T

he opioid crisis just keeps getting worse, in part because new types of drugs keep finding their way onto the streets. Fentanyl, heroin’s synthetic cousin, is among the worst offenders.

It’s deadly because it’s so much stronger than heroin, as shown by the photograph above, which was taken at the New Hampshire State Police Forensic Laboratory. On the left is a lethal dose of heroin, equivalent to about 30 milligrams; on the right is a 3-milligram dose of fentanyl, enough to kill an average-sized adult male.

Fentanyl, according to the Centers for Disease Control and Prevention, is up to 100 times more potent than morphine and many times that of heroin.

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Drugs users generally don’t know when their heroin is laced with fentanyl, so when they inject their usual quantity of heroin, they can inadvertently take a deadly dose of the substance. In addition, while dealers try to include fentanyl to improve potency, their measuring equipment usually isn’t fine-tuned enough to ensure they stay below the levels that could cause users to overdose. Plus, the fentanyl sold on the street is almost always made in a clandestine lab; it is less pure than the pharmaceutical version and thus its effect on the body can be more unpredictable.

Heroin and fentanyl look identical, and with drugs purchased on the street, “you don’t know what you’re taking,” Tim Pifer, the director of the New Hampshire State Police Forensic Laboratory, told STAT in an interview. “You’re injecting yourself with a loaded gun.”

New Hampshire, like the rest of New England, has been particularly hard hit by the opioid epidemic. The state saw a total of 439 drug overdoses in 2015; most were related to opioids, and about 70 percent of these opioid-related deaths involved fentanyl. The state has seen 200 deadly opioid overdoses this year so far, said Pifer.

Fentanyl was originally used as an anesthetic. Then doctors realized how effective it was at relieving pain in small quantities and started using it for that purpose. In the hands of trained professionals — and with laboratory-grade equipment — fentanyl actually has a pretty wide therapeutic index, or range within which the drug is both effective and safe.

The difference in strength between heroin and fentanyl arises from differences in their chemical structures. The chemicals in both bind to the mu opioid receptor in the brain. But fentanyl gets there faster than morphine — the almost-instantaneous byproduct when the body breaks down heroin — because it more easily passes through the fat that is plentiful in the brain. Fentanyl also hugs the receptor so tightly that a tiny amount is enough to start the molecular chain of events that instigates opioids’ effects on the body.

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This tighter affinity for the opioid receptor also means more naloxone — or Narcan — may be needed to combat a fentanyl overdose than a heroin overdose.

“In a fentanyl overdose, you may not be able to totally revive the person with the Narcan dose you have,” said Scott Lukas, director of the Behavioral Psychopharmacology Research Laboratory at McLean Hospital in Belmont, Mass. “Naloxone easily knocks morphine off of the receptor, but does that less so to fentanyl.”

Matt Ganem, a former addict, explains the excruciating process of opioid withdrawal. Alex Hogan/STAT

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  • We just got my nefews toxicology. He died Dec 2017. He had 17mg of fentanyl in his system. He was trying to kick heroin.. why aren’t the dealers being hunted down and charged with murder???

  • @Renojim,
    The war on drugs is not creating an environment of success. 193 kilos of illicit Fentanyl was discovered in NY enough to kill that population 11 times over.
    USPS doesn’t have a secure way of fighting Fentanyl either.
    DEA is overwhelmed so is USCG which missed 500 incidents of trafficking 2016 and Trump cut their budget.
    History Channel has a series called War on Drugs that explains as the CIA operatives have stated; “The USA has a cash flow addiction. Remove that and the drugs go away or decrease.”
    If you would have told me 25 years ago that narcan would be in police vehicles, I would have said no way!
    It’s all here and Carafentanyl is being mixed with heroin and killing many.
    Yet, illicit drug overdoses have not caught up with alcohol deaths.
    If we had more secure jobs in the USA most of the black market wouldn’t exist.
    People have to survive in areas that businesses closed and left for other countries.
    As much as I would say yes to Fentanyl or Carafentanyl to be blocked, it’s not going to work.

  • @bobby, @alexander
    great minds think alike. No politician has the wherewithal or strength to fix the problem. they want to appeal to the conservatives, religious right and now bigoted white males, rather than do what is right for the country to ensure their reelection.
    I am not a trump supporter but he made a comment that the answer to the drug problem is to legalize it. If he ever did this, I would change my opinion of the man in a heartbeat. But politics is a different issue which is why we need a true third party that represents a piece of the philosophy of the other two with the addition of beliefs that today’s frustrated voters want.

    If you always do what you have always done,
    you will always get what you have always got.

    Legalize drugs, create a third party. This will make America great again.

    • @ThePrisoner
      You nailed it! A third party that’s not on the books!
      May I add like Sweden / Norway the executive boards of major companies are made up of Union members, Employees, public Servants, basically middle class to keep companies home.
      Our WallStreet is not going to bring jobs back or rebuild companies that have left cities, towns, counties in ghost town conditions.
      I’m on board!

  • The safe thing to do is keep
    All your meds in a safe . And
    I have timers set on my phone as to tell me when I can take my meds . I have kids and grand kids . I want to be here to see my grandkids grow up . Please people put your meds in a safe and I also have dead bolt lock on my door . I am being as safe as I can . Don’t want the meds in the wrong hands . The timer makes sure no over dosing . It’s real simple to do , so just do it

    • I have a digital, fire-proof safe to keep ALL my meds in (even OTC meds) and I also have a timer set on my phone, just like you do!! My kids think I’m insane, but I showed them your post so they see it’s not just me being paranoid, it’s my being safe AND keeping them, their friends and anyone safe in my house!!

  • Scary stuff. I am currently taking Oxycodine along with a Muscle Relaxer and a Antiflamation. I take the Oxycodine only when I absolutely have to. Then I take 3 times daily (morning, noon and night) the other two. This combination works well for me along with physical therapy twice weekly. I have gone from hopelessness to optimistic, however I am very aware of the possibke addictions. I will be so happy when the day comes that I no longer need the medications. To sum it up; I am thankful and very cautious with my meds.

    • I really hope you don’t become a lost case, man. I wish you well and may you be ridden of that garbage poison and return to the time in your life when you realize you didn’t need that sh*t.

  • Well of course 30 milligrams is a high dose. But dispensed in micrograms is way lower and safer. If used safely. It’s like anything else like cigarettes, the more you smoke the more you want. It’s about control and not having thoughts of how to get more. Do drastic things. It’s all in how a patient handles it. But I can sure handle it much better than the pain I was in before I was changed. I’d never kill my self but thought death has to be better!! I think the more they mess with med compliant patient medication they will have a much higher deaths from suicide!!! Than they want or need. So again individual means of prescribing pain medication and tests for addiction tendency is somewhere to start.

    • my boyfriend of 15 years just died from an overdose 2 days ago from this fckn crap.. i am beside myself

    • Lisa Silva:
      I feel your pain. I lost my son to heroin 4/25/2012. He had the most amazing soul and I still say “I was definitely blessed to be picked to be his mother”.
      What is harder to bear is the aftermath of his death. 20 months and 10 mins (to the second) after Matt’s death (4/25/2012 01:22 am) my husband of 33 years died in our house, in our basement, and in my arms 12/25/2013 01:32 am) from brain aneurysm.
      There is always fallout from a loved one’s death, and it seems to be exponentially worse if that death comes from an overdose.
      Do what I didn’t and wish I had… find a support group. NOW. Don’t think “they didn’t know him”, “they didn’t love him”. They do know and they do love. Don’t do the “I’m going to tough it out”, it doesn’t work.
      You’ll never forget, but remember: YOUR story may just save someone else’s love.

  • this posting software is not good. i wrote this comment dec 2 but the software does’t due a continuous thread. it sends you another page for older comments. anyway…

    Neither Republicans nor Democrats have the guts to fix the drug situation once and for all. It is easy to fix and will generate millions of jobs, grow the economy, reduce the US debt, diminish the dual underground economy, destroy the cartels, change urban culture, decrease dependency on welfare and update people’s outdated views on addiction while making America great again without Trumps help. How?

    Just like Nancy Reagan meant to say, “Say Yes to Drugs!” Legalize all drugs with the drinking age. Drug manufacturing is regulated, open to start ups and pharmas. Legal recreational drugs must past same quality requirements we expect of prescription drugs. Towns cannot override national legalization. Drugs can and should be taxed at the national, state and local levels provided the pricing does not discriminate lower income groups ability to purchase them which would cause the reemergence of underground drug economy with cheap prices enticing cartels to come back. This is important.

    Next is reallocating the billions of our dollars spent by the DEA/FBI/CIA/Police etc in the failed war on drugs and putting it towards alcoholism & addiction research and mental illness research to cure addiction and control substance or alcohol abuse for once and for all. This means we will need more scientists and healthcare professionals.

    Funds will be used too for opening drug treatment centers and drug enjoyment centers which provide a monitored and safe environment much like casino’s do for gamblers. These enjoyment centers are like Morocco opium dens in the 30’s. You have a safe and protected place staffed by health professionals in which you can partake of drugs that produce a dream state or an acid trip. Free needles etc.

    Lastly, 90% of prisoners are incarcerated for non violent drug crimes. Releasing these prisons immediately reduces national and state wide operating expenses and frees our court system to once again focus on real crimes with a true right to speedy trial. the private prison operators will fight this. We won’t need them anymore!

    We have a right to bear arms. we should also have a right to drink alcohol and/or ingest drugs. Legalizing drugs will prohibit urban males and females from being attracted to the drug money as it will no longer exist. Instead, it will hopefully push them towards a career in healthcare working in these centers.

    And in the end this will make a significant impact on reducing our national trillion dollar debt and improve our society. Portugal made the first step showing it is the solution. Time for america to show the world! Real change takes real action, not fake news like, “Just say No to drugs.” Ya, right.

    I posted similar idea in november at https://www.bostonglobe.com/metro/2017/11/30/more-than-drug-cases-dismissed-after-misconduct-chemist-and-former-prosecutors/C9cWcNDn34axTv8mXRLB9O/story.html#comments

    “Resist much, obey little”
    Once unquestioning obedience, once fully enslaved;
    Once fully enslaved, no nation, state, city, of this earth,
    ever afterward resumes its liberty. – Walt Whitman

    • Prisioner:
      I would like to address only one of your comments/solutions. Do you really believe that so many of the (potential) addicts will go into health care?
      I don’t understand how legalizing drugs will be creating all these jobs?
      Also, I thought this was a Fentanyl forum, not a soapbox for lesgalizing drugs in general. How many deaths do you expect to save by legalizing Fentenyl? I think you would be in for a very rude awakening if you believe the number of deaths would decrease. My belief is they would skyrocket, and then you would run out of room in the cemeteries.

    • @Bruno
      You ask if so many addicts would go into healthcare? As we know all know in healthcare is addiction is an illness that a goes from function in life to dysfunction in life or death regardless of choice, medication, Street medication, food addiction, or even DNA by design as everyone’s pleasure center of the brain is different along with social or environmental exposures to vulnerable choices. With any success stories of people that over come The illness of addiction, it’s one story to help another.

      Now Fentanyl is coming in on the black market in Kilograms. Example, New York busted a Fentanyl ring with over 193 Kilograms of Fentanyl to kill the population of New York 11 times over. Heroin addicts don’t know Fentanyl is now mixed in with heroin and it’s killing a lot of people. Carafentanyl is another very potent drug that is worse than Fentanyl that is being used in heroin and sometimes all three together. Yes, killing people.

      I would go into the history of drugs. It would be a educational course. Reference History Channel series War On Drugs. Retired CIA explained it well, “The USA has cash flow addiction not a drug addiction problem. Remove the cash watch the illicit drug use drop considerably.
      Now, if there were a time for the DEA it would be for heroin, Fentanyl, and CaraFentanyl or any illicit drug equivalent to prevent mass death. Marijuana has been around for thousands of years and is overcrowding the US Jails for non violent crimes.
      To be fair, alcohol deaths still supersede that of illicit drugs.
      Portugal stopped incarceration for drugs and use dropped by 60%. Which means the cash cost dropped considerably because of the lack of demand.
      The term “Opiods” is a catch all for a spectrum for health science to illicit black market drugs and the soap box is about responsible patients that are being HURT because of the illicit market. There were pill mills and the makers of OxyContin have a very large class action case they have to respond to in court for dropping 4.2 million tablets in a two cities in West Virginia that the population didn’t exceed 800 people combined after the coal mines were shut down.
      My final point, who is vulnerable for any drug use?
      Any town or county that has lost a major manufacturer in the USA without job replacement. These good people that punched the clock, with mortgages, car loans, children, etc had no where to turn too other than black market jobs or use.
      It’s becoming worse.
      Now we have a whole different problem arising with over worked physicians that are committing suicide at 757 per year. I won’t get into the details however this is not good for the USA long term.
      Legalize the all drugs with exception of Fentanyl or its family and watch the problem drop along with over crowding prisons.

    • @Bruno
      No, I don’t think all addicts/users will go into healthcare, I hope they will resume their lives. And forums are forums. the posts grow a life of their own. But mine is about fentanyl. We wouldn’t have this problem if my plan was implemented.

      When i say healthcare will create many jobs, I am looking at it in a larger context to help solve the welfare addiction, the drug money culture and inner city societal cultures that these have created in our urban cities. Welfare and drug money are a bad combination and only serve to maintain this way of life rather. Breaking this culture, understanding and curing addiction, taxing drugs, eliminating easy money from selling drugs, destroying the cartels and gangs by closing their cash flow, changing attitudes and practices for addiction and recreational drug use, saving lives both from drug overdose deaths, HIV etc and the accompanying despair will make America great again.

      As for Fentanyl, prescription patches etc that are medically prescribed should continue. Patients benefit from it. It is the Chinese chem labs synthesising and pushing Fentanyl, along with its stronger analogues, that has to be stopped. These labs are selling death!

      Drug users are unaware that they are being killed. Nikki Tsongas (US Rep Lowell), authored and passed a bill this month that approves more money for instrumentation to detect drugs better at our ports. I emailed her (no response yet) and said, I hope it includes money for supplying free testing of drugs for our users in Lowell, Lawrence and Haverhill for we know only a small percentage of smuggled drugs get caught at ports.

      Her bill is essentially wasting money for it’s doing what we already know doesn’t work. If she had put the money toward free drug testing, addicts/users would revolt against dealers who purposely added fentanyl knowing it could kill their customers. This revolt would eventually make it’s way back to China. I think fentanyl may be the wake up rallying cry heard around the world.

      As I have said, those scum dealers in lawrence who were taped talking about how many users they had to kill until they got the fentanyl dose right for their heroin operation deserve the same fate.

      And Sen’s Schumer (NY) and Feinstein (CA) can talk all they want against the Dark Net Markets, but at least the DNM are supplying fentanyl test strips to their customers and are sending their products out for GS/MS testing for fentanyl. That’s more than what these two are senators are doing. They are taking the approach that we know doesn’t work: “We need to ban Bitcoin because of the DNM.” They are too ignorant to know that there are 1,400 other cryptos for currency and that right now the DNM are providing a service by supplying safer drugs.
      Our politicians are the least capable of solving the problem because they are too scared that they might not be re-elected if they do the right thing.

      Peace.

    • Portugal is the best case study as to what would happen if drugs were legalized.

      Studies showed that drug use did not increase at all after possession of small amounts of all drugs was decriminalized. All the numbers for reported users of each drug before and after decriminalization were either identical or within the margin of error and as such can be said to be essentially identical.

      So if legalizing drugs does not in any way increase or provide an incentive to use drugs for those who otherwise would not have if it were still illegal, what are the negatives?

      The benefits, however, are immense. By legalizing, you can then regulate the manufacture and sale of these substances.

      You can guarantee that these substances will be free of any dangerous impurities and additives

      Are packaged with labels clearly identifying the amount being purchased and therefore would eliminate accidental overdoses due to not knowing the dose.

      Violence associated with the sale of drugs would be completely eliminated as it would be sold in s normal retail environment instead of on the black market where there are absolutely no rules on what is fair or ethical.

      With the sale of drugs now regulated, the availability if the substances to people would be restricted to adults that understand the consequences of their use.

      An unimaginable amount of money would be saved by not having to spend money on drug enforcement at the local, State, and Federal level, not incarcerating drug offenders, savings in healthcare costs due to the gusted decrease in instances of common diseases amongst the addict community (help, hiv, etc.).

      The leaps that would be made in their treatment of addicts due to the funding that would be available for research of the biology, psychology, and socioeconomic factors related to addiction.

      So it’s overwhelmingly obvious that legalizing drugs creates a scenario where violence is decreased significantly, overdose deaths are deceased, treatment options for addicts are not just increased, but access to them is as well.

      Lastly, and possibly the most impactful thing for the majority of people, is that the legal and regulated sale of drugs would create a totally new industry and source of tax revenue. To satisfy the market for these substances, your need businesses to be created, stores to be built, employees to staff these stores to be hired, equipment purchased, and all the other necessary things to run a business. Then with the taxes from the sale of these substances, you could provide a lot of help to the many states struggling to balance their budgets right now. Just looking at what legal marijuana has done for the states that are now collecting taxes on that, you can see that legalizing other illicit substances would mean a HUGE boost to the tax revenue of the states.

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