Phenacetin is a Toxic Cutting Agent Found in Cocaine and Fentanyl

Recently, a public health alert was published by NPSDiscovery.org on a new toxic cutting agent, Phenacetin. According to NPS Discovery, Phenacetin is commonly used as an adulterant in illicit drug products, most often in cocaine exhibits, but has also been identified in samples containing heroin and/or fentanyl or multi-component seized material products. The addition of phenacetin to illicit drugs may be because of its minor euphoric effects, influence on some side-effects of cocaine because of its analgesic action, or to disguise the bitter taste of cocaine without compromising the physical properties of the product - both have similar melting points. Phenacetin is a known carcinogen and has associated adverse effects on cardiovascular, renal and urologic systems. Exposure to phenacetin is associated with nephrotoxicity, nephropathy, hemolytic anemia, methemoglobinemia, and kidney and bladder cancer.

Phenacetin Background

Phenacetin, a pain-relieving and fever-reducing drug, was discovered as an analgesic in 1887. It was one of the first synthetic fever reducers on the market and one of the first non-opioid analgesics without anti-inflammatory properties. Due to its hazardous side effects, including carcinogenic and kidney-damaging properties, the Food and Drug Administration (FDA) ordered its withdrawal from drug markets in 1983. Since being withdrawn phenacetin has become a common adulterant of illicit substances. In a 9-year longitudinal study of cocaine powders in the Netherlands, the percentage of samples containing phenacetin increased from 1.6 to 40.6 with a peak of 48% in 2006. Phenacetin was the most frequently identified adulterant in the samples.

Side Effects of Phenacetin

Headache
Nausea
Shortness of breath
Cyanosis
Ataxia
Lethargy
Confusion
Hallucinations
Methemoglobinemia