Benadryl (diphenhydramine): A Common Allergy Medication Turned Cutting Agent
***Bottom line up front: Benadryl, a common allergy medication, is being used as a cutting agent in fentanyl and other opioids. This mixture is present in a growing number of overdose deaths.
As our understanding of the complexities of substance misuse deepens, a pressing public health concern has come to light. An over-the-counter (OTC) drug, diphenhydramine, is increasingly being utilized as a cutting agent in illicit drug manufacture, with potentially fatal consequences. This discovery warrants immediate attention from clinicians, substance abuse treatment providers, outreach workers, and public health clinics.
Diphenhydramine: A Double-Edged Sword
Diphenhydramine, more commonly recognized by its brand name, Benadryl, is an over-the-counter antihistamine approved by the FDA in 1946 for treating allergies. Its efficacy stems from its ability to block histamine 1 (H1) receptors, thereby mitigating allergic reactions. Moreover, diphenhydramine possesses sedative and antiemetic properties, due to its capacity to cross the blood-brain barrier and impact the central nervous system (CNS).
Despite these beneficial properties, diphenhydramine has an ominous flipside. Its widespread availability in nonprescription sleep and cold preparations makes it an accessible substance for misuse, particularly among adolescents and young adults. Moreover, repeated use can lead to tolerance, with users requiring increased doses to achieve the same sedative effects, thereby increasing the risk of toxicity.
From Overdoses to Fatalities: The Grim Impact of Diphenhydramine
Research reveals a worrying trend. In 2016, diphenhydramine accounted for 3.2% of drug overdoses in the United States and ranked among the top 15 drugs most frequently implicated in drug overdose deaths. These statistics prompted the FDA to issue a warning in September 2020 about the dangers of consuming diphenhydramine at higher than recommended doses.
At high doses, diphenhydramine can cause serious heart problems, seizures, coma, and even death. Toxicity manifests as general CNS depression and an anticholinergic syndrome, with symptoms including delirium, agitation, hallucinations, and tremor. It can also induce QRS widening and QTc prolongation on an electrocardiogram.
A study conducted in 2019-2020 involving 92,033 overdose deaths discovered that 10.5% tested positive for diphenhydramine, with 2.4% citing it as a direct cause of death. More often than not, diphenhydramine was not the sole drug involved; it was frequently found alongside opioids. The enhanced sedation resulting from this combination significantly heightens the risk of overdose.
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A Call to Action
Given this alarming evidence, professionals in the field of substance abuse treatment and healthcare are urged to take immediate action. Clinicians should be aware of the potential presence of diphenhydramine in illicit drugs, familiarize themselves with the symptoms of toxicity, and understand that high concentrations can cause false positives on drug screens for morphine, methadone, PCP, and fentanyl.
Medical examiners and coroners are advised to test for diphenhydramine in all suspected drug-related cases. Forensic and clinical laboratories should include diphenhydramine in routine testing and develop sensitive confirmatory procedures for common adulterating agents such as diphenhydramine. Furthermore, sharing data on adulterants in drug seizures with local health departments, medical examiners, and coroners can help in early identification and prevention efforts.
This emerging threat underscores the urgent need for vigilance, education, and collaboration among all stakeholders involved in drug misuse prevention and treatment. As a community, we must collectively work towards early identification, intervention, and comprehensive treatment strategies to combat this growing menace.
The Deadly Mix: Diphenhydramine and Opioids
The danger of diphenhydramine misuse becomes acutely pronounced when combined with opioids. The heightened sedative effects of this combination pose a significant risk to users, often leading to deadly overdoses. The first signs of this hazardous combination became evident in the U.S. in 2005, when a series of adolescent fatalities were linked to a mixture of diphenhydramine or acetaminophen with Mexican brown heroin.
More recently, in 2019-2020, diphenhydramine was found in the fentanyl supply, leading to an uptick in overdose deaths associated with this combination. Furthermore, analysis of seized drug extracts revealed that diphenhydramine was also commonly found with other opioids, PCP, cocaine, and methamphetamine.
The Challenge of Treatment
Treating diphenhydramine toxicity is primarily symptomatic and supportive. The antidote, physostigmine, is currently in short supply, further complicating treatment efforts. Additionally, chronic misuse of diphenhydramine can present similarly to psychiatric disorders like major depression and psychosis, making identification challenging.
An Appeal for Increased Vigilance
In light of this growing public health concern, we must reaffirm our commitment to protecting our communities from the dangers of drug misuse. It is crucial for all healthcare professionals to stay informed about current trends and potential risks. By increasing our collective awareness and understanding, we can better identify those at risk, provide effective treatment, and ultimately save lives.
The misuse of diphenhydramine is a critical reminder of the broader issue at hand. It underscores the importance of ongoing research, surveillance, and intervention strategies to address the evolving landscape of substance misuse. It's a call to action for us all to do our part in stemming this rising tide.
In conclusion, the increasing use of diphenhydramine as a cutting agent in illicit drugs is a public health concern that requires immediate attention. By working together and employing a multi-pronged approach, we can make significant strides in combating this issue and ensuring the safety and well-being of our communities.
Frequently Asked Questions about Benadryl (diphenhydramine): The antihistamine Turned Cutting Agent
Q: What is Benadryl?
A: Benadryl is the brand name for diphenhydramine, an over-the-counter antihistamine used to treat various allergic reactions, motion sickness, insomnia, and symptoms of the common cold.
Q: What is the connection between Benadryl and opioid overdose?
A: Benadryl has recently been found to be used as a cutting agent with opioids, such as fentanyl, creating a risk for respiratory depression and overdose.
Q: What are the risks of using Benadryl as a cutting agent?
A: Benadryl can cause drowsiness and respiratory depression, especially when combined with opioids. It can also increase the risk of overdose, leading to life-threatening consequences.
Q: Is taking Benadryl and opioids together dangerous?
A: Yes, taking Benadryl and opioids together can be dangerous and increase the risk of opioid overdose. It is recommended to avoid taking them together.
Q: What should I do if I suspect an opioid overdose?
A: Call 911 immediately and administer naloxone, an overdose reversal drug, if available. It is important to seek medical help right away in case of an overdose.
Q: Can Benadryl be given intravenously?
A: Yes, in some cases, Benadryl can be given intravenously for the treatment of severe allergic reactions. However, this should only be done by a trained medical professional.
Q: What is the recommended dose of Benadryl?
A: The recommended dose of Benadryl varies depending on the condition being treated and the patient's age and weight. The maximum recommended dose for adults is 50 mg every 6 hours.
Q: What is conscious sedation, and how is it related to Benadryl?
A: Conscious sedation is a type of sedation that allows patients to remain awake and responsive while reducing anxiety and discomfort during medical procedures. Benadryl is sometimes used as a sedative for conscious sedation.
Q: How can opioid and antihistamine overdoses be prevented?
A: It is crucial to educate the public about the dangers of using opioids and antihistamines together, especially as cutting agents. Increased access to naloxone and other overdose reversal drugs can also help prevent overdose deaths.