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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  • 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, and decrease dependency on welfare while making america great again without trumps help. How?

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

    Next is reallocating the billions spent by the DEA/FBI/CIA/Police etc in the war on drugs and putting it towards addiction research and mental illness research to cure addiction for once and for all. We also take some of these funds and use them to open drug treatment centers and drug enjoyment centers. Enjoyment centers are like Morocco opium dens in the 30’s. You have a safe and protected place staffed by professionals to take 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 nation and state wide operating expenses freeing our court system to once again focus on real crimes with a speedy right to trial.

    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 dealer image as it no longer will pertain, hopefully pushing them towards a career in healthcare working in these centers.

    I posted similar idea yesterday 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

    • This would work EXCEPT privatized prisons and their political influence keep it from being so. Addiction, big Pharma & draconian policy fuel the prison industrial complex which fatten bank accounts.

  • @Anne, cleaning up?
    HBO just did a documentary on Meth Storm. The USA was able to decrease the amounts on Wall, main, and rural streets.
    Unfortunately, Mexico or its drug cartels has created the “Super Meth” in its purest form.
    Target audience, rust belt! Why, these areas in rural any where were people with jobs / careers that were yanked out out from under them by corporations that left for other countries. Leaving towns and counties / districts holding a bag of empty debt and high unemployment without replacement.
    Good people that were thriving and now using all kinds of drugs to sell or use to get by. It’s a reality that that is not going away.
    Much like our US bought and paid for politicians the black market drug dealers or users always has someone take their place when they depart.

    • AMEN TO THAT M. Everyone of us is a child of God. When Jesus came to earth He ate with, hung out with, came to save the sick. His disciples were a ragtag group of 12 imperfect men. I know you know where I’m going with this.
      I applaud you for seeing people as people. We all sin, we all make mistakes.
      Have a Blessed day M.
      Renee

  • Late Sunday/Early Monday you can hear “The Other Side of Opioids”. Learn how the DEA is persecuting pain patients and their doctors: coasttocoastam.com/show/2017/11/26.

  • In other words fentanyl is a wonder drug that could clean up the streets and get rid of the worthless junkie population? Sounds great to me.

    • I live in Washington State….the problem is horrible here…Seattle has a lot of money yet the homeles poppulation and drug use increases….its really sad…these are real people with problem not just a worthless junkie…

    • That’s a terrible thing to say. Junkies, as you call them, are very often good people, nice people who are just caught in the devil’s snare and can’t get out.
      You should pray for these poor unfortunate folks. I ask that you pray

    • Anne Rogers , everyone is somebody’s someone. 70 percent or more start through the medical world. In Canada alone, 30 million prescriptions are written every year by doctors for fentanyl. You callous, cold bitch . I guarantee your life will be touched by addiction , perhaps you will get hit by a car, and will be given fentanyl for pain relief and then you may understand how worthless you truly sound.

  • @LAD You nailed the problem that is the root of the problem.
    CIA operatives have said many times, “Its not the drug addiction, it’s the cash flow addiction.”
    Look no further than Portugal that legalized all drugs and addiction rates dropped to over 60%.
    Black market, Physician RX, the links in the chain, the anchor the Cash Flow Addiction.

    • Bobby,
      Whom are you saying has the cash flow addiction, the CIA,the users, the doctors or the pharmaceutical companies? It is logical to me that money’s spent on addictive drugs whether it be from people suffering with pain or other reasons which make up for 20% of the population should be kept for the society’s cost of maintaining these addictions and stay out of the hands of those organizations that are not in the loop such as CIA, probation officers, judges, privately-run jails Etc. Those that profit from this character flaw of society are the true criminals.
      Pete

    • @Pete. My oversight for not being specific.

      Check out the History Channel as one reference under the War on Drugs. CIA operatives explain; “The USA has a cash flow addiction.” Further explaining that if the cash was removed there wouldn’t be near the problems we would be having.
      Vietnam was a great start for the CIA moving heroin into the USA while young men were being radomly selected to war at 18 years old.
      Fast forward you will see Nancy Regan on the south lawn of the White House promoting the propaganda of “Just Say No” as President Regan or his administration / CIA moving Cocaine from Panama to the USA. The list of wars equate to moving illegal drugs will continue in this segment.

      Physician to RX overdose for pain management or abuse is 1 in 10 will die per day. This is not the problem.

      You will find on CNN the United States Coast Guard admitting they missed 500 or so trafficking incidents in 2016 because of lack of resources. Trump cut their budget just after that episode aired.

      Now, find your favorite search engine and look up a Sweden jail cell and compare it to the USA jail cell.
      Now search for this title ‘Prison is not for punishment in Sweden. We get people into better shape.’
      This will be found in The Guardian around November 2014.

      It’s a viscious cycle. Pennsylvania in York County Corner just did a press release of 16 overdose deaths on heroin or a spiking trend on Nov. 20, 2017. This is not a physician to prescription issue.

      Unfortunately, people who have chronic pain, or need an Opiod or opiate or have been on these types of medication responsibly are being included / treated like the drug addicts. Some people are hurting 24/7 and were yanked off by physicians without cause of a patient abusing because of the “Opiod” propaganda that doesn’t have the proper factual numbers to back it up.
      I could lead into Physician suicide is up from 557 to 661 last month but that’s a whole different arena!

      USA needs healthcare patient centered delivery system. When a patient is well documented with whatever treatment modality and it’s working. No need for intervention by CDC or other governing bodies.

      Yes there were 2 cities in West Virginia with populations of 400 or that had the coal mines shut down. Then the makers of OxyContin dropped 4.2 Million OxyContin tablets in each of those communities for use and sell and a class action law suit is under way with over 19 states on that band wagon for the pay out.

      I could talk about the horrible circle this is in. Take the laws away for drugs and Portugal saw 60% drop in addiction.

      The USA feeds off of cash / money / status. The USA doesn’t look at how to be more humanitarian. We Lock them up and no rehab, no education, create a profit machine. Now we have prison over crowding for non violent offenders. In addition Wall Street is doing well however jobs are still leaving in large numbers and people have debt, kids, and no way out.

      Hopefully I painted a big picture!

  • I think you actually missed the most important reason of why Fentanyl is more dangerous than heroin, it has a much narrower therapeutic index, it is a more powerful respiratory depressant.

    • Hi Melanie– the therapeutic index is the “window” between the minimum dose you need for the desired effect (pain relief or getting high) and the minimum dose that will poison or even kill you.

      Some opioids have a wide window–if you take significantly more than you need, even double or triple, it won’t necessarily be a medical emergency. Overshoot by just a little on fentanyl, which has a narrow window, and you can end up comatose or dead from respiratory depression.

      Because the dose that kills you is only slightly more than the dose that gets you high, and because the absolute amount of physical substance is so ridiculously small either way, ODing is very easy to do if you can’t accurately measure out microgram quantities of the drug, or if you believe you’re injecting something far less potent, like heroin.

    • James, actually fentanyl has a wider therapeutic index than that of hydromorphone the next strongest drug used for pain because of its fast action to block The receptors in the brain and quicker to leave the body. Heroin no longer has any therapeutic index because of it being removed from pharmaceutical use and made illegal.

  • Drug problem will never take care of itself. Ridiculous comment. Destroy the cartels,strong families and good jobs will go a long way. Education too.

    • Paul, cartels do not drive demand. Strong families can prevent addiction to those few that Kuwait after getting wisdom teeth pulled and are prescribed Percocets which can easily start the path to deadlier opioid use. Education is key to help prevent the one out of five people susceptible to addiction.

    • Paul, cartels do not drive demand. Strong families can prevent addiction to those few that Kuwait after getting wisdom teeth pulled and are prescribed Percocets which can easily start the path to deadlier opioid use. Education is key to help prevent the one out of five people susceptible to addiction.

  • I have been on opioid prescribed medication since 2011. I was able to stop for one (1) year after surgery ( I was pain free. In 2013-2014). 2014 I was in an auto accident an reinjured my back upon the impact and have been back on opioid prescription since. I know that if there were a way to live and keep the pain manageable without the drugs I would be happy to do so, however, at this time this is not possible. Some of you say that because a person has taken the drug so long they are addicted to it-Isomewhat true-my body is addicted, my mind is not. The year I was able to live without the drugs, I was weaned off and never missed them. I know I would be able to do that again at any time. I realize that I am lucky in that aspect and there are people who have addictive personalities. Those people need to seek help. If I were one of them, I would seek help! War on Drugs is not helping-We need to take the money out of the equation. Stop making it worth money to people. That is when the drug problem will stop. Once the money is no longer good enough to sell, make, produce, & traffics the drugs that is when the drugs will no longer be an issue. Take the money and put it toward healing, educating, rehab, and reform. Get the commercials back on tv “This is your brain on drugs”. Teach our kids as we taught them about drinking and driving. STOP JUDGING and start understanding that addiction is a problem that needs help. Know where to get help or send a person for help. REAL HELP! We need to STOP babies from being born addicted, mothers addicted when they get pregnant, fathers addicted when they impregnate the mother. These drugs have changed our DNA to the point that more children today are born with mental and physical defects then ever before in history. I have four (4) grand kids from the same son and daughter-in-law, of the 4 children, 1 has ADD, 1 has ADHD, 1 has Autisum (mild). Me, their grandfather, their father, their mother had never taken drugs, but their grand mother on their mom’s side was addicted to non prescription drugs. THREE (3) of my grandchildren suffer via DNA because of her drug use.

    We need to take the money out of the equation, educate our children & the drug problem will resolve it’s self.

    • I wish it was that simple. Drugs has always been big business so don’t know how you take money out of equation. Education is definetely important as is having a good,fulfilling job,purpose in life and strong family ties so people dont turn to drugs in the first place.Many of the people addicted don’t have addictive personalities. We have to work with other countries too and destroy the cartels like President Calderon was doing in Mexico in early 2000’s. Then we can hopefully reverse this epidemic for good.

    • The problem is that Western governments base their economies on the services that are suppose to help, 80% of the British economy is so irradiating the war on drugs diminishes it’s economy. Yet the users suffer while the suits exploit the derivertives in currencies due to the fluctuating markets because of BREXIT. Need real reforms ASAP

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