WA sees spike in new chemicals in street drugs, fentanyl

SEATTLE – The landscape of street drugs looked a lot different when University of Washington research professor Caleb Banta-Green began his career in drug epidemiology more than 20 years ago.

There were just seven illicit drugs he had to keep track of: cannabis, meth, cocaine, heroin, PCP, LSD and MDMA.

But in today’s “era of synthetics,” that number has swelled to more than 200, with more hitting the streets every day, including sedatives, animal tranquilizers and an industrial chemical used by plastic manufacturers, according to Banta-Green.

The increasingly “messy drug supply” – especially of illicit fentanyl – is making street drugs more dangerous, as their potency and contents are almost impossible to know without extensive testing, he said. And researchers and care providers are struggling to keep up with new chemicals hitting the market, including learning how to treat people who have used substances never intended for human consumption.

“This is by far the most complicated thing I’ve done,” Banta-Green said. “It’s a game of whack-a-mole and we can’t keep up, and it’s getting out of control.”

Banta-Green is director of the UW Center for Community-Engaged Drug Education, Epidemiology and Research, where he and a team of 15 researchers study opioids and treatments for opioid use disorder. Last year, they collaborated with eight “drug checking” organizations in Washington to test drug samples collected from people across the state and get a better sense of which chemicals and substances are present in the region’s illicit drug supply.

Most often, people brought in drug samples for testing – sometimes as small as a shard of a pill or powder residue left in a plastic bag – because they were worried about what it might contain. This was sometimes because their drugs had an unfamiliar chemical smell or because they caused unusual side effects, including intense headaches or lung pain, Banta-Green said.

The drug samples are tested on-site using test strips, which can quickly detect the presence of fentanyl, the powerful animal tranquilizer xylazine and benzodiazepines. Samples then are tested using a spectrometer, which can detect the presence of methamphetamines. Most samples are sent to a lab for a chemical analysis, where they can detect a wider range of chemical compounds.

Tests of 816 drug samples between June 1 and Nov. 30 revealed the presence of 237 unique drugs and substances, findings that stunned Banta-Green and his colleagues.

“Some were drugs people have heard of,” he said. “And some weren’t even drugs.”

Some of the samples contained “relatively inert” cutting agents, like baking soda, mannitol or sugar, or over-the-counter drugs like caffeine and acetaminophen. But others showed the presence of chemical compounds and drugs that are either not meant for human use or intended for other purposes, including procaine and lidocaine – local anesthetics used to numb or block pain during medical procedures – and xylazine, Banta-Green said.

Most concerning was the presence of substances that could be deadly even in small amounts, either because of their potency or because they’ve never been tested on humans. That included 12 samples containing carfentanil, an opioid that is 10,000 times more potent than morphine and 100 times more potent than fentanyl, and BTMPS, an industrial chemical used in plastics that was found in nearly half of all samples of drugs sold as fentanyl, he said.

The presence of cutting agents in street drugs is common. Manufacturers often add in other substances to reduce costs. But the variety of substances detected last year in Washington state’s drug supply, along with the number of unique substances found in individual samples, is new – and likely due to the country’s efforts to crack down on fentanyl, Banta-Green said.

U.S. efforts with China to block and ban the “precursors for fentanyl” has led Mexican cartels who produce the drugs to experiment, including by cutting their products with new substances, he said.

“Drug trafficking organizations still want to make money and still have a huge demand, so they’ll do their best to adapt,” he said. “They’ve got barely trained chemists making stuff up, and that’s all of our sense is the drivers on this.”

The result is a supply of street drugs in which users can’t know what’s in the drugs they’re buying, even if they’re buying from the same dealer or from the same batch, increasing the risk of accidental overdoses, he said.

David Reames, special agent in charge of the Drug Enforcement Administration’s Seattle Field Division, said the federal agency has also detected a similar increase in other substances in the state’s drug supply, including finding xylazine in about a quarter of fentanyl samples tested in the last two years.

He said the variety of new substances was likely a result of Mexican cartels adapting to U.S. efforts to crack down on fentanyl. But this change coincided with a decrease in the potency of illicit fentanyl being sold, a sign their efforts are working, Reames said.

Last year, 7 of 10 pills sold as fentanyl that were tested by the DEA contained 2 mg of the drug, which the agency considers a lethal dose. This year, 5 of 10 pills contained that amount, he said. The decrease in the potency is a mark of the success they’ve had at trying to tackle all areas of the drug trade, including working with China to prevent the flow of fentanyl ingredients to Mexican cartels.

Reames acknowledged there are risks to the new substances being found in the area’s drug supply, including that opioid overdose reversal drugs, like Narcan, do not combat the effects of overdosing on other substances like xylazine. And a less reliable drug supply could result in more people ingesting substances they don’t mean to, he said.

“You have no idea what’s in these drugs, fentanyl and methamphetamines both, but fentanyl specifically,” Reames said. “Whatever (the cartels) decide goes in, goes in.”

While it’s too early to tell the consequences of these new substances, Banta-Green said efforts are well underway in Seattle and King County to reduce and protect against overdoses of the most common drugs, especially fentanyl. Their efforts include “saturating the market” with Narcan, increasing drop-in addiction services, opening a postoverdose recovery center in downtown Seattle and launching a pilot program where Seattle firefighters and EMTs can administer buprenorphine, a medication to treat opioid use disorder.

But the region won’t see a serious reduction in the number of people dying from opioid overdoses until medications like buprenorphine and methadone become as easy and cheap to get as fentanyl, Banta-Green said. The need for those medications becomes more urgent as new and untested chemicals hit the market, a trend that shows no sign of stopping.

“Some people use fentanyl a dozen times a day, every day of the year, and every one of those is an overdose opportunity because the fentanyl here is so unpredictable,” he said. “In the era of synthetics, we’re never going to go backward – it’s always going to be synthetic and there’s always going to be innovation.”