An additive is a substance that is added to existing drug products. They are typically used either for medical purposes, or to discourage abuse. Many of these additives can be dangerous when taken at higher than prescribed dosages or when taken unknowingly.
These are added to substances for their medical purposes. Many of them can be harmful and potentially fatal if they are taken at a higher dose than recommended.
Common additives in cold, allergy or cough medicines include:
- Non-opioid painkillers (e.g. paracetamol and ibuprofen) - Some of these painkillers can be extremely dangerous if more than the recommended amount is taken.
- Expectorants (e.g. guaifenesin and potassium iodide) - These are added to thin mucus.
- Decongestants (e.g. phenylephrine, pseudoephedrine, and oxymetazoline) - These are added to dilate the sinuses to reduce congestion.
- Antihistamines (e.g. cetrizine, loratadine, and diphenhydramine) - These are added to reduce allergy symptoms.
In prescription opioids
Often OTC painkillers are added to prescription opioids, to prevent abuse, and to increase pain relief. These can be very damaging and fatal in case of an overdose. Common additives include:
- Paracetamol - This is the most common additive to opioid painkillers, and can cause liver failure if taken above the recommended dose.
- Acetylsalicylic acid (Asprin)
Cutting agents are chemicals, both active or inert, that can be added to illicitly sold substances in order to raise profitability by increasing the amount able to be sold, or to increase the potency without increasing production costs. Some of these additives can be completely harmless, while others can be dangerous and even fatal.
Common heroin additives
Street heroin is often cut with other opioid substances, often much more dangerous than heroin itself. Common additives include:
- Fentanyl and its analogs - Fentanyl can be an extremely dangerous additive, because of its extremely low dosage range. Heroin cut with fentanyl is much easier to overdose on than uncut heroin.
- Research chemical opioids (U-47700, U-x, etc) - Research chemical opioids are added to street heroin to increase its potency, or to increase the amount of product.
- Caffeine - Caffeine can mask the signs of an opioid overdose.
The following additives are not typically as dangerous as the additives mentioned above, although it can be harmful to snort or inject them.
- Baking soda
- Powdered milk
- Talcum powder
Common cocaine additives
Cocaine is often cut with other stimulants and other powdered substances.
- Caffeine and other stimulants - Other stimulants are sometimes added to increase the amount, while keeping the same or similar effect. These additives can be dangerous in case of overdose, or drug interactions.
- Anaesthetics (benzocaine, lidocaine, etc.) - Because cocaine is an anaesthetic, other anaesthetics are sometimes added to cocaine to increase the amount while keeping some effects and/or to mask the presence of not anaesthetising stimulants.
- Levamisole - Levamisole is an anti-parasitic drug used in pets, and is the one of the most common additives to cocaine. Levamisole can be dangerous because it attacks white blood cells, and can cause a condition called agranulocytosis, which weakens the immune system.
The following additives are not typically as dangerous as the additives mentioned above, although it can be harmful to ingest, snort, or smoke them.
- Baking soda
- Powdered milk
Ethyl rubbing alcohol
To prevent abuse, poisons and denaturants are often added to ethanol products that are intended for purposes other than human consumption. In the United States, it is a legal requirement for ethanol-based rubbing alcohol products to contain acetone and methyl isobutyl ketone. Many preparations of rubbing alcohol also contain denatonium benzoate, which while not particularly toxic, is extremely bitter tasting to discourage human consumption. In Iran, where consumption of alcohol is illegal, denatonium benzoate is added to over the counter rubbing alcohol to discourage it's consumption.
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