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.


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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  • There are so many drugs in this city. I never tried drugs. I live In a nice neighborhood.
    Drugs are really popular here syringes every where on the ground. I’m wondering what if feels like to try drugs. The courts and probation overlook users. It can’t be all that bad.

  • Eric drugs and fetenoyl are legal in NH. you only get 2or 3 months for a small time dealer ,user. Probation lets you shoot up. They need to regulate it so people don’t die from it, and give clean needles. Hep c / AIDS are more of an epidemic among users.

  • Look up Mike Gill state of corruptionnh on Twitter or Facebook. This is why politicians / judges don’t give time to dealers users he says it all. They only prosecute a few at the federal level that arnt in their network

  • My son just died from straight fentenoyl. It’s such a tragedy they trust people they shouldn’t and it cost them their lives. Now I have a life sentence of missing my son. Please people don’t risk it

    • Sorry Kathy , I have lost many –After running the reasons and solutions always it goes to we must legalize these drugs and make sure the purity is checked and the cost is kept down -the two reasons why there is so much trouble associated with this so called epidemic . It seems the only solution.
      Trumps current stance along with Sessions is arcane thinking of about 75 years ago based on hysteria and myth.

  • That’s how NH. Is dealing with the fetenoyl crisis. They revive them with narcan , so they can overdose again hoping they will die. There is no help for them. There is no jail time for them. I have seen many overdose up to and over ten times with out any penalty. I thank the firemen for saving their lives, many times over and over.

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