Understanding the Tiletamine Mis-Selling Crisis

A critical harm reduction alert for healthcare providers, people who use drugs, and anyone concerned about drug safety in Australia

By Dr Ferghal Armstrong, FAChAM
Addiction Medicine Specialist & Lifestyle Medicine Practitioner

The Notification That Demands Our Attention

On October 20, 2025, a drug notification crossed my desk that exemplifies one of the most dangerous aspects of the unregulated drug market: profound substance misrepresentation. In Melbourne, substances being sold as ‘4-MMC’ or ‘M-CAT’ (mephedrone) have been found to contain tiletamine—a veterinary anaesthetic—and N-Benzylcyclohexanamine, a chemical with unknown psychoactive properties.

This isn’t a minor discrepancy in purity or potency. This is a fundamental category error: people seeking a stimulant are receiving a powerful dissociative anaesthetic. The implications for individual safety, clinical practice, and public health are significant, and they deserve our careful attention.

After three decades in medicine, with extensive work in addiction medicine and harm reduction, I’ve witnessed countless situations where drug supply contamination has led to preventable harm. This particular case concerns me deeply, and I want to break down why—not from a place of judgment, but from a commitment to keeping people informed and safe.

Understanding the Expected Drug: Mephedrone (4-MMC)

To understand the danger, we first need to understand what people think they’re taking.

Mephedrone, chemically known as 4-methylmethcathinone (4-MMC), emerged on the recreational drug scene in the mid-2000s. It’s a synthetic stimulant belonging to the cathinone family—compounds structurally related to the naturally occurring stimulant cathinone found in the khat plant used in East Africa and the Arabian Peninsula.

The Expected Effects of Mephedrone

Users report that mephedrone produces effects reminiscent of a combination of MDMA (ecstasy) and cocaine. The typical effects include:

• Euphoria and enhanced mood lasting 2-3 hours when taken orally
• Increased energy and stimulation
• Enhanced sociability and feelings of empathy
• Elevated mood and decreased hostility
• Improved alertness and, subjectively, enhanced mental function
• Mild stimulation and increased libido

The onset of effects occurs within 15-45 minutes, with peak effects occurring around 30 minutes when insufflated (snorted) or within an hour when taken orally. The entire experience typically resolves within 3-6 hours.

The Known Risks of Mephedrone

Mephedrone is not without risks—it’s a Class B drug in many jurisdictions for good reason. Known adverse effects include:

• Cardiovascular strain (increased heart rate and blood pressure)
• Hyperthermia (overheating), particularly in dance/festival environments
• Compulsive redosing behaviour
• Potential for psychological dependence
• “Comedown” effects, including anxiety, low mood, and fatigu,e lasting several days
• Nosebleeds and nasal damage with regular insufflation
• Risk of seizures, particularly when combined with other stimulants

However, users who are experienced with this substance understand these risks and typically dose accordingly. They know what to expect, how long effects will last, and what harm reduction strategies to employ.

The Reality: Tiletamine—A Veterinary Anaesthetic

Now, let’s talk about what people are actually receiving: tiletamine.

Tiletamine is a dissociative anaesthetic in the same pharmacological family as ketamine. However, it’s significantly more potent and longer-lasting than its more well-known cousin. It’s not approved for human use—it’s exclusively a veterinary medicine used to sedate and anaesthetise animals for surgical procedures.

Veterinary Applications

In veterinary practice, tiletamine is typically combined with zolazepam (a benzodiazepine) in a product called Telazol. This combination—often further mixed with ketamine and xylazine (TKX protocol)—is used for:

• Large-scale animal sterilisation programs (cats, dogs)
• Sedation of livestock and exotic animals
• Veterinary surgical procedures requiring reliable, prolonged anaesthesia

The TKX protocol has been extensively studied in veterinary literature. Research shows it provides 45-60 minutes of surgical-level anaesthesia in animals, with effects persisting for several hours.

Effects and Dangers in Humans

When tiletamine enters the human recreational drug market masquerading as a stimulant, we encounter a pharmacological perfect storm. Here’s why:

Duration Mismatch: While mephedrone effects last 2-3 hours, tiletamine can produce effects lasting 4-6 hours or longer. Users expecting a relatively brief experience may find themselves impaired for significantly longer than anticipated.

Effect Mismatch: Rather than stimulation, tiletamine produces:

• Dissociation and detachment from reality
• Loss of motor coordination and balance
• Impaired consciousness ranging from sedation to complete unconsciousness
• Respiratory depression at higher doses
• Amnesia for the period of intoxication
• Prolonged recovery periods

Dosing Catastrophe: This is perhaps the most dangerous element. Someone dosing for a stimulant might take what they consider a “moderate” or even “high” dose based on mephedrone standards. But if that same quantity contains tiletamine—a substance for which they have no tolerance and which is more potent than ketamine—they may inadvertently take an anaesthetic dose that renders them unconscious or causes severe respiratory depression.

Clinical Case Considerations

In my practice, I’ve encountered patients who believed they were experiencing “bad ecstasy” or “weird MDMA” when they were likely experiencing effects from dissociative anaesthetics. The presentation can include:

• Confusion and disorientation extending well beyond the expected drug duration
• Profound ataxia (loss of coordination) leading to falls and injuries
• Inability to communicate coherently
• Nystagmus (involuntary eye movements)
• Agitation or combativeness when consciousness returns
• Complete amnesia for events during intoxication

From a harm reduction standpoint, this is particularly concerning because users may not recognise they’re in danger, may be unable to seek help, or may take additional substances thinking the first dose “didn’t work.”

The Unknown Factor: N-Benzylcyclohexanamine

The second component identified in these mis-sold substances is N-Benzylcyclohexanamine, and in some ways, this concerns me even more than the tiletamine.

What We Don’t Know

N-Benzylcyclohexanamine is primarily known as a chemical synthesis intermediate—a building block used in pharmaceutical and chemical manufacturing. It’s occasionally used as a cutting agent to bulk up drug products. However:

• Psychoactivity: Unknown
• Toxicity profile: Poorly characterised
• Drug interactions: Unstudied
• Safe dosage range: Non-existent data
• Long-term effects: Completely unknown

When I see “psychoactivity and risks unknown” on a drug notification, it’s genuinely alarming. It means we’re dealing with an uncontrolled experiment on human subjects who didn’t consent to be guinea pigs.

The Dangers of Unknown Compounds

In toxicology, we have a saying: “The dose makes the poison.” But with unknown compounds, we don’t even know what the toxic dose is. We can’t predict:

• Cardiovascular effects
• Neurotoxicity
• Hepatotoxicity (liver damage)
• Nephrotoxicity (kidney damage)
• Seizure threshold alterations
• Interactions with medications or other substances

This isn’t just an academic concern. The emergence of novel synthetic opioids like nitazenes in Australia has shown us how quickly unknown substances can lead to fatal outcomes. Each new compound represents a fresh gamble with human health.

Why This Happens: The Economics and Reality of Illicit Markets

It’s worth understanding why this kind of substitution occurs, because that context informs our response.

Supply Chain Realities

Drug prohibition creates unregulated markets where:

1. Price incentives drive substitution: Tiletamine may be cheaper or more readily available through veterinary supply chains than actual mephedrone.
2. No quality control: There’s no oversight, no batch testing, no accountability when products are misrepresented.
3. Synthesis challenges: As authorities crack down on precursor chemicals for popular drugs, manufacturers substitute with whatever they can access.
4. Deliberate deception or ignorance: Sometimes suppliers knowingly misrepresent products; other times, they genuinely don’t know what they’re selling due to upstream contamination.

The Cascade Effect

Once a contaminated or misrepresented product enters the supply chain, it can affect hundreds or thousands of users before any health alerts are issued. By the time health authorities identify a problem, significant harm may have already occurred.

This is precisely why harm reduction services like drug checking are so critical—they can identify these issues early, before widespread harm occurs.

Clinical Implications for Healthcare Providers

For my colleagues in healthcare, this notification should prompt several considerations:

Emergency Department Recognition

Patients presenting with what they report as “bad stimulants” may actually be experiencing dissociative anaesthetic effects:

• Consider dissociative intoxication in the differential diagnosis
• Prolonged altered mental status (>3-4 hours) suggests something other than typical stimulants
• Ataxia and nystagmus point toward dissociative agents
• Respiratory depression is inconsistent with stimulant use

Addiction Medicine Considerations

In my addiction medicine practice, cases like this remind me to:

• Ask specifically about effects experienced, not just drug names used
• Recognise that patients’ drug knowledge is based on what they’re told, not laboratory analysis
• Avoid making assumptions about what substances were actually consumed
• Educate about drug checking services as a practical harm reduction tool

General Practice Awareness

For GPs and family physicians:

• Patients who use recreational drugs may not volunteer this information unless asked non-judgmentally
• Understanding local drug trends helps contextualise reported experiences
• Knowledge of available harm reduction resources enables better patient support
• Recognising that drug use exists across all demographics and socioeconomic groups

Harm Reduction: What Actually Works

Let’s be clear about something: the most effective way to avoid harm from illicit drugs is not to use them. But decades of “just say no” messaging have proven ineffective at stopping drug use. What does work is meeting people where they are and providing information and tools that reduce harm.

Drug Checking Services in Australia

I’m encouraged by the expansion of drug checking services across Australia:

Victoria: The Victorian Pill Testing Service now operates both a fixed site (95 Brunswick Street, Fitzroy) and mobile services at music festivals. It’s free, legal, and confidential.

Australian Capital Territory: CanTEST has been operating since July 2022, Australia’s first permanent drug checking facility.

Queensland: CheQpoint provided services through April 2025.

New South Wales: A 12-month pilot program began in early 2025.

How Drug Checking Works

These services provide:

1. Chemical analysis of submitted substances using sophisticated testing equipment
2. Harm reduction counselling with trained professionals
3. Personalised risk assessment based on test results
4. Public health surveillance to identify dangerous substances in circulation
5. Drug alerts when particularly hazardous substances are detected

The Evidence Base

Research from established drug checking programs shows:

• Approximately 47% of substances tested don’t match what users expected, Department of Health, Victoria
• 65% of users had their first conversation with a health professional about drug use through these services, Better Health Channel
• Nearly one in three people said they would take a smaller amount after harm reduction conversation,s Better Health Channel
• Public support for drug checking has grown to 64% of Australians Alcohol and Drug Foundation

Importantly, evidence shows drug checking doesn’t increase drug use—it simply makes existing drug use safer.

Practical Recommendations

For People Who Use Drugs

If you’re going to use substances, please consider:

1. Use drug checking services: In Melbourne, the Victorian Pill Testing Service is accessible and free. It can identify exactly what you have.
2. Start low, go slow: Always start with a small amount when trying a new batch, even if you think you know what it is.
3. Never use alone: Have someone sober present who can call for help if needed.
4. Recognise warning signs: If effects don’t match expectations—particularly if you feel sedated when expecting stimulation—stop immediately.
5. Don’t mix substances: Combining drugs exponentially increases risk, especially when you don’t know what you actually have.
6. Hydrate appropriately: But not excessively—sip water, don’t gulp.
7. Know that calling 000 won’t get you in trouble: Paramedics are focused on saving lives, not reporting drug use.

For Healthcare Providers

1. Familiarise yourself with local drug trends through health department notifications
2. Ask non-judgmentally about substance use in your assessments
3. Know your local harm reduction resources so you can provide accurate referrals
4. Stay updated on drug checking services in your area
5. Recognise that harm reduction is evidence-based healthcare, not enabling

For the Community

1. Share drug alerts when they’re issued—they save lives
2. Support evidence-based harm reduction services in your community
3. Reduce stigma around drug use and addiction
4. Recognise that drug use crosses all demographics—it’s not “those people,” it’s our friends, family, colleagues, and neighbours

The Bigger Picture: Drug Policy and Public Health

This tiletamine situation highlights broader issues with current drug policy. When I look at this through my lens as both an addiction medicine specialist and someone committed to lifestyle medicine principles, several things become clear:

Prohibition doesn’t create purity; it creates unpredictability. In a regulated pharmaceutical market, if you buy paracetamol, you get paracetamol at a known dose. In unregulated markets, you might get anything.

Harm reduction is pragmatic public health. We don’t tell people who don’t wear bike helmets that we won’t treat their head injuries. We shouldn’t withhold life-saving interventions from people who use drugs.

The evidence supports a health-led approach. Countries and jurisdictions that have moved toward decriminalisation and health-focused interventions consistently show better outcomes than punitive approaches.

Looking Forward

The tiletamine notification isn’t an isolated incident—it’s emblematic of ongoing challenges in drug safety. Novel psychoactive substances continue to emerge, supply chains remain contaminated, and people continue to use drugs despite legal prohibition.

Our response needs to be equally persistent: continued expansion of drug checking services, ongoing public health surveillance, and sustained commitment to harm reduction as a core public health strategy.

Final Thoughts

If there’s one message I want readers to take from this article, it’s this: knowledge reduces harm. Whether you’re a healthcare provider, someone who uses substances, or simply someone who cares about public health, understanding what’s really happening in the drug supply empowers better decision-making.

The tiletamine mis-selling situation is dangerous precisely because of the gap between expectation and reality. People cannot manage risks they don’t know about. Drug checking services, public health notifications, and honest, non-judgmental conversations about drug use are how we close that gap.

In my years in addiction medicine, I’ve learned that judgment doesn’t keep people safe—information does. Support doesn’t enable harm—it prevents it. And compassion isn’t weakness—it’s the foundation of effective public health.

Stay informed. Stay safe. And if you encounter substances that don’t produce expected effects, please report them to health authorities or use drug checking services. Your experience could save someone else’s life.

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Resources:

• Victorian Pill Testing Service: 95 Brunswick Street, Fitzroy | Open Thu 12-4 pm, Fri 3-7 pm, Sat 1-7 pm
• DirectLine (Drug & Alcohol Support): 1800 888 236
• DanceWize (Peer Support): info@dancewize.org.au
• Emergency Services: 000

Dr Ferghal Armstrong is a Fellow of the Australasian Chapter of Addiction Medicine (FAChAM) and a qualified Lifestyle Medicine practitioner with decades of experience in addiction treatment and harm reduction.

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