Drug Purity: Know The Risks
Using illicit drugs carries inherent risk, but many of these can be mitigated through awareness and harm reduction strategies. While no drug use is entirely risk-free, making informed decisions can significantly reduce potential harm. The greatest drug risks and dangers often arise from uncertainty—users rarely know the exact composition, potency, or interactions of the substances they consume.
So, what are the primary drug risks associated with illicit drug use, and how can they be minimized?
What Unknown Contents and Cutting Agents Can Be Found in Drugs?
Illicit drugs lack quality control, meaning their contents are often unpredictable and the drug purity is uncertain. Many substances sold as MDMA, for example, have been found to contain everything from synthetic cathinones (novel psychoactive substances often used to mimics the effects of MDMA) PM(M)A (a more toxic analogue of MDMA linked to overdoses), or ketamine. In fact, in 2021, drug testing at UK festivals revealed that nearly half of all ‘MDMA’ pills contained no MDMA at all. Similarly, in the U.S., MDMA has been found to be adulterated with methamphetamine.
Substances like heroin and cocaine are frequently cut with additives such as fentanyl, levamisole, or caffeine to alter potency and maximize profits. These unlisted ingredients can introduce new risks, including unpredictable effects, increased toxicity, and heightened overdose potential. Fentanyl, in particular, has been responsible for a surge in opioid-related overdoses due to its extreme potency—sometimes hundreds of times stronger than heroin.
EZ Test kits can help users identify a substance’s composition, providing a better understanding of drug purity, what they are consuming, and reducing the risk of ingesting harmful adulterants.
Drug Purity of Illicit Drugs: Examples
Even when a substance is correctly identified, its potency can vary significantly. Inconsistent drug purity increases the risk of overdose, as users may consume more than intended. In 2017, a batch of almost completely pure cocaine in Eastbourne, UK caused multiple overdoses and two fatalities. Conversely, if a substance is weaker than expected, users may take excessive amounts to compensate, increasing the risk of toxicity.
The drug purity of cocaine, for instance, can range from 10% to nearly 100%. Unexpectedly high drug purity can be particularly dangerous if users are unprepared for its effects. MDMA purity has also fluctuated significantly over the years, with some modern tablets containing doses high enough to cause serotonin toxicity or hyperthermia.
EZ Test offers drug purity tests for MDMA, cocaine, and heroin, allowing users to evaluate the strength of their substances before consumption, and moderate their consumption accordingly.
What Are the Effects of Taking Excess Drugs?
Even when users believe they are taking a safe dose, small miscalculations can have serious consequences. Many psychoactive substances are highly dose-sensitive. For example, a low dose of 2C-B (a stimulant and psychedelic which has been gaining popularity in Europe and the USA) may produce mild euphoria similar to MDMA, but increasing the dose by just 10mg can lead to vivid hallucinations and intense physical effects, such as tachycardia (rapid heart rate), hypertension (high blood pressure), and hyperthermia (elevated body temperature). Inexperienced users may find this distressing, particularly if they were expecting a milder experience.
Similarly, 4-ACO-DMT, a substance related to psilocybin, can shift from inducing gentle psychedelic effects to an intense DMT-like experience lasting up to seven hours. This prolonged duration can be overwhelming for unprepared users. Substances like LSD and psilocybin also have long durations, meaning that a bad experience can feel inescapable.
A milligram-precision scale alongside EZ Test purity tests is recommended for safer dosing. Users should also start with small test doses to gauge their individual sensitivity.
Drug Risks and the Dangers of Mixing Drugs
Polydrug use—combining multiple substances—is common but significantly increases risks. Some drug combinations are particularly hazardous.
For example, mixing MDMA and cocaine places immense strain on the cardiovascular system. The conflicting effects on dopamine transporters can also dull the high, leading to excessive consumption. Many drug interactions remain poorly understood, compounding the dangers.
Benzodiazepines (such as Xanax and diazepam) and pregabalin are especially risky when combined with other depressants like alcohol or opioids. In Scotland, the combination of benzodiazepines and heroin has been linked to a rise in fatal overdoses. Alcohol, often underestimated, dramatically enhances the sedative effects of other substances, increasing the likelihood of respiratory depression.
While avoiding polydrug use is the safest option, those who choose to mix substances should thoroughly research potential interactions. Additionally, testing substances for unexpected adulterants can help prevent dangerous combinations.
Drug Risks: How Route of Administration Affects Drug Absorption
How you use drugs can expose you to more or less risk, even when taking the same amount of the same drug. Eating/swallowing drugs tends to make the experience last longer but can make it less intense and take longer to start having an effect. This is generally the least risky method of taking a drug. As well as producing a less immediate and less intense effect, if drugs are taken orally then there is the opportunity to remove the drug from your system by vomiting (just like when people find themselves throwing up after drinking too much alcohol), which can act as a protective barrier against overdosing. Once a drug is in your bloodstream (e.g. from injection, snorting and smoking) there is no way to try to remove it, even if you or your body realise you have taken too much.
Snorting a drug can make the drug take effect faster and give a more intense experience, but the experience is likely to be shorter-lived and the urge to redose may well be stronger.
Smoking/vaping drugs will generally cause them to kick in even faster than snorting, with a more intense high and even shorter duration alongside a more intense urge to redose when the drug wears off.
Injection is typically considered the most dangerous method of taking drugs. The experience will take effect even faster than smoking, be more intense and the effects are likely to wear off faster, with a stronger urge to redose. The dose required to feel the drug is likely to be lowest for this method of use. We recommend never injecting drugs, but if you do it is even more important to know what is in your drugs and how pure your sample is.
Drug Risks: Dependence and Tolerance in Drug Use
One of the most significant risks of drug use—whether legal or illegal—is the potential for dependence and tolerance. However, when it comes to psychoactive substances this is typically accompanied by increasing tolerance to a drug or group of drugs. Tolerance develops when the brain adjusts to a substance, requiring higher doses to achieve the same effect. Dependence occurs when the body relies on a drug to function normally, leading to withdrawal symptoms upon cessation.
Stimulants like methamphetamine and cocaine can create cycles of binge use, followed by crashes that contribute to psychological dependence. Opioids, such as heroin and fentanyl, can rapidly lead to physical addiction, with withdrawal symptoms that make quitting extremely difficult. Even seemingly mild substances like cannabis can cause dependence, particularly with high-THC products that may lead to withdrawal symptoms.
To prevent tolerance buildup, taking breaks from drug use is advisable. Regular self-reflection on consumption habits can help prevent patterns of dependence from forming.
Drug-Specific Risks
As well as posed by the illicit nature of drug use, it is also important to be aware of the risks associated with specific drugs and patterns of use.
Different drugs carry different long- and short-term risks. It is not possible to go through the risks of every drug in this article, but it is important that you understand the risks of any drug(s) that you are currently using or plan to use.
Common Drug Risks
- Ketamine: Long-term use is known to cause bladder damage, increased urinary urgency, and severe pain known as "K-cramps." Some users take more ketamine to alleviate this discomfort, creating a harmful cycle.
- Opioids (Heroin, Fentanyl, Oxycodone): These drugs are highly addictive, with overdose risks exacerbated by fentanyl contamination. Users often experience anhedonia (the inability to feel pleasure) during withdrawal, making it difficult to quit.
- Methamphetamine: Chronic use can cause severe dental issues (“meth mouth”), extreme weight loss, psychosis, and cognitive decline.
- Psychedelics (LSD, DMT, Psilocybin): While non-addictive, these substances can trigger psychological distress, especially in those predisposed to mental health conditions.
- GHB/GBL: Used recreationally and as a “club drug,” these substances have a narrow safety margin. Slight overdoses can lead to unconsciousness, respiratory depression, or death.
Key Takeaways
Despite the many drug risks, people continue to use drugs, believing the benefits outweigh the dangers. Motivations for use vary, including improved focus for work or academics, enhanced athletic performance (as seen with steroids and stimulants), pain relief, or recreational enjoyment.
The most crucial factor is informed decision-making—understanding the drug risks involved and taking steps to mitigate them. EZ Test provides tools to support harm reduction, empowering individuals to make safer choices without stigma or judgment.
Further Reading
For those interested in harm reduction, the following resources provide additional insights:
Unknown contents
The Loop – Drug Alerts
BBC News – Brexit and Covid Reduce Festival Drug Purity
National Institute on Drug Abuse - MDMA
Victoria Department of Health - PMMA
DEA Fact Sheet - Synthetic Cathinones
Unknown purity
Independent – Police warn over 100% pure cocaine on sale in UK
BBC News – Cheap cocaine barely 10% pure
Taking too much
Mixing drugs
Scottish Government - Benzodiazepine use - current trends: evidence review
Routes of administration
Addiction and tolerance
Drug specific risks
By staying informed, individuals can better assess the risks associated with drug use and make safer, more responsible choices.