The 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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  • I think we should talk about what Portugal is doing about it. Reagans ongoing,”War on Drugs” is a war on people with addictive disease, punishing them, making ill people criminals. Also, decriminalization Is not the same as legalization. Those with substance abuse problems in Portugal are now offered treatment, instead of caged, with incredibly beneficial programs. Such as the program thats offers businesses to pay half of an addicts wages foe the first year or 2, if they hire an addict recovering and rentering the highly competetive society. This is a win/win for both employer/employee. As addictive disease is a problem inwhich one bonds to a substance to self-treat an underlying issue, creating healthy social bonds replaces the relationship to the drug with healthy relationships to people. Positively, this alone has proved to be highly significant in battling addiction in Portugal. Not to mention varies other programs and ways to help. I recommend looking into this and coming to your own conclusion. I also encourage you to share your findings and further the conversation as this is a problem that cannot wait. Thank you for taking the time to read this.

  • My heart goes out to everyone who has lost a loved one to overdose. It is so tragic. I see it that way because they are just doing what they do to feel normal, to ease the pain inside, or to stop the withdrawals… Not for one second did any of them think this would be their last time, none meant to die that day. My 29 year old son overdosed on fentanyl on April 5, 2019. I am so heartbroken, life will never be the same. I cry every single day and stay to myself because he’s all I want to talk about and I feel like people are tired of hearing me talk about him all the time. However, it hurts so bad that I can’t bring myself to look at pictures of him yet. His urn is sitting on a shelf in my living room and when I walk by I can’t look that way. I keep thinking about all the horrible things that went on in our family during his active addiction and now I wish I could just hug him, look him in the eyes and say I love you son no matter what. Instead of doing that I said things to try to make him take a good look at himself in hopes he would stop using. These things must have sound like I was constantly putting him down. Why didn’t I see it that way then?!! God, I made so many mistakes when it comes to dealing with my son during his addiction. During all that hope I should have made him feel more self-worth. I should have told him I loved him every day and let him know how lucky I felt to be his mom; hugged him every day; reminded him of his talents, good deeds, sensitive heart, and told him how proud I was that he had such a loving soul that was so giving and compassionate toward others. I feel so horrible sometimes. The only thing that has helped so far is going to a support group for those who have lost someone to an overdose death. I thought our story was totally unique. I was very surprised to know other parents felt like what I just described. Although it sounds terrible, it helps to know that my husband and I are not alone or unique in any way when it comes to the crazy dysfunction that goes on in a home when someone there is struggling with addiction. I pray we can all find some kind of peace to get us through each day because although we must go forward there is no moving on. I saw a saying today that said: You don’t get over it, you get through it. It doesn’t get better, it gets different. God bless you all.

    • I’m a heroin and Fentanyl addict and I can promise you that there is no better way to try and deal with someone’s addiction and to try to get them to see what they are doing to themselves. You did the best you could and even if it doesn’t feel right or okay now, you were trying to save your son. I could not see what I was doing to my family, to my mother. I woke up while in the hospital for withdrawals after being arrested to find my mom next to me sobbing. All I wanted to do was turn over and pretend to still be asleep so I didn’t have to face her pain. I forced myself to look at her and to see and feel her pain as well as my own. I’m 4 1/2 months clean but I could so easily be dead from an overdose. I want you to know that stories like yours help keep me clean. I’m so sorry you lost your son to this horrific disease. I wouldn’t wish addiction on my worst enemy. As an addict I appreciate that you can see us with compassion. I hated having to use everyday just to survive but I didn’t know how to stop the misery of existing that way. I’m sure your son felt your love for him and didn’t doubt it. I hope that maybe seeing it as his suffering being over now, that you can find some semblance of peace. I’m so sorry.

  • I know the pain you all are feeling…my 27 year old son just overdosed on the fentanyl drug…we are having his memorial sunday…our lives will never be the same…we need to get this drug off the streets…our babies are dying because of it….his “friends” left his to die no one called 911…

    • Lisa,
      I am so, so sorry for your loss. I wish I had answers for this devastating loss and the loved ones left behind. It will be 2 years on August 27 that we lost our son to fentanyl and it still seems like yesterday. You are in my thoughts and prayers.

    • I have to say my heart aches reading your stories. I am a recovering heroin addict. In June 2019 it was my 1 yr of life without that poison. My 16 yr old daughter lost her father to an overdose and a few months later my 3 younger children almost lost they father to what he thought was heroin, but ended up being 100% fentanyl. Took 4 shots of Narcan to bring him back. So lucky he is. And for whatever reason God decided to spare me that day. And i didn’t do any of that. It could have easily been me. And my 16 yr old would have lost both parents. The one thing I want to offer families struggling with a addict close to them is to k bbn ow you can offer them rehab, sign them into one, give them ultimatums, whatever. But an addict has to be 100% wanting to leave that lifestyle in the past and take it so seriously. Its a lifestyle change. And if they arnt ready its not going to work. I had to change everything. Clear my phone contacts, keep my old addict “friends ” in the past. And most of all learned to live again. Its a day to day process. But im so glad and I will NEVER go back to heroin. Its not worth losing everything for. Because no matter how much you think you can control it it ends up controlling you. Always. My blessing and prayers are with the families going thru their losses.

  • I accidentally overdosed on Friday night August 16 .. myself and 2 coworkers from our bar thought we were doing a lil cocaine … we all flatlined & thank god were revived in time by the paramedics . The effect was so quick I don’t remember anything until waking up outside on a stretcher with ambulance and cops everywhere.. honestly most scary thing I’ve been thru especially knowing that all 3 of us girls were dead within a min of taking it . A huge wake up call .

    • I pray you learned a lesson!!!!!! My son was not so lucky. And whoever was with him left him to die. He lived in another state and police never called. His brother got a msg on Facebook telling him his brother was dead. I hope you can imagine, or at least try, to think what that msg could have done to your parents and loved ones. Our family is devastated and I am lost without him. Wake up young lady and I hope you tell authorities who gave you the drug. They DO NOT care about you. All they care about is money. Think long and hard and remember you may not get another chance to live if you do drugs again. And thank the Good Lord you lived through this. You may not get a next time.

  • Trying to prevent abuse is one thing, and fine. But doctors are now so afraid to prescribe anything. I had to change primary. The last one prescribed morphine for chronic back pain. 8 years, never had a problem, never sold it, never ODed. But NOBODY will continue the morphine. They’ll give me Norcos, tramadol, but nothing that works. Hence I’ve been in pain every day now for 2 months. Let the doctors do their job and HELP THE PATIENT!!!

  • Fentanyl was always so potent it should have been absolutely, totally, restricted from its inception in the same way as plutonium is. But hey, common sense does not make revenue for drug companies.

    • Drug companies cannot control people who do not know the chemistry trying to make it at home with inferrior accuracy, care, purity, and proper testing to insure the final product is the correct compound, or expensive, highly accurate scales and preparation proceedures necessary to dose it properly. Plus, they dont care so long as money is made. Lately though, the same can be said about Dr’s and drug companies like Norco etc not caring about patients and introducing dozens of harmful man-made chemicals as “anti-abuse” ingredients; in reality they are a health risk, cause the medications to be much less effective along with many other things yet lie to people about “epidemics” and “tolerance”

      Its not the compounds fault, nor the company that produces it dosed and labelled properly with warnings, that people do stupid things. You cannot legislate away bad decisions; instead place the blame where it belongs and urge the law to do their job and stop the street manufacturing…leave the poor suffering elderly, cancer patients, etc alone and stop trying to strip away their only source of relief. When taken properly as *needed* they all are quite safe with minimal side effe

  • I just found out that my 26 yr old son, who passed away on 6/14/19, died of fentanyl poisoning. He thought he was getting heroin, but was given straight fentanyl instead. He had NO CHANCE to survive. He battled his demons his whole life, until the devil gave him fentanyl. Now he’s gone…leaving behind a fiancé & step daughter. Even with stints in rehab, he was still addicted to the quick high of heroin. He had overdosed several times before & came out of it…not with fentanyl, there is no coming back from this!!

    • Denise, I am so sorry for your loss. My son Frankie passed away March 13, 2017. He also was 26. He also died from a fentanyl overdose. He too had no chance.

    • So sorry to hear about this lady son passing after taken fentanyl I personally know how strong this opioid is I take fentanyl pain patches for ankylosing spondylitis and at times I feel like it’s blowing my head off not the stuff people should abuse

  • My son died March 21,2019, from a terrible episode with Acetal fentenual. This is strong than the regular fentenual. Please get help with your addiction , your playing with a loaded pistol. This was his second encounter with fentenual and it took his life. He was only 26 years old,almost turning 27. He was our baby son, my old son is a heroin addict also. My wife and I , our lives will never be the same. Don’t mess with heroin, it’s a loaded gun.

    • I wanted to know about fentanyl when I came across this article. When I started reading the comments my heart was absolutely broken. James, I just cant find the words to describe how I feel for you and others on here that’s lost a son or daughter to drug abuse. I am a lucky man because I still have my daughter but what my wife and I have been through was a total nightmare. When you say you and your wife’s lives will never be the same, people just don’t know. People just don’t know the total hell one goes
      through like the endless nights wondering when the law was going to pull in your driveway with bad news or ask you to come identify your child’s body. I have about 11 years of this kind of hell in my life not to mention having to raise my granddaughter because of my daughters drug addiction. I know my hell doesn’t compare to yours and others on here but you was right when you say your life will never be the same. I will never be the same because my daughters drug abuse beat me down and took my health. I love her so much but I will never be the same. May God bless you James and all who have lost a child to these damn drugs.

  • And why has fentanyl become more common than actual heroin? Because of our backward draconian drug laws! Prohibition has never nor will ever work.

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