Source: Pittsburg Post Gazette
Publication Date: November 18, 2024
Medical Toxicologist: Anthony Pizon, MD, FACMT
Keywords/Topics: BTMPS, Adulterants, Substance Use Disorder, Illicit Drug Supply, Fentanyl, Xylazine

Industrial-grade chemical is showing up in street drugs

An industrial-grade chemical used to preserve plastic has appeared in drugs recently tested throughout the country, including in Philadelphia and Allegheny County. The chemical, BTMPS, is not meant to be ingested by humans or animals.

It’s a first for a nondrug substance like this to appear in the illicit supply, leaving harm reductionists and scientists vexed.

“This is a weird one,” said Christopher Moraff, founder of the drug-checking lab PA Groundhogs and an independent journalist. “It hit the East and West Coast at the same time, and it really perplexed us at first, because it isn’t a drug.”

What is BTMPS?

The acronym is short for a long chemical name: bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate; its brand name is Tinuvin 770. It’s used as a protective coating on plastics to prevent breakdown from UV rays. There’s very little — if any — research on BTMPS in humans, but a 2004 study conducted on rats found heart defects from long-term use of the substance.

According to the chemical’s safety data sheet, exposure to BTMPS causes reproductive defects, serious eye damage and skin irritation. On the 0–4 National Fire Protection Association rating scale, used to classify the danger of a substance, it’s rated a three.

In Philadelphia and Allegheny County, the chemical was first detected in May. In Los Angeles, it was found in June. It’s a rarity for a drug to pop up at the same time in different geographic locations, as opposed to moving across the country as a wave. Locally, it’s begun to increase in frequency in samples tested since September.

“BTMPS being in the drug supply doesn’t make sense,” said Claire Zagorski, a Ph.D. candidate at the University of Texas, Austin School of Pharmacy and the program coordinator and harm reduction instructor at the college’s PhARM program.

In addition to BTMPS, the veterinary sedative medetomidine — 200 times stronger than tranquilizer xylazine — is increasingly showing up in the fentanyl supply locally and in Philadelphia.

Tracking BTMPS

As part of a new federal program called the Rapid Drug Analysis and Research (RaDAR) program, the National Institute of Standards and Technology — an organization under the Department of Commerce — collected hundreds of samples sold as fentanyl, as well as residue from drug paraphernalia, between June and August and tested each sample for multiple adulterants.

In June, none of the samples contained BTMPS. By August, that 0% had spiked to 35%.

“It’s been a really steady increase in the last few months,” said Edward Sisco, a research chemist with the National Institute of Standards and Technology and lead researcher on the study, which was published as a preprint in September and is awaiting peer review.

People who work with those using drugs say they’re reporting burning eyes, severe coughing, trouble hearing, nausea, sedation and hallucinations. BTMPS has been reported to have a strong chemical smell or as smelling fishy.

“Generally, people are not feeling well from this,” said Sisco. “They are actively trying to avoid it.”

Since August, five samples from Allegheny County and tested by the University of North Carolina Street Drug Analysis Lab have tested positive for BTMPS. In two out of the five, BTMPS was the primary substance. The five samples included a medley of other illicit substances, including fentanyl, cocaine, heroin, benzodiazepines, xylazine and medetomidine. UNC has logged more than 500 samples positive for BTMPS across 14 states.

Chris Moraff confirmed that among Philadelphia drug samples tested in October, seven out of 23 tested positive for BTMPS.

“Nobody really knows what to think about this yet,” said Alice Bell, overdose project prevention coordinator at the syringe service program and harm reduction organization Prevention Point Pittsburgh. “There’s such a mix of stuff; it’s pretty impossible to know what’s causing [these symptoms].”

Overdose complications

BTMPS has calcium channel blocking properties, which has proven dangerous for reversing overdoses. The brain and body use calcium channels to transmit brain signals, keep blood pressure steady and help the heart beat properly.

The calcium channels that BTMPS is attracted to primarily exist in the heart and on blood vessels, said Anthony Pizon, chief of medical toxicology at UPMC and who oversees the Pittsburgh Poison Center.

“Overdoses from calcium channel blockers are often challenging to treat,” he said.

That’s because doctors must give patients drugs to drive up blood pressure and heart rate, metrics that can be difficult to stabilize. Rescue efforts may be further dampened if the patient is already prescribed calcium channel blockers for high blood pressure or heart disease already.

Theories about why

Harm reductionists and scientists who are seeing this trend have multiple theories about BTMPS’ presence.

One theory: It’s simply another inexpensive, white powder.

“I’m guessing they’re using this as a bulking agent,” said Pizon. “I presume it’s really cheap, really easy to get ahold of, and really easy to add to the supply.”

Zagorski thinks it may be added to preserve fentanyl, preventing it from breaking down from light exposure.

Or, it could be there by accident.

“I don’t think it’s being intentionally put into the supply the way xylazine was,” said Laurel. “I think instead, it is a smaller chemical that happens to be in another cutting agent.” Bell shared this point of view.

What xylazine, medetomidine and BTMPS all have in common is the effect of lowering blood pressure, said Moraff. This could be creating another layer of sedation and nodding off. “I don’t think it lowering blood pressure is a coincidence,” he said.

Regardless of how it got into the supply, harm reductionists say it represents further evidence of the danger of an unregulated drug market — and the futility of drug scheduling.

“The toxic drug supply right now is ever-changing, and the more we regulate certain substances, the more we have these very unpredictable, volatile substances being added into the supply,” said Laurel.

Zooming out

Medetomidine began increasing in the drug supply earlier this year.

In May, Gov. Josh Shapiro moved to classify xylazine as Schedule III under the Controlled Substances Act in an effort to curb supply of the tranquilizer. Though it’s not clear whether the two events are connected, experts warned that removing xylazine would make room for another, stronger substance, as fentanyl once eclipsed heroin.

Medetomidine and BTMPS are two examples of a larger trend.

“We are experiencing the biggest disruption of the street opioid supply since the introduction of fentanyl,” said Moraff.

Sisco said it’s been difficult to gather real-time information and keep track of the drugs in the supply because of how quickly they’re being introduced, highlighting the need for better analytical tools in the field.

Those on the ground like Laurel and Bell, who work with people using drugs, say a safe and regulated drug supply is crucial. Laurel stays busy with her organization Savage Sisters reversing overdoses, teaching overdose prevention in schools and creating updated guidelines for wound care and overdose reversal protocols.

“We’re doing the best that we can on the ground, but you have to wait for confirmatory lab results, and you’re just constantly trying to provide life-saving services to individuals, and you have no idea what they have consumed,” she said. “This is a difficult space to navigate when providing crisis intervention and life-saving services.”

Sean Frank, emergency management coordinator and chief of the Shaler Township Police Department, agreed that adulterants in the drug supply are an issue but wondered how the country could transfer to a regulated supply.

”How is that going to work if it’s coming across the borders?” he asked. “Even if it was legal, you are still going to have people who want to make money.”

Shaler PD does “everything it can” to put an end to drug dealing when it receives a complaint, said Frank, in order to reduce the circulation of adulterated drugs throughout the community. It has not yet received samples positive for medetomidine or BTMPS but struggles with the presence of xylazine.

Pizon said he is working with his team at the Poison Center and with UPMC to add BTMPS to the list of drugs it checks when it tests samples.

“We’re going to keep our eyes peeled for this,” he said.