Brown University researcher: Street drugs are getting more potent and more mysterious

When it comes to street drugs in Rhode Island, they don’t make them like they used to, a recent study led by a Brown University researcher shows.

As one anonymous study participant put it: “Certain crack is not what it used to be.” 

An increasingly complex illicit drug supply in the Ocean State is a major theme in new qualitative research from Brown University epidemiologist Alexandra Collins. In this case, innovation’s not a good thing, but a source of heightened danger for people who use drugs — and a challenge to policymakers and public health officials who are charged with staying one step ahead of distributors. 

“We’re trying to play catch up. There’s a lot more potent adulterants that have been added that we just don’t really know how best to support folks,” said Collins, the study’s lead author and an assistant professor of epidemiology, in a recent phone interview. “I think a lot of what we have right now is really rooted in responding to an increase in fentanyl.”

The last decade’s opioid overdose crisis made the synthetic opioid fentanyl a household name. As a major concern for law enforcement and public health nationwide, fentanyl is tightly surveilled as are its analogs, or drugs with similar chemical structures. But drug laws only target specific substances — and there are still lots of substances circulating outside the law and among people who use drugs, as evidenced by Collins’ research.

“This study is trying to figure out ‘What do we have [in the local supply]?’ and ‘How can we respond in a more timely way in our messaging at the state level and our outreach and programming at the community level?’” said Collins, who is a member of Brown University’s ​​People, Place & Health Collective, one of the organizations which helps maintain the Prevent Overdose RI website.

The article, published in the May 2024 issue of the International Journal of Drug Policy, shares results from the 50 interviews Collins and her team conducted with people who use drugs in Rhode Island. The interviews took place from May to December 2022. Participants were kept anonymous, as is typical for scientific research, but they were supplied pseudonyms by researchers and described by their age and gender.

“There are so many designer drugs right now — like fentanyl is not even fentanyl,” said Logan, a 30-year-old white male respondent. “Before, it was heroin, then they came out with the synthetic thing called fentanyl. And now, the synthetic’s not even a real thing. There’s a synthetic for the synthetic.”

A too-diverse supply can affect all people who use street drugs, not just those who call opioids their drug of choice. Available testing kits and strips are usually tasked at detecting fentanyl. But many kinds of drugs act on the brain’s opioid receptors, and some have no chemical similarity whatsoever despite their overlap in function. 

As a 2023 article in the medical journal Cureus explains, efforts to stem the supply of fentanyl at the federal level seemingly inspired clandestine chemists to get creative and dig through pharmaceutical history for less obvious adulterants. One answer came in the form of nitazenes, which are derived from the versatile chemical compound benzimidazole, also used to make fungicides.

Nitazenes are totally unrelated to fentanyl, chemically speaking. They’re also way more potent: Fentanyl is about 100 times more potent than morphine. Some estimates place nitazenes as 1,000 times more potent than morphine — which is also the reason they were shelved for human use when first discovered in the 1950s. Nitazenes have drawn federal attention and have also been recorded in Rhode Island’s local drug supply.

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According to Collins’ article, people who use drugs turn to cues like texture, color and taste to detect adulterants in the absence of adequate testing. One female interviewee, nicknamed Partrice, only used cocaine — which is supposed to “pick up,” or clump together when heated for smoking.  

“But if it’s taking forever to pick up … it’s cut with something,” Patrice told researchers. “It got fentanyl, it got something in it. You better not f****** do it.”

Collins said that novel drugs can be reliably identified through a device known as a “quadrupole time-of-flight mass spectrometer,” which she called a “a very, very comprehensive machine that actually has one of the most robust libraries of substances and analogs.”

These machines aren’t cheap, however. Collins said overdose prevention sites, like the one scheduled to open this summer in Providence, could potentially increase the availability of this testing. Samples would still need to be sent to a lab, so there would be a delay in results, but people using the consumption sites could bring in substances obtained locally. This could help state health officials and community organizations better understand the local supply, Collins said. 

In the meantime, Collins pointed to DrugsData.org — run by the Erowid Foundation, a longtime harm reduction resource and nonprofit — as one resource that catalogs what’s really inside pills and powders. DrugsData.org runs on a budget of about $120,000 a year, its website states, and they charge for analyses of substances submitted. Submissions are currently on hold.

Collins attributes her study’s success to collaborations with community partners, like Project Weber/RENEW, as well as help from the Rhode Island Department of Health. The state has quickly incorporated findings from researchers, Collins said, and pointed to state-published resources on xylazine, another new and common adulterant.

But knowledge from the street is still slow to reach the upper levels of policy, Collins said.

“It boils down to a lack of sustainable funding that the state even gets from the federal level,” she said. “All of it boils down to we just don’t have enough resources. Organizations supporting folks who use drugs don’t have enough resources to really be able to do as much as they’d like. … It’s still a bit of an uphill battle, just to meet people’s needs.”

For now, people who use drugs may have to keep relying on strange textures and gut feelings. 

Said study interviewee Brandi, a 41-year-old white woman who noted crack’s changing contents: “That’s the thing — I can’t really tell [what’s different]. I’m curious. I know damn well it ain’t just fentanyl.”