“Notes from the Field” offers a behind-the-scenes look at the challenges, successes, and transformative moments in our community. At WakeUp Carolina, we share insights and stories to foster understanding, ignite conversations, and inspire change.

Welcome to WakeUp Carolina’s “Notes from the Field.” In this installment, we address the pressing issue of treating laced substances. Our transparency and commitment to community well-being drive us to shed light on the challenges and risks for those exiting treatment.

Treating Laced Substances

We regularly interact with families and individuals impacted by substance use and work closely with the Mount Pleasant Police Department and The Town of Mount Pleasant on overdose cases. In early 2024, we noted the increasing danger of substance use, particularly with laced substances. Individuals often believe their source provides “safe” drugs, which is far from the truth.

We’ve encountered substances like cocaine laced with fentanyl, heroin with xylazine, and marijuana with fentanyl. People, often unaware of the lacing, face severe risks. To combat this, we distribute test strips for xylazine and fentanyl.

The Danger of Laced Substances

Individuals build a tolerance, requiring higher quantities for the same effect, leading to multiple substances being mixed. Dealers enhance the high by adding other substances, posing overdose risks, especially for newer people in active use.

At detox facilities, urinalysis often reveals unexpected substances. Treatment facilities need protocols for dealing with these complexities, as laced substances complicate recovery.

Commonly Seen Laced Substances

Cocaine and Fentanyl


  • Intense Withdrawal Symptoms: Detoxing from cocaine laced with fentanyl can lead to intense withdrawal symptoms, including cravings, anxiety, depression, irritability, fatigue, insomnia, and physical discomfort. The presence of fentanyl exacerbates these symptoms, making detoxification particularly grueling.
  • Medical Complications: Fentanyl, a potent opioid, can cause severe physical dependence and withdrawal symptoms. Detoxing can lead to respiratory depression, heart palpitations, high blood pressure, seizures, and even overdose, which can be life-threatening and require immediate medical attention.
  • Psychological Effects: The psychological impact of detoxing from cocaine and fentanyl includes intense cravings, mood swings, paranoia, hallucinations, and suicidal thoughts. Managing these effects often requires professional support and counseling.
  • Dual Diagnosis: Many individuals detoxing from these substances also have underlying mental health issues, such as depression, anxiety, or trauma. This complicates the detox process and necessitates integrated treatment to address both substance use and mental health issues.
  • Relapse Risk: The high risk of relapse is driven by intense cravings, withdrawal symptoms, and psychological effects, making sustained abstinence challenging.

Adderall Laced with Methamphetamine


  • Severe Withdrawal Symptoms: Detoxing from Adderall laced with meth can lead to severe withdrawal symptoms such as fatigue, depression, anxiety, irritability, increased appetite, and difficulty concentrating. The combined stimulant effects prolong and intensify these symptoms.
  • Cardiovascular Issues: Both Adderall and meth increase heart rate and blood pressure, exacerbating cardiovascular problems during detox. This can lead to heart-related complications, which require careful monitoring.
  • Psychiatric Symptoms: The combination can lead to psychiatric symptoms like paranoia, hallucinations, psychosis, and mood swings. These issues stem from the impact on brain chemistry and often necessitate psychiatric intervention.
  • Cognitive Difficulties: Chronic use impairs cognitive function, affecting memory, attention, and executive functioning. Detox further impairs these abilities, complicating recovery.
  • High Relapse Risk: Intense withdrawal symptoms, psychiatric issues, and cognitive difficulties increase the likelihood of relapse, making recovery an uphill battle.

Cocaine Laced with Xylazine


  • Respiratory Depression: Xylazine, a central nervous system depressant, can slow breathing and lead to respiratory failure. Detoxing increases the risk of severe respiratory complications.
  • Profound Sedation: Xylazine causes extreme drowsiness and lethargy, making it challenging for individuals to stay alert during detox. This sedation complicates the detox process.
  • Cardiovascular Complications: Xylazine can slow heart rate and lower blood pressure, exacerbating cardiovascular issues during detox and increasing the risk of heart-related complications.
  • Central Nervous System Effects: Detoxing from cocaine laced with xylazine can result in dizziness, confusion, disorientation, and impaired coordination. These symptoms complicate the detox process and necessitate careful monitoring.
  • Combined Withdrawal Symptoms: Managing the withdrawal symptoms from both cocaine and xylazine, which include cravings, anxiety, depression, irritability, and physical discomfort, requires significant medical support.

Key Questions for Healthcare Providers

  • Have you used opioids or benzodiazepines recently?
  • Can you provide details on the specific substances you have used?
  • Are you aware of any substances that may be laced with dangerous additives, such as fentanyl, xylazine, or carfentanil?
  • Have you experienced any unexpected or severe reactions to substances in the past?

Why It Matters

Our “Notes from the Field” series aims to raise awareness and foster understanding within our community. The intersection of MAT administration and laced substances highlights the need for tailored, vigilant treatment approaches. By addressing this challenge, we strive to enhance MAT program effectiveness and contribute to a safer, more supportive environment for recovery.

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