Fentanyl is bad news, and it’s even worse when mixed with other drugs, including cocaine.
A powerful synthetic opioid medication 50 times stronger than heroin, fentanyl has been used legitimately to treat severe pain for several years. More recently, non-prescription fentanyl made in illegal labs has become a major contributor to the nation’s opioid crisis.
The Center for Disease Control (CDC) reports that about 70,600 Americans died from overdose associated with fentanyl and other synthetic opioids (not counting methadone), in 2019.
In the United States, fentanyl has topped the list of most deadly drugs for at least three years. The CDC reports that in 2018 fentanyl was involved in at least half of all overdose deaths in at least ten states.
The actual number may be higher, as reporting varies. Many states don’t register specific drug combinations found in the body after an overdose, and many don’t routinely keep track of fentanyl-related overdoses.
A Growing Problem: Cocaine Laced with Fentanyl
Cocaine laced with fentanyl is a relatively new problem that may expand and become another epidemic. Although opioids still account for more fatal overdoses than any other drug, cocaine has moved into second place – a and the death toll from cocaine overdose is rising.
The problem is that buyers often have no idea they’re purchasing cocaine laced with fentanyl. This situation is extremely dangerous, especially for unsuspecting cocaine users who haven’t developed a tolerance to opioid drugs.
Drug enforcement officials aren’t sure why fentanyl is showing up in cocaine more frequently, but they have various suspicions. Some think the intent isn’t malicious, theorizing that cocaine is accidentally tainted in illegal labs or by careless packaging.
Others, including many physicians and treatment providers, think the problem is more malevolent. They think that cutting cocaine with fentanyl, inexpensive to manufacture in illegal labs, is simply an effective way for traffickers to boost their profit margins.
While the low- and mid-level dealers get much of the blame for fentanyl-laced cocaine, it may be cartels who are selling adulterated products to increase the price by making cocaine more attractive to buyers.
It’s difficult to know who to blame. The reality is that cocaine is packaged and repackaged numerous times as it makes its way down the supply chain. Fentanyl may be found in products sold by dealers who typically sell expensive, top-level cocaine to wealthy buyers, and to dealers who provide cheap cocaine to those who can’t afford to buy pure product.
Either way, cocaine users are at tremendous risk of fatal overdose. According to the Drug Enforcement Administration (DEA), fentanyl “…is crazy dangerous”, and very small amounts can be lethal for even full-grown humans.
Intentional or not, sellers of fentanyl, including fentanyl-laced cocaine, are at risk of lengthy jail time if they get caught. Recently, a federal grand jury in California indicted a seller for the distribution of fentanyl resulting in death.
Cocaine + Opiates: A Deadly Combination
Speedballs – which involve a combination of cocaine and an opioid drug – are nothing new in the world of illegal drugs, and the practice was especially popular in the 1970s. The practice of combining opiates and stimulants has claimed the lives of many well-known people, including John Belushi, Chris Farley, Ken Caminiti, River Phoenix, and Philip Seymour Hoffman.
Historically, mixing cocaine and opiates has most often been intentional. Cocaine is a stimulant that provides an intense rush. The opiate, be it heroin or fentanyl, has the opposite effect, depressing the central nervous system and minimizing agitation and anxiety when the cocaine wears off.
Stimulants like cocaine can trigger several dangerous effects, including high blood pressure and irregular heartbeat. Opiates may result in drowsiness and respiratory distress.
The difference is that buyers today may be completely unaware that their cocaine is mixed with fentanyl. They may be mixing drugs – a.k.a. speedballing – without knowing what they’re doing, or that what they’re doing is more dangerous than taking either drug alone.
Harm Reduction with Narcan
Unfortunately, naloxone works only on opiates and is of no benefit if the overdose is caused by cocaine. However, it can reverse overdoses when cocaine is combined with opioids, including fentanyl. Because of the strength of fentanyl, multiple doses of naloxone may be required.
Laws concerning naloxone vary, but a growing number of states have made it much easier to get the drug into the hands of friends and family members. Most insurance companies pay for naloxone and many nonprofit organizations, community programs, and healthcare providers offer the medicine free of charge.
Naloxone is available in several forms, some of which are appropriate only for trained medical providers. However, nasal spray, available in an affordable, generic version, is safe and easy to administer, even by people with no medical training.
The U.S. Surgeon General advises that family and friends of opioid drug users should keep naloxone within easy reach.
Fentanyl Test Strips
It’s difficult for buyers to know if cocaine contains fentanyl. However, more and more community organizations are distributing fentanyl test strips as a strategy to combat the growing problem of drugs laced with fentanyl. San Francisco, for example, is providing fentanyl test strips and Narcan free of charge to vulnerable communities.
The strips are easy to use with very little instruction, and the response from drug users, thus far, has been positive. On the downside, San Francisco’s Harm Reduction Coalition reports that fentanyl is showing up in a growing number of samples.