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.

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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  • Some of these comments are ridiculous! First of all people ie: Users or Pain Patients need to be RESPONSIBLE AND ACCOUNTABLE!!! Anyone receiving a script needs to take care of that script. Which most do, that’s all they get. After most have been cut off or cut back significantly. They are locking it up. Those who have been cutoff due to epidemic are now buying on the street or just committing suicide due to pain not being controlled.

    As for USERS/ABUSERS they are out looking for street drugs. They know what can happen. Going after doctors, hospitals and pharmacies isn’t going to help your loved one. Your loved one isn’t getting his drugs from a script or pharmacy. You want to “shut it down”?? Then I hope to God you or your loved one never had agonizing daily pain from anything that could happen. Disease or accident.
    Stop lumping patients and addicts together. 95%+ are NOT the same.
    I get it you’re angry. But direct your anger at the right direction. Don’t make my loved ones suffer too.
    Many pain patients use opiates everyday and arent strung out. It takes the pain away to the point they can work, care for their families and function for the day.
    Addicts- there are functioning addicts just as there are functioning alcoholics. You may never know who they are.

    There’s street Fentanyl and prescription Fentanyl and I assure you, they are not the same.
    Do some research and get the facts. Talk to some addicts. Talk to some counselors. Talk to your dr!! Talk to a pharmacist. Talk to your police dept. Go to painnewsnetwork.com or nationalpainreport.com, Moveon.org, etc etc etc the facts are out there.
    There will always be drug dealers and drug users. Supply and demand. What about your government? They allow so much into this country. Goes back 100 years. Do your research.
    A wall isn’t going to stop drugs!!
    They are manufactured here too. They are smuggled in from many avenues. Mail, boat, humans, planes, etc.
    Alcohol is a drug too!!
    Just watched MSNBC. One Nation Overdosed. Mostly about Fentanyl. Some dealers are going back to methamphetamine since so many are overdosing.
    One cannot blame one person but many. Anyone who purchases street drugs has to know just what can happen by now. Its everywhere. Its on tv every day.

  • I wonder to what extent the epidemic of opioid deaths is caused by inadequate mixing. I’ve been involved with industrial powder-mixing operations, and it’s not easy. For an incredibly powerful drug like fentanyl, I don’t know how amateurs could possibly dilute it effectively. You need specialized equipment for that. It would be really hard to avoid having some bags a lot more powerful than others. You can’t just put the ingredients in a big jar and shake it — not even close. I sometimes think I should go into the business of making equipment for these drug dealers so we could avoid any more inadvertant opioid deaths due to improper mixing.

  • Why the hell don’t we just completely ban this stuff? It’s killing more people than ludes did, and most deaths on those were car accidents, not overdoses.

    • Why don’t we ban liquor. Way more deaths. Because people need to be responsible and not put a needle in their neck. At that point you gave up on life anyway so a little spice to speed it up is really what they want anyway. Pumping the gas is what they call it at the bottom.

  • The h in pic if close to will take out about 4 ppl if 90npeevwmt or better. The fentynal dose is a low dose they give e.r patients every day sometimes. If it’s carfentynal it will kill you. But I’d you have any good opiod tolerance the dope one the right is nothing NOTHING close to the tiny fentynal. Now if it’s carfentynal ok the grim reaper is wating for you and the dope , even if 80 %. A little research will do a lot. As little​ field test will some wonders
    Peace, love , respect

  • #Fentinall,a elephant tranquilizer.
    #Suspicious Fentinal sales,attempted murder,murder in the 1st.degree.

    Fentinal is way stronger then herion and you get 30 to 50 times less for the same price,if you can overdose on that amount of herion and the smaller amount of Fentinal then that is Murder,attempted murder because if the person buys it in the same qaunity ,that’s going to kill them .Every other law pertaining to Malicious intent ,attempted murder 1st.degree murders ,manslaughter,involuntary manslaughter ,what ever charges they get or end up with ,that’s the way it is whether they have lawyers or not.Drug Dealers ,especially herion,Fentinal dealers are a huge menus o society ,lower then low and they are killing our children ,family’s our friends and neighbors.”Its that bad “.
    I think people should get manditory 50 years just for the sale of it If their customers die from it especially the more suspicious ones ,when you know they either weren’t even on drugs ,let alone that kind of drug and/or you know it was against their will .”That’s murder” 1st.degree murder,1st.degree attempted murder and all kinds of other charges They should get the death penalty.
    Drug Dealers are making alot money ;especially herion and crack dealers,so they don’t need to scrimp on making go further actually it’s the other way around Drug Dealers are saying you the same amount of Fentinal for much cheaper,well that might be true ,but defeats the purpose if they can only put the size of a “flea” or smaller and mix it in the herion,so where is the savings on the herion?
    Also,the Dealers are left with alot of left over Fentinal,they are selling as herion only too.
    If you have even just a small fraction of Fentinal it can kill you ,it causes cardio,respitory arrest,so you die either way.
    I think it is too stupid ,dangerous ,not worth the risks and of coarse the ovxious people lives and the ones who love them shouldn’t have to say.
    How in the hell can a Drug Dealer make money if they are killing g off all their customers,people asked?
    Well,according to some Drug Dealers and their other lower affilliates,they are picked sometimes ,so it’s premeditated murder either way,in the 1st.degree.
    There are alot of weird people in the world and there are alot of Drug Dealers living
    everywhere,alot of them are Sexual Deviants,perverts and they like to live around the same places as other pedifiles.
    Areas that have children,parks,playgrounds ,Beach communities,schools;especially the ones that are less expensive to live in .The real big Drug Dealers might live way out in Country,Suburbs and whatnot,but not all of them alot them that aren’t real big prefer the City and suburbs BRB SLS

    • If you’re going to try and demonize something, at least spell it right. It’s FENTANYL, the nyl is bc it’s a carbonyl and then fent part is from the phenyl group

    • Please learn how to spell and use proper grammar before you act as though you know everything there is to know about drug dealers. All drug dealers are different, some have families and don’t want to hurt anyone. Stop using stereotypes you hear in the media to demonize people you don’t know and with words you can’t even spell.

  • To the world….after reading the first comment I feel compelled to give those of you the truth.if you have been taking methadone if u miss one day you do not endure excessive withdrawals.n those that claim that are suffering from the side effect produced by a psychological breakdown.I’ll spare you the breakdown n science of it all.and I doubt that man didn’t know his wife was using.if he was a addict and couldn’t tell when his wife was under the influence of opiates something’s wrong.I’ll b writing a book called the living dead n it does not get more real and in depth about the real life of opiate users than any literature or published reading on the shelf.not only is it terrifying and heartbreaking it is the story of a enslaved soul trying to break free from the demons that pull his strings…p.s.to the man ..I’m sorry for your wife and if my opinion is offensive.I too suffered a loss that can never b replaced.my advice is find someone who can mend ur heart.she’s out there…

  • Hello everyone. This is not entirely related to the above post but it is related to a lot of the comments. This will be a long post, so please please bear with me. First of all, I feel deeply for all of you that have lost loved ones due to the disease of opioid addiction. It IS absolutely a disease. Your sons, daughters, husbands, wives, friends, etc that are struggling with this brutal disorder were not weak….not foolish…they were very very sick. This addiction is indeed a real mental illness that the addict can in no way control on their own. Prayer, wanting to stop, knowing it may kill you, trying to live for others…none of these things can correct the disease. In the same way that wishing you didn’t have diabetes or cancer will make you not have it. They didn’t want to die, they didn’t want to hurt you, they had a disease that they couldn’t control. So here goes my story:
    I am a 45 year old male living in Michigan. I was a very good athlete in HS and college. I played division 1 NCAA baseball on scholarship. During my baseball career I had 3 shoulder surgeries that left me with chronic pain in the back of my shoulder. The team doctor prescribed me 750mg Vicodin (90 per month) to deal w the pain and still be able to play. My tolerance quickly skyrocketed and within 1 year I was taking 18-20 of those per day…every day. When that became too expensive I switched to OxyContin. For roughly a year that worked fine for me and I actually excelled my final 2 years on the baseball diamond to the point of being signed as an undrafted free agent to a MLB team. I was designated to their rookie team…and never made it above single “A” baseball (not related to my addiction, I just wasn’t quite talented enough of an athlete.) So at the age of 24, I was done playing the game I love…and firmly in the grasp of an opiate addiction. Still, I was a happy person with a lot of hope for the future. I went back to school after my ball playing days fizzled and completed my course of study, so I have a college degree. I got a really good job at age 25 and was making over 80k a year. Everything seemed near perfect! I married the love of my life at age 27, I adored her to the moon and back. She was my best friend, lit up my world and I couldn’t wait to settle down w her and start a family. We had our first son together when I was 26. It was the happiest day of my life, I cried like a baby 🙂 However, after years on Vicodin and Oxy’s…for some reason they were not enough for me anymore. I started to feel like I was producing no dopamine and needed something else to “make me feel normal”. I was making enough money to feed my habit but couldn’t stand to see my bank account dwindle away day after day. Then an old friend told me about methadone. I tried it, felt sick as a dog, projectile vomited and swore I’d never take it again. Yet 1 week later I was in a methadone clinic drinking daily doses of the most dangerous “maintenance ” drug in existence. I told nobody, not my wife…not my friends…nobody. I stopped at the clinic on my way to work every day and got my dose…and that was that. When I couldn’t get to the clinic, the wd was so severe that I started buying little dime packs of heroin just to hold me so I wouldn’t be in withdrawal and could function normally as far as work, home life, etc. It was also by far the cheapest method of “feeling normal”. I was a very high functioning addict…very few people knew I was a full blown addict…and nobody knew the whole truth or just how far I had actually fallen. In a matter of a few years, I went from minor league baseball player signing autographs…to just another lowlife sitting in a methadone clinic and buying cheap heroin. I had every reason in the world to stop. I had a beautiful wife that loved me like crazy for some reason, by this time I had 2 fantastic sons that idolized me and brought me pure joy…and just an overall happy, easy life waiting for me. Yet I could not for the life of me quit. My brain just would not allow me to be free. Finally after years and years of living this double life, I broke down and told my wife everything…and I mean everything. We talked and cried all night, she was so incredibly supportive…and she immediately took control and came up w a plan. She got me into a suboxone doctor that same week, but the first attempt I had with it failed. Finally on the 3rd try and after forcing myself to be in severe wd when I started taking it….it clicked. It was a miracle to me. I felt normal, no withdrawal, no high, just back to being me again. Eventually she helped me do a fast taper and I was completely off everything. I have been off all drugs for 6 years now. I wish to God that was the end of this story…it is not. Three years ago, that light of my life…woman that believed in me when I didn’t even believe in myself, my better half and best friend…died of a drug overdose. She snorted some heroin…cut with fentanyl…and had a pontine brain hemorrhage. I came home one night after taking my son to the movies so that she could get a break from the kids and some personal time to herself….and found her face down in front of her vanity w blood coming out of her nose and mouth. She was already dead when I got there but I still tried to revive her after calling 911. They pronounced her dead on arrival. I can still smell and taste that room in my mind…I can still remember clutching her cold hands and kissing her cheeks sobbing and telling her I love her…please please don’t leave us!! I didn’t want my sons to see it, so I tried to collect myself and had them walk down the street to my parents, so they wouldn’t see their mommy wheeled out of our house in a body bag. Ironically, the person that saved my life and carried me through my darkest days…never giving up on me…had secretly developed her own habit and I was so wrapped up in my own struggle that I failed to see it. Apparently she had become depressed after the birth of our 2nd son and rather than admit to me, or anyone else that she was struggling…she tried to self medicate. I’m haunted by the thought that she kept it secret so that it wouldn’t burden me or damage my recovery. She was not a junkie, she was not weak, she was the greatest and most beautiful human being I’ve ever known. I miss her more than I could ever explain. She suffered in her own mind and had absolutely nobody to turn to. Obviously I would have done anything for her if I’d have known…but instead she suffered w her disease completely alone. I didn’t help her….My God!! I didn’t help her!!! She was a beautiful soul, caring, selfless, loving and a wonderful mother to our sons…and they will never know the simple joys of sharing their achievements w their momma. My heart aches every day, I’ll never be the same…never forgive myself for not noticing her disease. I let her down after she raised me up and saved my life. I live every day of my life trying to be the absolute best father I can to our 2 sons, which I now raise alone. I have not and will not re-marry. I have not had any type of relationship w another woman since she passed. Not physical, emotional, nothing. She is my wife…and she is gone. These drugs can take great people, with beautiful lives….and completely destroy every fiber of your being. If you know someone is struggling, get them help…suboxone is the best alternative in my opinion. As long as it’s tapered down fairly quickly. I feel for all of you, I know what it’s like to never feel whole…to always yearn for someone you will never see again, to look in my sons faces and explain to them why their mommy is gone. God bless you all

    • Thank you for sharing your story. I just lost my brother on 6/8/17 to a heroin fentanyl overdose. My family loved him and I stood by him going to meetings and trying to support his recovery. I wish every day there was more I could have done. There are so many words I wish to write. But, I just want to say thank you and sending love to your family.

  • Thats a weak comparison, the weakest cut heroin dose on the left, and the strongest illegally made fentanyl on the right, probably not even fentanyl but a similiar fentanyl like drug. Addicts scrape 3 fentanyl patches and shoot it all to get an eqvilant high to 1 once cut heroin dose off the street. That is 75 milligrams at once of fentanyl. And these scum bag addicts get the needles free, and also get the narcan nasal shooters free. So their looser boyfriend, girlfriend or even child sit nearby and if they stop breathing they shoot the narcan up their nose to bring them back to life. Total crap.

    I’ve been a nurse dealing with the worthless addicts for 25 years, they will never stop till they are dead in a gutter. They have no trouble getting drugs in Jail and Prison because the guards bring it in to supplement their income.

    fentanyl is so cheap from China its gonna put the CIA out of business with their heroin import scams.

    The cure is to get the Narcan off the streets. People will always use illegal drugs, and saving them so they can continue to steal to support their habit is not the answer.

    • Dawn, my heart breaks at your hostility towards people with addictions. I promise you that nobody loves being an addict. (You may need to review the definition of addictions and remember that the struggle can be extremely difficult to overcome) So may young people make the mistake to take these drugs and it completely destroys their life and lives of those that love them. You being a nurse terrifies me. Your lack of sympathy is shocking!
      Do everyone a favor and find a different calling. I suggest loving God and loving others.

    • I hope you never have to deal with the heartbreak of having someone you love addicted. Only then would you understand how wrong you are. They are not worthless. They are parents, children, siblings. Imagine someone you love struggling with addiction every day of their lives. Imagine strangers who know nothing about them thinking they are worthless and not worth saving.

    • Dawn,
      My heart aches for anyone who has been under your care. I believe you are in the wrong profession. With such apathy, I hope you never experience the loss of a loved one to a drug overdose.

      I just lost my brother. He broke his back roofing in 1998. He tried to fight workers comp and disability for years to get proper treatment.

      He just received an approval letter on 7/3/17 for permanent disability. He’s gone now, so a little too late.

      Please show more wisdom and compassion in a field where people seek help.

    • While some other are correct in your lack of empathy for these addicts, they act as children, as though the problem does not exist in the extent that you deal with. The problem is not how we deal wit them, it’s that addicts to this crap are being created to begin with. People need to stop with the “Your lack of sympathy is terrifying” emotional response which is irrelevant; the real thing that’s terrifying is the destruction of families and communities and the ghastly state of these addicts.

    • Shame on you. You call yourself a nurse?! We, as nurses, care for the sick. Addiction is a disease. It is our job to help them and educate them. Perhaps you should consider another profession or perhaps retire. The sooner the better

    • Um, you don’t get fentanyl from scraping the patch. You won’t get anything, or at least, next to nothing. The drug is actually embedded within the mesh, it’s not in the gel or on the surface of the mesh. You have to soak the mesh in tea or hot water to get it out of the mesh. I’m astounded that you don’t understand the pharmacodynamics of this medical device if you’ve trully been in the field for so long!

      Just because you’ve been ‘played’ by some abusers doesn’t mean that they deserve to die. That’s cold lady! Brutal! I think you need to reexamine your ethics. If you decide to keep that attitude/ethos, you should quit your job. You’re in the wrong line of work. You might be in the wrong line of work anyway since apparently you’re not attending CME classes in the drugs/devices that you use every day at your job and don’t understand how they work. Just sayin’…

    • Dawn, its disappointing to hear you call addicts worthless. I am also a nurse and I want to make it clear that Dawn is not speaking for all nurses when she says this. There is a physiological component to addiction, you can say it is a choice but it isn’t always so easy. I know I shouldn’t eat an entire pack of oreos, but sometimes I do. Everyone makes choices. When I am at work my job is to help patients. Not judge.
      You might want to read the book Trauma Stewardship, it sounds like you a burnt out from working an emotionally and physically difficult job.

  • I have been reading all the comments regarding heroin and fentanyl,I lost my son just 3 months ago and got the results from the Coroner yesterday and Heroin,Fentanyl and cocaine were all in his system…his death was the result of this deadly combination of these drugs…I am sure the mix with the fentanyl caused his death, I sure blame the drug dealers.

    • My condolences to you.. we also lost our 26 yr old son feb 9 of this year to a fentanyl overdose. This is ridiculous. We seem to be loosing a generation of 20+yr old males!!!

    • Hey,I’m so sorry to hear about your son I totally understand what ya going threw. I have a daughter that is three years old. If I lost her to that drug idm how I’d feel god will forgive him .a lot times kids are just or men teenagers woman young woman rather with wrong guy or girl that leads them or group of peoe cuz if o e is partying every one else is doing it its hard to fit in do to not being on same level so some rather leave that person or groups of people or join the dark side. I’ve lost 56 friends woman men fathers husband’s aons daughtera parents cousins uncles all over the drugs mix or just leathel doeses or drug deal went bad shot murdered r.I.p Scotty Montero kid like your boy just fitting in or what not told dealer to put down the gun don’t shoot my friend he will give you the money doesn’t have to be this way pointed the gun and killed him for just trying to be a hero brave . what in saying is it need to be shit down like that doctor saying g shuts morphone down blows it out the water … Who gives a shit blame the dealers yes but our pharmacies our hospitals are ones developing it . of it isn’t made any note where they going to get it won’t be locally be some one in a lab making it and shipping it over so if pharmacies shut this down it would cut out at least 65 percent od . they will have no where to get it from peoe that are hooked on it from percscription can trade for THC weed so many different ways they can take it food drinks smoke and will help them get off it its non addicting . what I need is parents like you to fight this I’m sock my friends firing I’m going to my church in Plymouth this Sunday and get a pstitin going we need bring this to news needs to stop go to courts Please msg me on fb my name is his you find me on fb

    • I’m sorry about your loss. I too lost my 26 year old son on March 13 of this year. The toxicology report came back and he died of a fentanyl overdose. No heroin in his system at all

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