanax has been laced or replaced with fentanyl.
If their regular customers die, suppliers and dealers don’t care, because there are ALWAYS more addicts ready to take their place. In fact, overdoses provide free advertising proving that they are delivering high-quality products.
Even paramedics and other first responders cannot tell the difference, and too often, that delays life-saving emergency treatment. For example, if they see paraphernalia and powder that looks like cocaine, there is no reason for them to administer Narcan, which can only reverse opioid overdoses. By the time an actual chemical analysis is performed, it is too late.
Furthermore, fentanyl is so potent that it may take multiple doses of Narcan to revive overdose victims. It is unlikely that any witnesses or bystanders have even one emergency reversal kit, let alone several.
What Happens Next?
Law enforcement officials know fentanyl is a deadly problem being pushed on their streets. “Death rates involving cocaine increased by approximately one-third during 2016-2017” according to researchers as the Universal of California in Fresno. There is growing concern users may begin taking other drugs to avoid fentanyl-laced cocaine.
Some cocaine users may be switching to heroin to stay away from tainted drugs. On the other hand, many will continue consuming cocaine on purpose because it is cheaper than heroin and other opioids. The medical community is taking the same preventative measures for stimulant users once administered to heroin addicts. Take smaller doses, keep Naloxone on-hand, and avoid using alone.
There is some good news, however. Traci Green, an epidemiologist at Boston Medical Center, has found “the tools that are going to be most effective are the ones we already have.” With the knowledge and skills needed to help begin educating users and, hopefully, expanding drug treatment access in America, more people can start to understand the tremendous risk of fentanyl use, intentional or otherwise, and get help before it’s too late.
What Does All of This Mean to YOU?
“If anything can be likened to a weapon of mass destruction in what it can do to a community, it’s fentanyl. It’s manufactured death.”
~ Special DEA Agent-in-Charge Michael Ferguson, New England
All of this information highlights one inescapable fact — illicit drug use is NEVER safe.
Fentanyl and synthetics have completely changed the landscape of substance abuse and addiction. It no longer matters whether you are experimenting as a first-time user or if you have a years-long habit, the possibility of fentanyl means you are playing Russian Roulette with your life, every…single…time.
The best way to protect yourself from fentanyl is to never abuse illicit drugs and to only take medications that were legitimately prescribed to you by a physician and dispensed at a pharmacy.
If you are already battling drug dependence or addiction and you cannot quit on your own, then maybe you need specialized professional treatment.For individuals struggling with the ever-tightening grip of opioid and cocaine addiction, it is crucial to find a trusted treatment facility. If you live in the Scottsdale, Arizona, area SpringBoard Recovery is your best local resource to help you successfully regain your sobriety.
Frequently Asked Questions
Why is Fentanyl Laced Cocaine Increasing in Popularity?
At one point in time, the Columbian government had a plan to completely exterminate the coca plant. They tried a few different methods, including spraying coca fields to destroy crops and paying farmers to change what they grow.
Columbia’s “war on drugs” did not last very long, and there are currently efforts in place to work toward legalizing the drug. A report called “Coca Industrialization: A Path to Innovation, Development and Peace in Columbia” highlights the plant’s nutritional properties and promotes the use of it among indigenous areas.
Columbia is manufacturing large amounts of cocaine today. Fentanyl makes a good additive for drug dealers because it makes the drug more profitable. It results in a more powerful high for the user and a drug that is a lot more addictive than either drug is on its own.
What are the Symptoms of an Opioid Overdose?
If a person overdoses on any opioid drug, including Fentanyl, it is an emergency that requires immediate medical attention. Some of the symptoms of an opioid overdose are:
- Vomiting or gurgling sounds if the person is unconscious.
- Becoming limp and unresponsive.
- A pale face and clammy skin.
- Blue/purple lips and fingertips.
- Being unable to speak.
- Becoming unconscious.
- Slower breathing rate or breathing that stops altogether.
- Slower heart rate or even a heart rate that has stopped.
What are the Symptoms of a Cocaine Overdose?
It is also possible to overdose on cocaine, which is also a medical emergency. Some of the signs of a cocaine overdose include:
- Becoming extremely paranoid.
- Severe anxiety.
- Having hallucinations.
- Having chest pain.
- A higher than normal body temperature.
- A rapid heart rate.
- Breathing difficulties.
How Can You Tell if a Drug is Laced With Fentanyl?
Drug users should use extreme caution whenever they use because virtually any drug can be laced with Fentanyl. But it is not possible to tell by just looking at it.
When drugs like cocaine are cut with Fentanyl, a powdered version of the substance is typically chosen. It looks just like cocaine, so a person who is using it would not have any idea it was laced unless they were informed.
The only sure ways to tell if a drug has been laced with Fentanyl is to have it tested or to test the user after the fact. By then, it might be too late because it could have already caused an overdose.
How Long Will Fentanyl Laced Cocaine Stay in Your System?
When determining how long Fentanyl laced cocaine will stay in your system, it is important to consider each drug separately. A drug’s half-life is used to determine how long it will take to eliminate it from the body.
If a person has used cocaine only one time, it can be detected in their urine for 3-5 days afterward. A larger dose or someone who uses it only occasionally may test positive for as long as 7 days after their last dose. For heavy users, it may be possible to detect it for as long as 14 days after the last dose.
Fentanyl may show up in urine tests for as long as 72 hours following the last dose. But this depends on the size of the dose the person took and on their method of administration.
The body is only able to process substances one at a time. This is going to lengthen the amount of time it takes to eliminate both cocaine and Fentanyl from the system.
Who is Most At-Risk for Being Exposed to Cocaine Laced With Fentanyl?
Anyone who uses cocaine could be at risk for being exposed to Fentanyl. But there have been increasing reports about college students using the combination. The DEA has warned that anyone who uses cocaine should also be aware of these risks. In one county in Ohio, for example, 30% of their overdose deaths over the last year involved both drugs.
- Yahoo! News: https://news.yahoo.com/deadly-drug-cocktail-fentanyl-laced-001628230.html
- WebMD: https://www.webmd.com/mental-health/addiction/news/20181031/fentanyl-laced-crack-cocaine-a-deadly-new-threat#1
- Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/index.html
- Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/data/statedeaths.html
- Drug Enforcement Administration: https://www.dea.gov/sites/default/files/2020-02/DIR-007-20%202019%20National%20Drug%20Threat%20Assessment%20-%20low%20res210.pdf
- Arizona Daily Independent News Network: https://arizonadailyindependent.com/2020/06/29/1-4-million-in-fentanyl-heroin-meth-cocaine-seized-by-nogales-cbp/
- U.S. News: https://www.usnews.com/news/best-states/arizona/articles/2020-06-11/nearly-300k-fentanyl-pills-seized-at-arizona-mexico-border
- azcentral: https://www.azcentral.com/story/news/local/phoenix-breaking/2020/01/23/over-170-000-fentanyl-pills-seized-phoenix-drug-bust/4558619002/
- canoe.com: https://canoe.com/news/crime/254-pounds-of-death-biggest-ever-fentanyl-bust-made-in-arizona
- National Institute on Drug Abuse: https://www.drugabuse.gov/publications/drugfacts/fentanyl
- Substance Abuse and Mental Health Services Administration: https://www.usa.gov/federal-agencies/substance-abuse-and-mental-health-services-administration
- WebMD: https://www.webmd.com/mental-health/addiction/default.htm
- abc NEWS: https://abcnews.go.com/US/crisis-surge-cocaine-mixed-fentanyl-communities-law-enforcement/story?id=63846815
- CNN: https://www.cnn.com/2019/10/25/health/fentanyl-deadliest-drug/index.html
- Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/data/fentanyl.html
- Arizona News: https://www.abc15.com/news/state/fentanyl-deaths-from-mexican-oxy-pills-hit-arizona-hard
- UPI: https://www.upi.com/Health_News/2019/08/08/Cocaine-laced-with-fentanyl-causes-increase-in-deaths/8391565297010/
- npr: https://www.npr.org/sections/health-shots/2018/03/29/597717402/fentanyl-laced-cocaine-becoming-a-deadly-problem-among-drug-users
- TheWorld: https://www.pri.org/stories/2018-07-06/push-legalize-coca-leaf-production-colombia
- MedlinePlus: https://medlineplus.gov/opioidoverdose.html
- US National Library of Medicine: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703432/
- News Medical Life Sciences: https://www.news-medical.net/health/What-is-the-Half-Life-of-a-Drug.aspx#:~:text=The%20elimination%20half%2Dlife%20of,half%20of%20the%20starting%20dose.
- Campus Drug Prevention: https://www.campusdrugprevention.gov/news/fentanyl-laced-cocaine-threatens-put-more-college-students-risk