Tainted Drugs

I return to the question of why synthetic opioids are popping up in random drugs like cocaine and MDMA. How worried should people be. And why fentanyl is never, ever going away. (it's a long post!)

Pink pills pressed with the words “Red Bull” were sold as MDMA at a rave in Sidney, Australia. The problem was, these pills contained no MDMA whatsoever. The pink pills instead contained a powerful synthetic opioid of the nitazene family. Nitazenes are anywhere from hundreds to thousands fold more potent than morphine, and could be tenfold more potent than fentanyl (here is an interesting history of nitazenes). Anyone using nitazenes without knowing it, and crucially, without have a high tolerance to opioids, is in big trouble.

At least one raver at the festival took one of the pink Red Bull pills and began to exhibit symptoms uncharacteristic of MDMA. Thanks to a robust harm reduction and drug checking operation, the raver was saved by naloxone and the pills were analyzed to see what was in them. Once festival organizers were alerted that the pills contained nitazenes, they took immediate action that probably saved many lives.

The organizers cut the music, took center stage, and warned 21,000 people not to take the pink Red Bulls.

“After the announcement, a number of people reported that they had the ‘Red Bull’ tablets but would dispose of them,” Mary Harrod told The Guardian. “It is an example of a highly effective, cooperative response that prevented further harm with no fatalities on the night.”

Disaster averted. This is a great example of harm reduction working. Without naloxone and drug checking, this rave could have turned into a mass casualty event.

Perhaps the most notorious case of tainted drugs in America happened outside of Denver in February 2022, where one night a group of friends snorted cocaine that turned out to be fentanyl, and they died in a mass overdose.

It’s a devastating case. Seven people were hanging out that night in apartment 307, one of them being a baby. Five died and two survived. The newborn baby lost both of her parents that night. The other survivor, Cora Marquez, appears to have also used the tainted cocaine that night but she did not fatally overdose.

Over one year later, after an intensive police investigation looking for the dealer, no arrests have been made. The case remains open. How fentanyl popped up in that cocaine is still a mystery.

“There just simply was not enough evidence to charge anyone with this crime,” Adams County District Attorney Brian Mason said.

Prosecutors would have to find who sold the cocaine to the group, then try to figure out if the dealer knew the cocaine was laced, or if the dealer did the actual lacing. It’s a tough case to prosecute. I can imagine a defense attorney arguing that their client did indeed sell cocaine to the group, but that someone else mixed fentanyl into it. Maybe someone in apartment 307 used both cocaine and fentanyl and accidentally confused the bags. Who knows what happened.

Cases like these spark a lot of fear. People buying street drugs just don’t know what they’re getting. It’s a dangerous situation. It makes me grateful today that I stopped using before this mess. The game has changed a lot since then. The risk of death has heightened to levels I never thought possible.

What’s Up With The Supply?

There’s good(ish) news and there’s bad news.

First, the bad, because I’m a pessimist. Fentanyl has very much etrenched and clawed its way deep into the drug supply. The genie is out of the bottle, you can’t put the toothpaste back in the tube, etc. It’s here and it’s here for good. Fentanyl is just too easy and too cheap to manufacture. Synthetic opioids like nitazenes and fentanyl, along with stimulants like meth, are a drastic departure from traditional crop-based drugs like cocaine and heroin. The only actual limit on the production is the amount of precursor chemicals available. And these are pretty much infinite. Any country with a chemical industry can become a source country for meth and fentanyl precursors.

Even if by some miracle the US, Mexico, and China all agree to actually do something about this, then precursor sourcing could switch to India or some other country. I don’t know how this can ever stop. If you have any idea, I’d love to hear it.

A quick digression about “the border”

It’s an election year, which means Democrats and Republicans are under significant pressure to do something about all these fentanyl deaths. Grieving parents and families are clamoring for action. Naturally, there’s a push to “fentanyl-proof” the border and prevent it from getting here. OK. Sure.

The problem is that task is pretty much impossible to accomplish. Here’s why.

We know roughly the total amount of fentanyl consumed in America each year is in the single digit metric tons. That’s a tiny amount. For a sense of scale, research estimates that Americans consume about 145 metric tons of cocaine and 47 metric tons of heroin annually. Cocaine and heroin are much easier for law enforcement and border patrol to detect and seize because these substances take up way more space in the trafficking process.

Heroin and cocaine have been abundantly accessible in the US for many decades. I don’t recall there ever being a “drought.” I can’t remember the last time a major US drug bust ever made a substantial dent in cocaine and heroin access. If they cannot interdict enough cocaine or heroin, I don’t see how they can do it with fentanyl.

Because fentanyl is so strong—doses are measured in micrograms—that means very small amounts can supply a lot of customers. If all of the fentanyl consumed in the US in just one year can easily fit inside one 20-foot cargo container, and more than 22 million cargo containers of much bigger sizes arrive in America by air, land, and sea every year, then how on earth will the authorities every seize enough fentanyl to make a difference? Again, for sense of scale, America anually imports more than 1,000,000 metric tons of avacados. That’s just avacados! Just .0006 percent of those avocados could be fentanyl and that’s enough to supply the entire U.S. for a year.

This is not a needle in a haystack situation. This is like trying to find a pearl at the bottom of the The Mariana Trench. It is pure folly to think that border guards and DEA agents are going to meaningfully reduce the supply of fentanyl. That is not cynical, or partisan, or some radical thing to say. It is based on the math and physics of the situation we’re dealing with.

It’s important to be honest about the reality of this, which is something federal officials or politicians have a problem doing.

Last year, the DEA seized more than 78.4 million fentanyl-laced pills and nearly 12,000 pounds of fentanyl powder last year alone. That is a lot. But it also is a drop in the bucket. The federal government does not ever say what the denominator is in this equation: 12,000 pounds of fentanyl powder was seized out of how much? 12,000,000? 78.4 million pills out of… 300 million? How much sails through undetected—nobody knows. But we can assume it’s a lot since more than 110,000 people died from drug overdoses, the majority of those involved synthetic opioids.

This is why I think the narrow focus on the supply misses the mark. Of course it’s a supply problem. But can’t we be doing so much more to help people stay alive? To help people build a life that they feel is worth living? I have to believe the answer is yes.

“You mentioned some good news?”

I did.

The good news: Drug checking is a crucial tool for dealing with a chaotic and volatile drug supply. Naloxone and drug checking clearly made a difference at the Sidney rave. They can, and are, making a difference now.

Drug checking is becoming more accessible and mainstream. Fentanyl test strips are very easy to come by. To be clear, I don’t think test strips are a miracle that will save everybody. Test strips could help the recreational weekend warrior who likes the occasional key bump at the bar.

Depending where you live, some harm reduction groups even have advanced technology, like infrared spectroscopy or mass spectrometers that can produce a quick (and sort of) reliable read out of ingredients. (To learn more about that tech, its capabilities and limits, here is a podcast I reported and produced for Undark; I don’t know why, but the editor of that podcast kept telling me to talk faster, and so when I listen back it feels like I’m talking way too fast. Ugh. Who actually likes the sound of their voice?).

There’s more good news. The cocaine-fentanyl contamination does not appear to be systemic. As in, cases of contaminated drugs appear to be narrow and isolated fluke incidents. If there was a broader contamination that ocurred at higher level in the supply chain, like if all the cocaine had fentanyl in it, then there would be many more these horrifying incidents like Denver. I am constantly am on the lookout for these cases and I don’t see them pop up that often. Surely I’m missing some.

The sad truth is that most drug deaths are the result of people deliberately and knowingly using and mixing multiple substances. Most people using on the street are well aware that fentanyl and xylazine and a bunch of other synthetic garbage is in the supply. Yes, there’s still cases of young people taking counterfeit pills, and that’s a very serious and grim problem. It’s still just a small percent of the total deaths. There’s tons of fake pills out there, and a good rule of thumb is to assume that any “oxycodone” or “blue m30s” sold on the street more than likely contains fentanyl.

Because the contamination is not widespread, this means that tainted cocaine is probably occurring closer to the retail-level, involving smaller scale, individual dealers rather than big traffickers distributing tainted product all over the country.

The major traffickers apparently are aware of this problem. Hence, the development of “rainbow” fentanyl. It’s a lot harder to mix fentanyl into white powders like cocaine if the former is blue or purple or yellow. This gets us to law enforcement’s dubious explanation of why fentanyl is popping up in other drugs.

"Rainbow fentanyl — fentanyl pills and powder that come in a variety of bright colors, shapes, and sizes — is a deliberate effort by drug traffickers to drive addiction amongst kids and young adults," DEA director Anne Milgram said.

Reports actually show the opposite is true. From Luis Chaparro in Business Insider:

The coloring "is to make it look different than coke or white heroin," the fentanyl cook, speaking on the condition of anonymity, told Insider.

"We know that some of the dealers in the US started mixing cocaine with 'fenta' without letting their buyers know, and that is very dangerous," the operative said.

"Also we mix some of the heroin with fentanyl to make it more powerful, but we mark it, to let the buyer know that this one has 'fenta,'" he added. "Whatever happens when it's taken from our hands, it's not our problem."

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A while back, I wrote about a New York drug delivery service that sold cocaine contaminated with fentanyl to customers and three of them died. Back then I speculated that the contamination probably happened vclose to the retail-level. As more information became known, it appears that was correct. It was contained to that specific delivery service who was stuck with a bad or weak batch of cocaine, and then, idiotically, tried to make it better by adding fentanyl. At least, that is what the police said.

To what extent drugs tainted by fentanyl is intentional is where things get muddy.

The DEA recently made a “One Pill Can Kill” quiz, and it asked this question: Why do drug traffickers mix fentanyl into other drugs? It gave four possible answers: 1. To kill drug users. 2. To change the drug’s appearence. 3. To increase users’ addiction. 4. To lower manufacturing costs.

I genuinely didn’t know how to answer this.

The correct answer, according to the DEA, is “to increase users’ addiction.”

This is the rationale I typically see in news reports, and it is typically sourced by a law enforcement official. It’s not that I think this explanation is impossible. It just sounds implausible. In order to get “hooked” on something, you kinda have to know what it is your using. Customers who want a stimulating cocaine buzz will probably not call back for more if they snort a line and immediately fall asleep (if they ever wake up at all). That’s the exact opposite effect they’re seeking. If the likely outcome of selling cocaine laced with fentanyl is dead customers and a whole lot of heat, then this isn’t actually increasing addiction. It’s just killing people.

So that still leaves why an open question. Some dealers might very well be greedy, malicious, or just plain reckless and insane enough to deliberately spike their product knowing it could kill whoever uses it. I’m not ruling that out 100 percent. I’m sure it happens. I just think we have to leave the door open to other, more rational explanations.

A different reason comes down to sloppy practices. Paramedic and friend of the newsletter Stephen Murray (recently made famous by a powerful This American Life episode), made a video demonstration of just how easy it is for traces of white powders to be accidentally mixed together. Murray’s demonstration shows how bagging drugs (in this case, fake drugs!) on a wooden, porous surface can easily lead to accidental contamination.

Stephen’s idea is that drug dealers tend to sell more than one kind of drug. They could be breaking down their various products (cocaine, fentanyl, etc.) in the same place and on the same surface. And if they’re sloppy about it, contamination can happen quite easily, especially when both drugs are white powders.

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It will always be difficult to ascertain the intent of this problem. What’s important for people to know is that this is a very real problem.