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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  • So we have a problem do we??? then
    Do the only right thing and legalize these drugs without schedule or regulation . No more deaths and no more prison industrial complex .
    Until this is done more and more people will die. so why is this not done???
    follow the money at the top . Proves money is more important than life .
    “The degree of civilization can be seen by entering it’s prisons”

    • Neither schedule nor regulation? As in, no way to monitor who is mixing/cutting/measuring the doses, nor to regulate who is producing the drugs? That sounds like a recipe for massive death and disaster.

    • Just because someone suggests decriminalization of drugs does NOT say that person is a drug user!!!
      Just because someone is a chronic pain patient does NOT mean he/she/they are cause of this so-called “opioid epidemic”!!
      I lost my second son to heroin in 2012. He’d been clean for 20 months, but fell off the wagon. I still feel his absence within my family and most definitely in my heart.
      I have been a chronic pain patient since July 1999. Ask someone who is a “CPP” and I guarantee his/her/their response? “I’d LOVE to be pain free”. 99.9% of us didn’t ask for this to happen.
      Myself? I had a wonderful career (nursing), had been accepted & looking forward to a new career (radiology) when I was slammed to the ground with several different issues/diagnoses.
      Now? There are days (esp in winter), I have to take a pain med b4 I can even get out of bed!!
      This is NOT what I imagined my life would be like 20 years ago!!!
      So, for those people who can only say “you’re nothing but a pillhead” or (even more idiotic) “you’re the reason this ‘epidemic’ is here” I want to offer you this choice:
      Live in my body and deal with what I have to live with for a week. Too long? Okay, 2 days? Still too long, o ye so smart people? 24 hours then.
      I would place a freaking HUGE wager you could NOT tolerate my life for even a single hour!!!
      So please, before you cast blame, look around YOUR family, YOUR friends, YOUR co-workers and see if any of them are CPP. THEN you may make the stupid thoughts verbal!!

  • The answer to the opioid crisis.is to have heroin.clinic’s. A place that you could go and get pharmaceutical heroin 3 or 4 times a day. People would then know what they are getting. Opioid addicts are aware that people are getting dope cut with fentanyl or other fentanyl analogous they dont care when they are sick. I think this may be a governmental plan for genocide on opioid addicted people because someone’s really trying to make it hard to get painkillers like hydromorphone. It’s easier to get fentanyl from a lot of doctors than hydromorphone. This is my experience at least. If I could I would gladly go to a heroin clinic I have been on methadone,suboxone, I’m currently in a long term treatment center they are working with me on my pain meds trying to teach me how to manage them instead of abuse them but even though it clearly shows on a mri my back is pretty messed up doctors are so afraid of treating pain with the painkillers I have been on for years because they may lose there license if I overdose. I don’t blame them either they worked to get it but they should have a better pain contact with patients saying these meds can kill expressly if abused

    • And just who,pray tell, is going to pay for this stroke of genius? The taxpayers,who don’t use this poison? BULLSHIT!!! They already pick up the tab for enough worthless slackers.

    • Dale:
      I really don’t like to assume because you know what they say about assuming… but I’m taking a leap here.
      I’m going to assume you live in a city (definition: population above 50k), at very least a large town. I would also venture a guess that somewhere in your hometown is a methadone clinic. Why do I say this? Because 98% of large towns/cities have them!!
      Do your tax dollars go to these hotbeds of “worthless slackers”? NO!!! Why? Because the “worthless slackers” have to get a job to pay for each dose. No freebies handed out. EVER!!
      Now, it takes roughly couple hundred bucks (prob more than 10 years ago, but let’s use those figures) to make enough methadone for 500 patients. Each patient had to pay $25/day for his/her dose.
      DO THE MATH!!!

  • This shit is getting out of hand..in the world killing people who do it. They dont care about them selfs why should anyone else care!! People an programs to help them an most of them only do it cause they have to buy the court if they dont want to get help an stay clean an off the shit. Why should any one care if they die!!!!! They choose this path of life for them selfs i didnt choice it for u.. but your ruin youself any one who cares for u an trys to help u all… get your act together an get ofc the drugs…. all your doing is killing yoursrlfs an hurting your family in the process.. u dont care that is what hurts the most….

  • I no longer care about drug addicts overdosing. It is not possible to help those who are addicted, especially if they don’t actually want to be helped. What is the purpose of protecting them?

    • I can’t believe that you just said that. I have been on heroin for 15 years and I have been clean for 10 years now and counting.

  • My son passed with 3.5 ng/mL fentanyl and 0.13 mg/L cocaine. Can someone tell me the percentage rate of the fentanyl and percentage of cocaine. I strongly feel this was intentional on who sold this to my son. He lasted for eight minutes and my heart is shattered.

    • @Barbara First I’m very sorry for your son’s passing. Hope you and anyone that knew your son know that grieving is a process too. Your a normal human having a normal response to a abnormal event or situation.
      Fentanyl in the controlled healthcare environment is usually given in micrograms (mcg). Cocaine is black market and unable to manage or control.
      I would suggest you use google or a search engine for appropriate dose for fentanyl for your son’s weight.
      Also, every human is different therefore everyone has a different response to Fentanyl.
      Depending on your son’s history of use or abuse the black market is not controlled.
      If you are his mother and your gut feeling is telling you there is more to the story look at it from fact base as much as you can during this life changing moment.
      There is Fentanyl and carafentanyl based black market combinations that are killing many. Back that up with cocaine use and I wouldn’t be surprised anyone would actually die from this combination if not in a controlled healthcare setting.
      If you can gain grief support or you have facts that may lead authorities to possible homocide then take action or reach out to them.
      Fentanyl / heroin / cocaine/ Super Meth is coming into the United States in large quantity in the black market and it’s very dangerous.
      The only way to stop or decrease it, is people stop buying it.

    • That is heartbreaking. I hope you can find the strength to continue. losing a child is painful. I am sorry for your lose.

      to your question, the level of 0.13 mg of cocaine in the blood is common in drug intoxication deaths. Fentanyl intoxication levels are usually around 26ng/mL so his seems lower but I do not know drug to drug interactions and how this affects the levels.

      There are three background issues aside from the deadliness of fentanyl:

      1/ Evil drug dealers will cut heroin with fentanyl or replace the heroin with it entirely
      2/ There have been rare reports that a batch of cocaine may contain fentanyl
      3/ Mixing heroin (assuming no fentanyl) and cocaine is done by a small % of users for the high

      I hope he didn’t do the fentanyl and cocaine on purpose but instead thought he was mixing heroin and cocaine. Worse, it is even scarier to think that someone is putting fentanyl in cocaine. This has the potential to kill thousands more.

      Fentanyl may be fine for some for pain management but when scrupulous dealers try to sell it as heroin it is very easy to overdose on. A drug gang was arrested in lawrence this summer and the FBI has their phone conversations where they were laughing at how many junkies they killed before the got the fentanyl dosing correct. it is a terrible tragedy in the heroin world. The globe had an article about two addicts who thought they were taking heroin but their drug tests always came back negative. One died because of fentanyl in his supposed heroin powder which actually contained no heroin.

      So, the question is, did he do this mix himself to achieve a certain high or did he not know fentanyl was in the heroin or cocaine? Law enforcement know about fentanyl in heroin but if it was in the cocaine, law enforcement should be making this widely known to protect others from dying.

      Good luck in trying to find your answers and hopefully they may help others avoid the same fate.

    • Barbara-I am so sorry for your loss and share your pain. I lost my 38 year old daughter on Nov. 11, 2017, so the pain is still so real for me too. Two of the drugs found in her body were Fentanyl and Acetyl Fentanyl. The second is worse than the first. I too am looking at the fact that this was given to her. And the person who gave it was a dealer. Trying to work with police to see what they can do. In the meantime, I can make people aware. I never heard of it until November. These are devastating drugs.

      Barbara S.

  • I go all around Florida talking to juvenile kids thank you so much for educating me if you have any more literature please feel free to send it to me my mailing address is 8259 Northwest 12 Court Miami Florida 33147 thank you so very much

    • Its not how you think. People make the mistake of taking the painkiller. And it works. Problem is getting off it.. 26years later. Its impossible without help and even with help if your looking after poorly family etc you cant be going away to get clean. No one wld ever do it if they knew. Everyone thinks theyde get off it. Even people who smoke seem to believe THEY are stronger than opiates

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