Over the past 18 months, there's been a lot of media attention about the rise in cutting agents and adulterants found in drug seizures. More recently, Public Health England (PHE) warnings have been distributed in the UK about new substances found in MDMA and Heroin.

When an alert comes out, it's generally due to the life-threatening impact of taking this substance.

But what's a cutting agent, and how is it different from an adulterant?  

Cutting agents are described and defined into three separate categories:

1. Contaminants – These are substances that have not been intentionally added but result from the drug's production, manufacturing, and transportation. Poor production methods, including using lower quality chemicals in the manufacturing process, can increase the contaminants present in the drug.  

2. Diluents – These are substances added to a drug that are inactive and do not change the chemical or the high and are used to bulk out the product.  

3. Adulterants – These are chemicals added to the drug to either increase the high of the drug or mimic the drug's natural effect on the body.  

We will look at some of the most common cutting agents in the substances we're likely to be taking now, including the risks and harm these can cause. Next week, we'll discuss how we got here and what we can do to address it better.


In 2021, Cocaine in the UK and Europe has been reported to be between 53% and 68% purity. The most common cutting agents used are:


Central Nervous System stimulant 

Category: Adulterant 
Use: Diluent & Adulterant 

Risks: Caffeine is addictive. It can increase the heartbeat, cause anxiety, headaches, restlessness, and increased dehydration. 


Medication used to treat parasitic worm infections

Category: Adulterant  
Use: Diluent & Adulterant 

Risks: Levamisole has been found in cocaine for over a decade now. At first, its inclusion in cocaine was unknown but was found in most cocaine that was seized. Initially, it was thought Levamisole was used as a diluent or bulking agent. Further research has shown that Levamisole can increase the high of cocaine and have an amphetamine-like high. At increased doses or long-term use, the side effects can include blood disorder, diarrhea, headache, insomnia, nausea, vasculitis (inflammation of the blood vessels.  


A diuretic, medicine that increases the amount of urine you produce

Category: Diluent 
Use: Diluent  

Risks: Mannitol has anti-caking properties that ensure the drugs stay in a powdered form and do not clump together. It is not used to degrade the high in cocaine. Mannitol can increase the risk of heart failure and is associated with coughing, gagging, and wheezing. Mannitol can also cause a runny nose, fever, trouble breathing, and vomiting.  

Boric Acid 

Acid that is used as an insecticide and flame-retardant chemical

Category: Adulterant 
Use: Adulterant 

Boric Acid added to cocaine can heighten the aesthetic feelings of cocaine. Boric Acid has a very similar look to that of Cocaine crystals.  


Local Anaesthetic

Category: Adulterant
Use: Adulterant

Benzocaine, Lidocaine, and Novocaine are all synthetic versions of cocaine. They have been designed to remove the euphoria from cocaine but to keep its aesthetic properties. Lidocaine can be found in Haemorrhoid and tattoo numbing cream. Benzocaine is a local anesthetic usually applied to the mouth and gums to relieve toothaches and sore throats. Novocaine is another local anesthetic primarily used in dentistry, usually when having a filling.

Risks: These are all adulterants. They are added to cocaine to give the user that feeling of numbness in the nose and the back of the throat, but more importantly when you rub that last bit on your gums. This will convince the user that what they have is of higher quality. Benzocaine and other local anesthetics can cause methemoglobinemia, a severe condition in which the amount of oxygen carried through the blood is significantly reduced. 


The party drug of the '90s is still going strong 30 years later.

MDMA or ecstasy usually comes in pill form and has several known cutting agents commonly identified, usually psychoactive substances that have been designed to give similar feelings to those caused by MDMA. Most cutting agents used are Cathinones, a derivative of the khat plant, more commonly known as MCAT.

PMA (Para methoxyamphetamine) 

Also known as 4MA, it has psychedelic properties and has been identified as a common MDMA adulterant. 

Category: Adulterant 

Use: Adulterant 

Risks: PMA affects the body's temperature control, and the risk of overheating may be greater than ecstasy. People can get so out of control that they don't realise they're in danger of overheating and dehydration. 

4MC, Mcat, Mephedrone

A Cathinone stimulant that gives the user feelings of cocaine and ecstasy.  

Category: Adulterant
Use : Adulterant

Risks: Mcat was initially sold as "bath salts," marketed as a legal alternative to ecstasy, speed, or cocaine. Up until 2010, it could legally be purchased in head shops. When consumed, it can produce feelings of anxiousness, headaches, overstimulation, and hallucinations. It may even cause fits and heart palpitations. When cut or sold as MDMA, it can increase the length of the high and cause insomnia.


Central Nervous system (CNS) stimulant.  

Category: Adulterant 

Use: Diluent & Adulterant 

Risks: Caffeine is one of the most common cutting agents found in MDMA. It is used primarily as a diluent or bulking agent. Caffeine is a stimulant and is addictive. It can increase the heartbeat, cause anxiety, headaches, restlessness, and increased dehydration. 

Due to lockdowns across most of Europe in the last two years, MDMA has not been the drug of choice. The labs that make MDMA have diversified or increased the production of Crystal Meth, or methamphetamine. The MDMA on the market now has been cut or wholly made using Cathinones or pure caffeine.


In the early 90s, heroin was cut with bulking agents rather than adulterants. These bulking agents were typically baking soda, sugars, laxatives, or on occasion, rat poison. These products were added not to increase the high but to bulk out the heroin to maximize profits. As we have moved forward 20+ years, the powers that be realised adding cheap adulterants to heroin can give that increased euphoric feeling, albeit synthetically.  

Lately, there have been reports in the UK that Heroin has been altered with fentanyl. 


A synthetic opioid

Category : Adulterant
Use: Adulterant

Risks: Fentanyl is a synthetic opioid that is 50 to 100mtimes more potent than morphine—recently been identified in heroin to increase the high of poor-quality heroin. The same way that heroin or morphine binds to opioid receptors, so does fentanyl. The reason to use fentanyl is to give that increased high or euphoria. It's also a cheaper way to increase the high. Due to its increased potency, the Injecting Drug User (IDU) increases their chances tenfold of overdose and often death.

Now that we've identified the most common ways these substances are cut, we need to examine how exactly it is we got here and what can be done to help addicts. Check back here next week to find out. 

Stay safe.