One morning earlier this week, my phone began ringing. People were calling about what was being described as a deadly batch of “heroin.” People I have known for years and participants at the syringe exchange in Greensboro, North Carolina where I live. They were panicking about whether they, too, had used what had sent at least one exchange participant—I’ll call him “John”—to the hospital.
So I made calls, talked with people, and tried to find out as much as possible. This is difficult though. No one wants to say who sold the drugs, to implicate themselves or others, so information you get in these circumstances is often cryptic. Criminalization and fear of the “fatal drug delivery” laws that see people who sell or share drugs being charged with homicide prevent the sharing of accurate information.
But I was able in this instance to see some photos of the drug mixture that had sent John to the hospital. It looked milky-white and clumped up. This is not what heroin should look like, so of course when I shared them on Facebook, the comments rolled in: ”Who would ever do that??” and “What kind of person would inject something that looks that bad???”
Well, I will tell you. Someone who has spent their last bit of money on drugs, someone who is on the precipice of being completely dope-sick, and while they know it does not look right, they pray there is enough of the real drug in the mixture to help them be well.
We are also entering a new era of drug use. Heroin does not always look the same these days: Fentanyl tends to be white, with a different texture. People who use drugs from heroin to molly are getting used to them not looking the same as they have traditionally looked, often because—with the prevalence of new “synthetic” drugs another factor—they aren’t the same. Most of the time people have no idea what they’re really using.
John, the young man who used the bad batch, told me what happened. He did a small “tester” shot first—and the fact that he did that, rather than using a larger amount, might well have saved his life. He then waited, became worried and began calling friends—unfortunately he had been using alone, so there was initially no one with him to help. Every minute that went by, he said, it got more and more difficult to breathe.
He began to worry that he would pass out. But because he had been doing something that is criminalized, he waited much longer to seek medical help than he would have done for a health issue unrelated to drug use. Finally, he could not take any more and had friends bring him to the hospital.
The nurses at the hospital warned John that there had been some deaths recently caused by drugs cut with Frontline, the anti-parasite medication for dogs.
I tried to find out more, but I was unable to speak with the nurse who shared this information with John, or to find any other confirmation. Again, this lack of transparency around illegal drugs and health is frustrating and dangerous.
It is true that cocaine in the US is often cut with levamisole, an anti-parasitic agent used in veterinary medicine which can cause conditions including agranulocytosis, leading to increased vulnerability to infections.
This may have been what the nurse was—extremely inaccurately—talking about. And I almost think the nurse may have told John this, and that people were dying, just to scare him. Often people talking to drug users exaggerate things like this, hoping to “scare a person straight,” which is absolutely ineffective.
I last talked to John on Wednesday afternoon. He was out of the hospital and doing well, although he was told he has a heart murmur. He was grateful he had done a small test shot first. He did this because of the education he received through Urban Survivors Union, at the local chapter I founded.
This automatic hazard of an illegal market is one of the realities of being a drug user. We don’t get to go in a store and shop around, test sample bags, or choose from varieties of different flavors and potencies. We don’t get to sue if the product doesn’t match the label. There are no returns. We are often forced to buy drugs quickly, often outside, hoping not to bring too much attention to ourselves or the dealer. You give the money, they give you a bag. Sometimes it’s good… Other times, not so much.
Buyer beware! And drug users do utilize a number of strategies to reduce the likelihood of their buying fake drugs, but there are no guarantees.
In an unregulated market, anyone can sell. People who use often try to sell, or at least act as middle men, to hustle up enough money to take care of their own habit. Some people sell drugs because they’re strapped with criminal records and struggle to find decent paying jobs. Others are people who are dazzled by the idea of quick money, power, popularity and the drug dealer lifestyle.
There is no school for dealers other than prison, and dealers’ knowledge about the product they’re selling ranges from impressive all the way down to zero. I have found that many dealers who themselves don’t use drugs are tragically uneducated. Many don’t even know enough about the business to break an ounce down into traditional selling weights (8-balls, sixteenths, grams, etc.).
Drugs get cut with adulterants—sometimes deadly, mostly benign—for many different reasons. One of the main reasons is to improve profit margins. But another important reason is to prevent widespread overdoses: Thoughtful dealers will have a “test-dummy,” who receives a free sample in return for finding out how strong or weak a supply is. If a batch is too strong, seasoned dealers go ahead and cut it to reduce the potency. After all, overdoses bring the heat.
People cut drugs with all kinds of stuff: Often with just whatever they have that looks a little bit like the drug; sometimes with the intention of making it seem stronger by using a substance with similar effect (baby laxative or caffeine pills in cocaine, and so on). Once in a while, you even hear of a misguided dealer who cuts their drugs with a more expensive drug than the one they are selling… This I have yet to figure out.
At Urban Survivors Union in Greensboro we work with dealers, encouraging them to distribute naloxone or at least give the syringe exchange card to their clients. Most dealers are not bad people and are just trying to make it in this world too. They don’t intentionally want to hurt anyone. So we have had real success by simply providing information and educating people who sell drugs. For example, they can inform people when they have new batch, or when their drugs are particularly strong. This kind of thing really makes a difference.
Drug users know that every time we buy substances, especially if we inject them, we risk harming ourselves through adulterants. Many times over the years, just like this week, I have witnessed hysteria erupt in communities about batches thought dangerous or deadly.
Sometimes the information I receive—like the “Frontline” story—seems downright crazy, but we have to report what we hear to try to protect people who are using. I would rather over-warn than withhold information.
As John’s experience and many others show, harm reduction strategies are so important for people who use. Here are five I recommend:
1. Develop a relationship with your dealer; talk to them, educate them and obtain information from them every chance you get.
2. Always try a small amount first. Test shots really do save lives!
3. Never use alone; have a harm reduction plan, including naloxone and other measures.
4. DanceSafe and some other harm reduction organizations offer pill testing, which is a great service! It is important to know what you are using. You can order some of these kits online.
5. Education is key. Here is one extensive guide to the adulterants found in drugs.