The Drug Supply is Contaminated!

Cases of accidental overdose are skyrocketing because the drug supply is a polluted nightmare.

In early March, in the span of just 24 hours, paramedics in Austin, Texas, responded to 18 overdoses that occurred near the downtown entertainment district.

In late February, five people were found dead from overdoses in a suburban Denver apartment.

Again in late February, five students took pills at a school near Las Vegas and all of them had to be rushed to the hospital. One of the students later died.

And this weekend, while on spring break in Florida, Five West Point cadets and one of their friends were found overdosing as medics and bystanders rushed to revive them with CPR and naloxone. As of Friday night, two of them were in critical condition and on ventilators.

What on earth is going on here? What is behind this sudden spate of overdoses?

America’s drug supply is contaminated. It’s polluted and it’s causing overdoses and deaths to skyrocket. There is something very serious happening, and if I’m sounding alarmist, that’s because, well, I’m alarmed. And I think we all should be.

Those five people found dead in an apartment near Denver thought they had purchased cocaine, but it actually turned out to be a potent synthetic opioid called fentanyl. Cocaine users have no built up tolerance for such a strong opioid so even a small dose is enough to cause severe respiratory depression and death if no one is there with naloxone on hand to revive them.

As for those West Point spring breakers? It appears to be a similar case: They purchased cocaine to party and stay up late but the cocaine turned out be fentanyl instead.

What’s annoying about coverage of that incident is that reporters quoted a Fire Chief who claimed that two people giving CPR to the overdose victims—who he said had not ingested the drugs—also started overdosing. To be sure, these drugs are highly potent, but you need to actually inject, snort, or swallow them. Standing near fentanyl or even touching it (which I have done!) is not going to cause an overdose. It’s also difficult to accidentally inhale street fentanyl because it tends to be in powder form which is dense and therefore cannot be suspended in the air for very long. It’s important to point all this out because bystanders can save lives! But if they’re erroneously afraid of overdosing they might withhold lifesaving measures.

As for what happened in Austin, Texas? It appears a potent batch of fentanyl mixed with a veterinary tranquilizer called xylazine was going around.

"This weekend was very much out of character for what we typically see even during our worst days in the pandemic," Dr. Jason Pickett, chief deputy medical director for the City of Austin, told local news. "This is a sign that there is something now in the drug supply that’s very dangerous." Dr. Pickett is exactly right.

Dr. Pickett also noted that paramedics responding to overdoses had to use many more doses of naloxone than usual. This tipped them off to the fact that there may have been something else in the drugs that wasn’t an opioid, like xylazine. That means naloxone will have no effect because naloxone only reverses overdoses caused by opioids.

Adding some more context here, xylazine isn’t even approved for human consumption. It’s a sedative used on animals and it was not designed for humans and hasn’t really ever been tested on humans. To learn more about xylazine, check out this new study, which got a great write up in STAT News.

With the SXSW festival underway in Austin, the DEA also alerted the community about counterfeit pills going around.

Which leads me, finally, to those five students in Las Vegas who took pills at school. Local authorities think those pills were counterfeit, and that they probably contained illicit fentanyl. The students who didn’t die exhibited symptoms like nausea and vomiting, which is usually what happens when people take too much of an opioid. These pills are pressed to look like Xanax, Adderall, or painkillers, but they’re really just fentanyl.

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To zoom out a little bit and try to make sense of all this: A couple months back I wrote about the contaminated drug supply in The New Republic. I emphasized that the skyrocketing level of overdose is not necessarily being driven by some huge influx of injection drug users who are addicted to fentanyl. Instead, it seems that everyday, recreational drug use is just much more deadly than it has ever been.

“It’s not that fentanyl is attracting more users or creating new users,” Bryce Pardo, a drug policy researcher at the Rand Corporation, told me for that piece. “It’s just a very dangerous time to be a drug user and to be buying street drugs.”

A group of friends doing some lines of coke at their apartment; some curious teenagers popping pills in school; dudes on spring break sharing a bag of cocaine. This type of drug use has always occurred. And yes, sometimes bad things would result from it, like addiction or reckless driving or someone getting their stomach pumped. But now, this type of drug use could be deadly, and it didn’t used to be.

That’s what’s new. Many a drinkers have done a key bump of cocaine in a bar to keep the party going. But now, with the drug supply the way it is, that key bump could contain a lethal dose of fentanyl. The implications of all this are horrifying.

The illicit drug supply is unregulated. Your bag of cocaine or pills bought on the street does not come with a list of ingredients. No proof by volume label. No dosing instructions. And the person selling it to you is probably no chemist, and has no idea what’s really in that mystery bag of potent powders.

All this means that people must know what harm reduction is and how to practice it. Simply put, harm reduction is a practical philosophy that makes behaviors like drug using less risky. Typically, this meant preventing the spread of HIV by using fresh syringes and never sharing. Harm reduction has much broader application than that.

In this context, harm reduction means that people must be highly vigilant about what drugs they’re taking, where the drugs came from, and whether those drugs have been tested for contaminants like fentanyl. (Online harm reduction organizations like NextDistro and FentCheck are working their butts off to get people naloxone and fentanyl test strips). If you’re not sure what’s in your drugs, it’s always smart to start off with a small dose to see how it makes you feel. If you bought cocaine, do that silly thing they do in movies and give it a little taste. Are you getting any numbness? What’s the consistency of the powder? Before snorting a huge line, use your God given five senses and try to assess what you’re about to use.

Talking about harm reduction is much easier than actually doing harm reduction. And the fact that drugs are criminalized in this country means that, in many places, doing harm reduction is criminalized. And of course, one reason why the drug supply is in such bad shape right now is because of prohibition and criminalization. If bottles of baby powder or Tylenol start causing mass disease and sickness, those products are pulled from the shelf immediately. In an illicit market, there is no regulatory mechanism to protect consumers. That’s why it takes so much education, vigilance, and yes, personal responsibility, to use drugs in a manner that won’t kill you or your friends.

Unless America takes a radically different approach to drug enforcement, it seems that more needless and preventable overdose deaths will keep happening.

Stay safe out there.