The Hidden Danger: Local Anesthetics as Toxic Adulterants in Illicit Street Drugs

Bottom line up front: Lidocaine and other “caine” drugs are being added to street drugs. this is nothing new, but there has been a significant increase as of late. There is a whole generation of cops that hasn’t dealt with the “caines” being introduced to the drug supply and we need to get you up to speed.

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The world of illicit drugs is fraught with dangers, not just from the drugs themselves but also from the substances they are often mixed with. One such group of substances is local anesthetics (LAs), commonly known as 'Caines'. This article delves into the alarming trend of LAs being used as adulterants in street drugs, the associated risks, and the necessary precautions.

Understanding Local Anesthetics

Local anesthetics, such as Lidocaine, are synthetic compounds primarily used in medical procedures to numb specific areas of the body. They are typically available as over-the-counter topical creams, transdermal patches, or injectable solutions. The numbing sensation they produce is due to the blockade of neuronal sodium channels, which reduces the transmission of pain signals.

While these substances have legitimate medical uses, they have found their way into the illicit drug market. Drug dealers often add LAs to illicit drugs to reduce the discomfort associated with injecting or snorting drugs.

The Cocaine and Lidocaine Connection

Cocaine, a naturally-occurring alkaloid extracted and purified from the coca plant, is often mixed with lidocaine. Unlike lidocaine, cocaine is a stimulant used for its euphoric properties. However, the combination of these two substances poses significant health risks.

Data reviewed in a recent public health alert shows that lidocaine was the most frequently observed LA adulterant, often found in cocaine samples. It's speculated that lidocaine is added to cocaine to add mass, enhance the euphoric effect, or relieve the physical pain associated with injections.

However, the combination of cocaine and LAs is dangerous due to increased toxicity. This can lead to severe health issues, including seizures, bradycardia, hypotension, myocardial depression, and cardiac arrhythmias.

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The Lesser Known 'Caines'

While lidocaine is the most commonly used LA in illicit drugs, other 'Caines' such as procaine, benzocaine, tetracaine, mepivacaine, and bupivacaine could also be added to drug samples. These substances are less frequently observed but pose similar health risks.

For instance, benzocaine, most commonly available as a topical product in the medical market, can cause methemoglobinemia in large doses. This condition reduces the delivery of oxygen to vital organs by changing the function of hemoglobin.

Implications for Law Enforcement Officers

In the ever-evolving landscape of illicit drug trade, local anesthetics, particularly 'Caines' like Lidocaine, are increasingly being used as cutting agents. This trend is important for law enforcement officers to be aware of, as the presence of these substances can serve as an indicator of drug sales during investigations. Recognizing this can aid in the identification and prosecution of illicit drug activities. It's crucial to stay updated on these trends for effective policing in our communities.

Recommendations for Clinicians and Forensic Practitioners

The increasing prevalence of LAs in illicit drugs necessitates heightened vigilance among clinicians and forensic practitioners. They need to be aware of the signs and symptoms of cardiotoxicity or methemoglobinemia from LA in users of cocaine and, to a lesser extent, users of heroin/fentanyl.

Clinicians should pay attention to signs such as cyanosis (blue skin color), low blood oxygen, distressed breathing, headache, dizziness, delirium, seizures, bradycardia or tachycardia, abnormal heart rhythms, low blood pressure, and altered mental status.

Forensic practitioners, on the other hand, should assess their laboratory scope and capabilities for analyzing lidocaine, procaine, and benzocaine in post-mortem, forensic, and clinical toxicological cases. They should consider reporting on the frequency and co-occurrence with drugs to stakeholders in their jurisdiction.

Conclusion

The use of local anesthetics as adulterants in illicit drugs is a growing concern that poses significant health risks. As we continue to combat the illicit drug trade, understanding and addressing this issue is crucial. By staying informed and vigilant, clinicians, forensic practitioners, and users can better navigate the complexities of this issue.

For clinicians, this knowledge can aid in the accurate diagnosis and treatment of patients who may have been exposed to these adulterants. Forensic practitioners can adapt their testing protocols to detect these substances, contributing to more accurate reporting and analysis of drug samples.

For law enforcement officers, awareness of this trend can provide valuable insights during drug investigations, aiding in the identification and prosecution of illicit drug activities.