What Are the Risks of Cocaine Laced with Fentanyl?

Opioids, such as fentanyl, heroin, and new synthetic variants (like carfentanil), are driving a severe drug overdose epidemic in the United States. Fentanyl is being illicitly produced in underground labs and is often mixed with various street drugs, including cocaine, to enhance their effects at a minimal cost. Cocaine laced with fentanyl carries significant risks, as even tiny quantities can result in a fatal overdose. The National Institute on Drug Abuse (NIDA) reports that nearly 70% of overdose deaths involving stimulants in 2022 also included fentanyl.

Both cocaine and fentanyl come with their own risks. Some individuals may intentionally combine these substances to amplify their effects or to mitigate the negative impacts of one or the other. However, many users are unaware that they are consuming fentanyl-laced cocaine. This combination is particularly hazardous, as the stimulating effects of cocaine can obscure the signs of an impending opioid overdose. 

Even without a lethal dose of fentanyl, mixing these drugs places immense strain on the body, as they send conflicting signals to the brain, leading to unpredictable reactions. Some dangers of fentanyl-laced cocaine include addiction, paranoia, insomnia, heart attack, respiratory failure, increased risk of brain aneurysm, stroke, and even death.

Why is Cocaine Laced with Fentanyl?

Fentanyl was initially developed to help patients manage severe pain after surgery, and it remains a valuable medication when used under strict medical supervision. Those who are prescribed fentanyl are carefully monitored due to its high potential for dependence and addiction. The Drug Enforcement Administration (DEA) reports that illegal fentanyl is mainly produced in secret labs overseas and smuggled into the United States for sale on the black market. Its production is relatively simple and cost-effective, with crude labs capable of synthesizing fentanyl in under a day. Moreover, fentanyl is highly potent; just 2 milligrams—comparable to 10 to 15 grains of table salt—can lead to a fatal overdose. These characteristics make it a cheap cutting agent for cocaine.

Drug dealers often mix cocaine with various substances, including household items, boric acid, and anesthetics, to boost their profits and sell larger quantities. Unfortunately, these additives can diminish the drug’s potency and the high experienced by users, which is where fentanyl comes into play. By mixing cocaine with these substances and adding fentanyl, dealers can enhance the drug’s strength. However, the potency of illicit fentanyl can vary, and dealers may unintentionally introduce a deadly dose into cocaine, putting their customers at risk of overdose.

How Can You Tell If Cocaine is Laced with Fentanyl?

When drug dealers and manufacturers use cutting agents in cocaine, they aim to make the product appear pure, which makes it very difficult to spot fentanyl in cocaine. This is particularly challenging since fentanyl is tasteless and colorless. In response, various health and government organizations have implemented harm reduction strategies to help users identify the presence of fentanyl, ultimately aiming to reduce overdose fatalities. One effective tool in this effort is fentanyl test strips (FTS). The Centers for Disease Control describes FTS as small paper strips capable of detecting fentanyl in various substances, and they are relatively inexpensive.

To use these test strips, a small amount of the drug is dissolved in water, and the strip is dipped into the solution for 15 minutes. FTS are highly sensitive, requiring only a tiny amount of drug residue to yield a result. While these strips are a valuable harm-reduction resource, they do have limitations. For instance, FTS cannot distinguish between fentanyl and its analogs, meaning they might miss certain analogs like carfentanil. Furthermore, they do not provide information on the quantity of fentanyl present, only confirming its existence. There is also a risk that a tested portion may not contain fentanyl, while other parts of the drug supply could be laced with lethal amounts.

What Happens if You Take Cocaine That’s Laced with Fentanyl?

When fentanyl is added, it’s very rare for users to realize it is in the cocaine they are consuming, increasing the risk of overdose. Fentanyl is a highly potent and addictive synthetic opioid with an effect that’s 50 to 100 times greater than morphine. Its potency is partly due to its fat solubility, allowing it to pass the blood-brain barrier much more quickly than morphine. This means that even a small amount is enough to cause a drug overdose.

Furthermore, cocaine laced with fentanyl resembles a “speedball,” a polydrug mixture of a stimulant with depressants. This can lead to adverse effects from both drugs, including anxiety, panic, hypertension, cognitive impairment, and confusion. Worst-case scenario, even without a lethal amount of fentanyl, the combination can be fatal as it can cause heart attacks, strokes, and respiratory depression. Additionally, cocaine with fentanyl poses a greater risk of substance abuse and addiction. Treating polysubstance addiction is particularly challenging, as it often causes more severe withdrawal symptoms, and there are currently no FDA-approved medications specifically for polysubstance dependence.

Spotting the Signs of a Cocaine and Fentanyl Overdose

Drug overdoses are medical emergencies, as they can lead to permanent brain damage and be fatal.  It is crucial to spot the signs of a drug overdose to get help as soon as possible. Cocaine mixed with fentanyl can produce a particularly risky overdose as cocaine’s stimulating effects can initially mask a lethal amount of fentanyl. Because its half-life is shorter, those effects can decrease more quickly, leading to a fentanyl overdose. Meanwhile, because cocaine is a stimulant and fentanyl is a potent depressant, they can overwhelm the body in different ways. Polysubstance use is especially dangerous because side effects can be unpredictable, meaning an overdose can look different in each person. 

A combined overdose may show a mix of both stimulant and opioid overdose symptoms, such as:

• Severe agitation, confusion, or paranoia
• Severe drowsiness or inability to stay awake
• Rapid or irregular heartbeat
• Slow or shallow breathing
• Chest pain
• Cold, clammy skin
• Seizures
• Blue or purple lips or fingertips
• Nausea, vomiting, and loss of consciousness

Contact Resurgence Behavioral Health for Cocaine Laced with Fentanyl Help

Cocaine laced with fentanyl is increasingly common, and despite the availability of fentanyl test strips, there’s no foolproof method to ensure the safety of the drugs you consume. The only surefire way to prevent an overdose is to stop using altogether. Breaking free from addiction to cocaine or fentanyl is a challenging journey, but it is possible with the right support, commitment, and treatment. Resurgence Behavioral Health provides extensive treatment programs that address the underlying issues of addiction, helping individuals move toward long-term recovery equipped with critical tools and coping strategies. By working with our caring team of professionals, engaging in therapy, and establishing a solid support network, individuals can break through the physical and mental challenges associated with addiction.

We offer all levels of care, including medical detox, inpatient treatment, and outpatient programs, to guide patients toward lasting recovery and a brighter, drug-free future. If you or someone you love is facing addiction, don’t wait to contact Resurgence Behavioral Health at 855-458-0050 and take the first step toward recovery.

External Sources

• National Institute on Drug Abuse – Drug Overdose Deaths: Facts and Figures
• Drug Enforcement Agency (DEA) – Facts About Fentanyl
• Centers for Disease Control (CDC) – What You Can Do to Test for Fentanyl

David Rofofsky
After growing up in New York, David chose to get help with substance abuse in California because of the state's reputation for top-tier treatment. There, he found the treatment he needed to achieve more than nine years of recovery. He's been in the drug and alcohol addiction rehab industry for eight years and now serves as the Director of Admissions for Resurgence Behavioral Health. David remains passionate about the field because he understands how hard it is to pick up the phone and ask for help. However, once the call is made, someone's life can be saved.

Research | Editorial