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What Do People Cut Heroin With? Dangers & Risks

Elena Hill, MD, MPH profile image
Medically Reviewed By Elena Hill, MD, MPH • Updated Aug 21, 2023 • 6 cited sources

“Cutting” a powdered drug usually refers to mixing it with other substances. People often cut heroin with starch, sugar, talc, quinine and caffeine. It is also regularly cut with dangerous drugs like fentanyl.

Drug dealers often cut their heroin supply with other substances for a few reasons. [1] By adding cheaper, readily available substances to the drug, they increase the volume of the powder and can sell more. 

Heroin can be cut with benign substances such as sugar or starch. It can also be cut with other drugs such as caffeine, pcp, methamphetamine, fentanyl or cocaine. This can be incredibly dangerous because people can inadvertently ingest substances without meaning to. Impure heroin, or heroin that is “cut” with other substances can therefore drastically increase the risk of accidental overdose. 

What Are the Common Cutting Agents Used in Heroin? 

Cutting agents commonly used with heroin include both inert/benign substances such as:

  • Sugar: Sugar is used as a cutting agent for heroin because it is cheap, readily available and has a similar appearance to pure heroin. Sugar is one of many common innocuous fillers used to cut heroin, much like powdered milk and baking soda.[2]
  • Starch: While sugar matches the appearance of heroin, starch is more similar in texture and weight. It also does not have the telltale sweet taste of sugar, making it easier to hide that the heroin has been cut. 
  • Talc: Like starch, talc is similar in weight and texture to pure heroin, so it can be easier to hide that the purity of the heroin has been diluted. However, the addition of talc to heroin can also be dangerous since inhaling talc can lead to lung problems and other health issues.
  • Caffeine: Caffeine is often added to heroin because it mimics some of the effects of heroin in the body, making the drug appear to be more potent than it actually is when it has been cut with other substances like starch or talc. Caffeine comes with its own set of problems, however, and too much can contribute to deadly heart health issues.
  • Quinine: Quinine, like all the substances on this list, is cheap and easy to find, making it an easy cutting agent. Additionally, the taste of quinine is bitter, like heroin, which can cover up the fact that the supply has been diluted. 

Conversely, heroin can also be cut with non-inert, more dangerous substances, including:


The presence of fentanyl in a batch of heroin is exceedingly common, and it can make the drug much more dangerous and increase the risk of overdose.[4] Fentanyl is a synthetic opioid that is cheaper to obtain and produce than heroin. These days, many supplies of heroin are cut with fentanyl for this reason. While it brings the price down, it is also incredibly dangerous and puts the unknowing individual at risk for overdose. 


Methamphetamine is a highly addictive stimulant that can increase heart rate, blood pressure and body temperature, leading to an increased risk of heart attack, stroke and other health problems.[5] Cutting heroin with methamphetamine is sometimes done intentionally by the user in order to get “energy” or a high to counteract the “downer” effects of the heroin. This can be extremely dangerous and can actually counterintuitively increase the risk of overdose. 


Phenobarbital is a central nervous system depressant that can increase the sedative effects of heroin, leading to a heightened risk of overdose and death. The combination of heroin and phenobarbital can lead to respiratory depression and other serious health problems. It may potentially increase the addictive nature of the drug as well. 


Lidocaine is a local anesthetic that can numb the skin and mucous membranes, leading to a decreased sensitivity to pain and other sensations. Cutting heroin with lidocaine can alter the effects of heroin, making it harder for users to gauge the correct dose to avoid overdose. Using both substances together can lead to cardiovascular problems, like irregular heartbeat, which can contribute to stroke. 

Random Substances

The truth is that most heroin that makes its way down to the street level may be cut with not just one but several substances.  For example, there was a case in which heroin was laced with a substance used to dye the petals of plants, and this caused skin necrosis in users.[6]

What Are the Dangers of Cutting Agents in Heroin?

Some of the risks of using heroin that has been cut include the following: 

  • Increased risk of overdose: Cutting agents can dilute or significantly increase the potency of the drug, making it harder for users to determine the correct dosage and increasing the risk of overdose.[3] If the drug is cut with a weaker substance, many users will be disappointed by their experience and take more of the drug in an effort to get high. They may ultimately overdose as a result. Conversely, they may take the dose they are used to taking of a drug that is more potent than they are used to and subsequently overdose. 
  • Health consequences: Some cutting agents, such as talc and caffeine, can have negative health effects when used in combination with heroin. Combining these effects with the effects of heroin compounds the issue.
  • Legal consequences: Possession and distribution of drugs that have been cut with other substances can result in more severe legal consequences. Even if the user or seller believes they are buying or selling one substances, they may be held legally responsible for any substances that their heroin is cut with. 

How To Prevent Complications From Cut Heroin 

It is very difficult to ensure your heroin supply has not been cut. If it has been cut with unusual substances, it can be even harder to identify those substances. 

There may be over the counter tests that can be purchased to help identify some common substances that your heroin may be cut with, such as fentanyl or cocaine. 

In other countries, there are harm reduction programs that will test substances for users to ensure they are not cut with other substances prior to use. However, these programs are not usually available in the US. 

For so many reasons, whether you are buying/selling heroin or using it, it is very important to understand what cutting heroin is, and the risks it poses to your health. If you do purchase heroin and intend to use it, make sure you are aware of the risks that it may be impure.

At Bicycle Health, we are standing by to assist you in helping yourself or a family member move from active heroin use to sustained recovery. Call now to learn more about how we can connect you with the lifesaving Medication for Addiction Treatment (MAT), so you can begin the healing process.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More

  1. Methods for Impurity Profiling of Heroin and Cocaine. United Nations Office on Drugs and Crime Vienna. 2005. Accessed January 2023.
  2. Heroin Uncertainties: Exploring Users’ Perceptions of Fentanyl-Adulterated and -Substituted ‘Heroin’. International Journal of Drug Policy. August 2018. Accessed January 2023.
  3. Serious Health Threats of Novel Adulterants of the Street Heroin: A Report From India During the COVID-19 Pandemic. BMJ Case Reports. August 2021. Accessed January 2023.
  4. What Is Fentanyl and Why Is It Behind the Deadly Surge in US Drug Overdoses? University of Massachusetts Medical School. May 2022. Accessed January 2023.
  5. What Is Methamphetamine? National Institute on Drug Abuse. Oct 2019. Accessed January 2023.
  6. A Local Epidemic of Laced Heroin Causing Skin Necrosis. Cureus. May 2019. Accessed January 2023.

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