Apr. 10, 2008 -- Reports of German pot smokers sustaining severe lead poisoning from tainted marijuana suggests that illicit drug users may be getting a lot more than just a high from the substances they abuse, health experts warn.
The cases, documented in an article in the current issue of the New England Journal of Medicine, involve 29 young adults, ages 16 to 33, who were hospitalized in Leipzig, Germany, with lead poisoning during a period of several months.
While doctors were initially baffled by the rash of poisonings, they eventually determined that all had smoked marijuana that had been tainted with small lead particles.
"The current working hypothesis of the police is that because of its high specific gravity and inconspicuous grayish color, lead was used to increase the weight of street marijuana sold by the gram and thereby maximize profits among dealers," the researchers noted in the article.
And the dividends for dealers were significant. The researchers estimated that adding the lead to the marijuana increased the profit per kilogram by $1,500.
"The medical community, including pediatricians, should consider adulterated marijuana as a potential source of lead intoxication," the researchers wrote.
Drugs Routinely 'Cut'
Though doctors and drug experts in the United States say they are not aware of any similar cases of marijuana-linked lead poisoning in this country, they warn that illicit drugs of all varieties are often mixed with other substances -- many of which can have health effects if ingested.
"It's really quite common for drugs to be cut with less-expensive substances to increase a distributor's or dealer's profits," said Dr. Marcel J. Casavant, chief of pharmacology and toxicology at Nationwide Children's Hospital in Columbus, Ohio. For example, he adds, cocaine is routinely blended with everything from sugars and magnesium salts to talcum powder and even other drugs.
And these mixes often put users at risk.
"The product quality is concerning in that other compounds may be added to resemble the desired drug, yet serve as a cost-effective substitute, or that the quantity of drug added to a compound is uncertain," said Kelly M. Smith, assistant dean of academic affairs at the University of Kentucky College of Pharmacy in Lexington. "The user never truly knows how much of an active ingredient is contained in a cigarette, tablet, rock or vial."
Adding to the problem is that many illicit substances -- such as marijuana and MDMA, or ecstasy -- are not manufactured legally. This sets these drugs apart from many other drugs that are frequently abused, such as certain opioid pain medications.
"Thus, diversion of legitimate drug supplies is not possible," Smith said. "The user must then rely upon street products, which may have been manufactured in someone's kitchen laboratory. Ecstasy users are therefore at the mercy of the illicit manufacturer, and must trust that the tablet they have purchased indeed contains ecstasy, as well as ecstasy in a known quantity."
In the worst-case scenario of drug cutting, distributors who are unhappy with a particular dealer may deliberately contaminate the drugs they give them -- and the lives of those who purchase from this particular dealer may hang in the balance.
"When the users start getting sick from that dealer's products, those who live take their business elsewhere," Smith said. "Even the dealer doesn't really know what's in the bag."
But even when faced with a bad reaction, drug users don't always seek out medical help.
"People on marijuana only rarely go to an emergency department," said Dr. Richard O'Brien, spokesman for the American College of Emergency Physicians. "Typically those who get into medical trouble or suffer trauma under the influence who are using street drugs are using cocaine or heroin or meth; we also see rare GHB [date rape drug] abuse."
Smoke, Snort at Your Own Risk
Of course, most who are willing to use illicit drugs may have already come to terms with the calculated risk of their chemical exploits. But as O'Brien points out, drug users should at least be fully aware of the health risks they are taking.
"Street drugs are not pure, nor can they be assumed safe, in any manner or form," he said. "Using illegal drugs is risking your life."
"Adverse -- and potentially fatal -- reactions to many of these drugs are thought to result from poor manufacturing, rather than face-value overdoses," she said. "The user goes on faith that a less expensive, chemical cousin with greater risk has not been substituted, nor does the tablet contain more than thought."
"Use of illicit drugs is then, in a sense, a bit like Russian roulette."