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.

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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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  • I wonder how many opioid deaths were intentional? As the various crisis we face intensify and the hope for a better future disappears, I see a bright future for the drugs manufacturers; compressed into a dark coloured pill, it might pass for the Black Mariah used in MASH to make suicide painless. I’m not looking for a Black Mariah yet, but I know I will NLT 2024 – when the 6th Mass EXTINCTION’s multiple events: the “decreasing resources crisis,” the “poisoning of the planet,” and “global population overshoot and collapse,” can no longer be ignored, even by our Glorious Gropin’Fuhrer, Hair Drumpf and his merry $$trumpettes, KKKonfederates and fellow Ignoranti. THEY are an added incentive to make the transition to whatever is really next. That we know is inevitable. What hasn’t entered the mainstream conversations is what extinction means for planning, long term loans, inheritances, hospice, disposal of the remains, etc. Reassembly and Resurrection of the Dead will be up to the mythologists.

    • Yeah Don,
      A lot of those deaths were part of the Epidemic of Despair, and uncounted suicides. Many of the dead were in their fifties, to old or disabled to work, and no future to look forward to. They are only telling part of the story, one where they leave out a lot of facts. One community thought they would shame all of the “overdoses” of course they did not seprate out the deaths form heroin and fentanly. More than half of the dead were over 50, and had a serious health issue.
      The created the market for fentanyl when they took away pain medications from sick people, and stopped the supply for the addicted, forcing them to illicit drugs.. They even conflated the words addicted and dependant, rendering all people with chronic pain into craven drug addicts. They did this for a reason, because many of those people with chonic pain wre the peopel the medical industry either could not or would not help. Many went for years with untreated injuries, and could not afford healthcare. There is even a lot of “Failed Surgeries” the industry buried those as if they never existed. The implants and surgeries they were sold had bad outcomes. These had to be hidden, so they came up with some false narrratives. Now there are people with cancer on their deathbeds given an acetominiphen, so they don’t get addicted. There are some really gruesome photos of peopel who survived multiple hip surgeries, and infections , along with their acetominiphen plan for pain. The industry had to hide the numbers of patietns who have had to get hip, knee and spine implants removed, sometimes several times. Now they are all considered drug addicts, so they can’t even sue.

      Let’s call it what it really is, and Epidemic of Despair. The day that creature was put in office, was the proof that the Dystopia is upon us. The suicide rates are stil rising, in spite of the silly way the media has covered it. When the administration claimed they were doing something about the so called opaite epidemic, what they really did was promote random faith based treament, which is what they have been doing for the last 20 years and it still has not worked.

    • Dear Don,
      I am a 60 year old mom and if my son posted what you wrote, I pray someone would reach out to him…..Are you my son??? Anyway, I just want you to know please don’t give up HOPE. You are loved! We are living in very dark times…
      And yes, I believe that Satan is alive in well. He steals, kills and destroys!
      Many times I don’t want to continue this life here on earth, It’s hard
      (especially if you feel all alone). Faith is being sure of what you hope for and certain of what you can not see!
      Worship the Creator and not the created. Ask and it shall be given to you,
      Seek and you shall find, Knock and the door will be open to you!! Jesus said these words……
      Love, Mom

    • It is almost as if they used the so called opiate epidemic to drive membership in faith based end times churches. The people who could afford it had accese to slick, upscale rehab centers that are marketed nonstop. Of course the low income people who were addicted were sent to varios faith based groups, moldy church basements with untrained volunteers or staff that mislead them about faith based treaments. Both of these had a lot of deaths, and remissions, yet they continued to promote these unnaccountable “treatments.” Even when evidence of deaths, after release occurred, they still peddled the model. It was as if religious evangelicals and such viewed this horrer as a way to recruit people to their extremist beleifs. Many communities had no treament, jobs or even a reason to live. The media described this as if all it took was faith, since they saw a profit in that misinformation.
      It looks like the deaths and suicides are going to rise every year for the forseeable future, yet no one has acknowledged how the misinformation and quest for profit is adding to the number of deaths. The reqallity shows 15 years ago, and the “Awareness” campains appear to be introducing more people to addiction and despair.
      Puritanical peope at the CDC are still spreading misinformation, and no one has stepped in to demand facts.

      https://www.motherjones.com/crime-justice/2019/02/opioid-epidemic-rehab-recruiters/

      The media is not teling the story of the veterans who are being denied pain care.
      https://mtstandard.com/news/local/obituaries/rory-g-hosking/article_685c2a50-6cea-5fb6-959d-7201b0b2af5e.html

      Americans want a simple and magical answer while avoiding the socio economic issues…
      https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304187

  • Our son was given Oxycodone after being hit by a car. Unfortunately we were not aware of the addiction potential. He worked always, bought a car, and was doing well we thought. Until he told us he was going thru detox. Then the dr put him back on it. He let an old friend move in and 2 weeks later was dead from heroin/fentanyl overdose. The police, coroner, nobody called us. His younger brother got a msg on Facebook telling him his brother was dead. We called and called cops and they would not call back. EMS ruled his death natural causes and I had to fight like hell to get a toxicology. They refused autopsy. Woops EMS was wrong. Police said no reason to investigate friend so I had the job. And here we are a year and a half later and I can’t say more. Our lives destroyed and the pain never ends. I keep going by seeking justice every day. Our son was so full of life and I still can not accept he is gone. I pray he didn’t suffer. I can’t understand why this happened. I flew to his apt with his brother after he died and I found prescriptions for 120 Oxycodone, Valium, Ambien, just unreal. And Florida says sorry nothing we can do. Unfrikking real. Does anyone really care?

    • Dear Mom,

      I feel your pain. I lost my daughter to a heroin/fentanyl overdose last June. From your comment, it sounds like your son developed an addiction to oxycodone. Most likely he went through the phase where oxycodone went from being crushable to non crushable. The quickest way to feed an addiction of crushable oxy is to snort it. When oxy became non crushable many users moved on to snort heroin. From what I understand, fentanyl became an added ingredient to heroin thus creating this lethal combination. The problem is fentanyl, where it is purchased, how strong is it, how does it react with what it is mixed with. Past couple of years there have been thousands of deaths of people snorting whatever with fentanyl. Too much fentanyl and you go to sleep and your lungs shut down. From what I understand, your son did NOT suffer. This affliction has caught our society completely off guard. Which is why, in my opinion, the authorities basically were not responsive to you. This affliction is very real and continues to take lives. The authorities see this every day and I think it is very scary for them. Being addicted to opiates is like any other addiction unfortunately it can have legal consequences and this is happening to good people.

      There are a tremendous amount of people who care about this problem, about human addiction. The use of opiates is common amongst people who suffer from depression and anxiety. I think we need to regulate the availability of fentanyl as it is readily available from China. From what I am told, fentanyl is now an epidemic in Australia. It is being used directly and not mixed!

      I hope this helps you. Your son like my daughter through a series of misfortune made a fatal mistake and now we are left to pick up the pieces and try and out our life back together. It can never be the same but rest assured tou are not alone as there are many many people going through the same thing we are going through. I hope this helps. If I have offended anyone then I do apologize.

  • I don’t get it. In the months leading up to my spinal surgery last year, I was taking Oxycodone 10mg x3/day and wearing a 2.5mg fentanyl patch at the same time. (Thank the Lord, the surgery was a success and I’m off the stuff now).

    The package says that it contains 2.5mg of Fentanyl, and provides 25 mcg/h.

    So, does that mean that each one of these patches contains a nearly lethal dose of fentanyl, if you cut it open and ate it all at once? This seems an extraordinarily dangerous thing to give to people to self apply.

    I have a friend at work who claims that one of these patches somehow “burst” and dumped the entire dose into her grandfather, killing him.

    Is that even possible?

    • Yes Robert,
      The Patches contian enough Fentanyl to kill, if the contents were released all at once. That was why Oxycontin was deadly too, and sought out by the addicted. In order to function as a time release formula, they contain an excess amount of the drug. Complaints were made to the FDA regarding defective Fentanly patches years ago, and the were ignored. A lot of physicians were completely unaware of how any of this worked or how toxic these products are. Of course these Facts have been kept from the public. Not one mass media article about the so called opiate epidemic mentioned any of this information. Pharma made sure that these Facts, were not covered by the media. This deliberate gap in fact based information, most likely led to a lot of deaths. The FDA did not follow up on any reports of “burst” Fentanyl patches, that might have cut into pharma profits. 20 years out and they are still deliberately misreporting the Facts about opiods.

    • Robert, if you have to take the pain patch 25mcg.Take the generic form Mylan,because it is made with a matrix so it can’t burst or leak out ever.

  • I am on day 10 of taking my 50 mcgs of Fentanyl patch. I was on for 6 years it was HELL! I seized, spent 6 days in the hospital and they could not control it. Do not do at home do inpatient. I still am not alright.

    • Or don’t do it unless you’re dying. It’s a dog eat dog world people. Don’t listen to anyone you don’t trust.

  • “…The chemicals in both bind to the mu opioid receptor in the brain. But fentanyl gets there faster than morphine — the almost-instantaneously— 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 explains why we read about so many more cars and trucks drifting off the road and colliding into sides of houses or worse yet crossing lanes and colliding head on into an on coming vehicle. The impaired driver has overdosed on opioids and is fast asleep behind the wheel while his out of control car travels at deadly speed. This opioid impaired, comatose driver is operating a lethal weapon, committing at least the crime of involuntary manslaughter and law enforcement and the courts must bring the perpetrator and his supplier to justice.

    • The “good” thing about abusing fentanyl, if there is one, is this is extremely unlikely to happen (the driving and running into things).

      Fentanyl crosses the blood brain barrier so quickly the user wouldn’t really have time to start the car and put it in drive. Fentanyl doesn’t come in pill form, so shooting it up means it gets there near instantaneously. Snorting it would be the same – it would get absorbed through the capillaries in the nose, which are right next to the brain, so if you’re taking enough to fall asleep you’re going to be asleep very quickly, seconds later. I have given Fentanyl IV in the ICU environment, and you’re really talking less than 10 seconds before the patient starts experiencing pain relief. People sometimes feel fentanyl before I even finish flushing the line. It’s actually a terrible drug for longer term pain control (as in, >30 minutes) – it binds quicker than the other stuff, but it also wears off much quicker. It’s great for quick procedures or emergency situations. There’s a reason why we had every 15 minute dosing for fentanyl for someone on life support who was fighting the breathing machine.

      Anyway, anything that comes in pill form is going to be a bigger problem with running off the road – oxycodone, hydrocodone, morphine, hydromorphone, because you actually will have time to start your car and get on the road before the drug hits you, even if you crush it and snort it. It just doesn’t cross the blood brain barrier and bind as quickly, so these people would at least have enough time to put the keys in the ignition, turn them, and start driving. You might have time to put keys in the ignition, tops, with fentanyl… very doubtful you’d even make it out of your parking spot or driveway before you passed out if you shot up a laced heroin with a high fentanyl concentration.

  • In the early 90’s the drug companies sent Vicodin samples in a little foil package to dental offices to give to patients. Problem is the staff would take and use them and got addicted after about five days of taking only 2-3 pills a day. I don’t know what some of them did when they quit the job.

  • I hate illegal drugs – especially since I was in the Army in 69-70-71. LSD was rampant at Ft Gordon Georgia. Heroin was everywhere in VN. The behavior of the users was disgusting especially the nearly comatose and drooling H addicts.
    Legalize drugs? Very, very stupid. Don’t put that shite in your body.

    • Im not attacking what you believe, but i disagree. When I was in school, cannabis was easier to get than cigs or alcohol. I say decriminalize it all, and create a safe alternative, for people who have the desire to do such things.
      There are many countries that do it, and it appears to work out the opposite of what you would probably think. As long as people avoid equality,there will be a constant culture war happening

    • Your a fucking socialist moron. If you support the military industrial complex your a brainwashed idiot he uknowningly supports socialism. get educated you dumbass socialist.

  • Years ago, back in 2007 I tried to explain to a Physician why a prescribed Fentanly Patch was dangerous. Thanks to the Lobbying efforts of Pharma, and the AMA, Physicians chose to remain willfully ignorant. They refused to take Continuing Ed in Pain Management or Opiate Addiction. They let people with Chronic Pain suffer and die, after they stopped prescribing, and refused to treat them. They refused to treat people with addiction too.
    There is nothing new here, the unscientific and ill advised reaction to the Opioid Epidemic created this. Even now people are dying and they are still putting more restrictive legislation on pain patients, and legitimate pain Physicians. It is easier than dealing with the Corporations who undermined the law in search of profit. Facts and Data are just inconvenient, it was more profitable to have the media still mislead the public.
    There are shortages now of pain medications for surgery, burns and trauma, because none of the reaction was thought out.
    This is the logical extension of unregulated for profit healthcare. There were no surprises here, this was all calculated. They are not going after the cause of this, instead they are going to double down on the ignorance and stupidity.
    Maybe if there are any Scientists left in a few years to do objective research, they will come to the conclusion that this was Genocide. After all the British, used opium, to get a foothold in China. They used to teach that in History Classes.
    We live in dangerous times folks, where the profiteers make policy. This is even more dark and dangerous than we know. The US used to have Laws and regulations on marketing pharmaceuticals, our politicians took money to do away with the Laws. The for profit healthcare system did not even collect clear data on the dead, by design. At the same time our media refused to cover or explained away, the activities of the corporations that profited. They promoted a “Free Market” deceiving the public at every turn. Even now the speeches and committees are deceptive. We can;t expect a bunch of industry insiders who paid off our politicians to come up with a rational response.

    • I was in Viet Nam when I saw the movie MASH, and was inspired by its theme song. I knew that what was given to “Painless” was probably a licorice jelly bean. I’ve had the same problem as “Painless” for the past 20 years. So what?

      As the 6th Mass Extinction’s events become more obvious so has the poisoning of the planet’s food and water resources. The Collapse of global populations from starvation, caused by our failure to invent an effective response to the 90,000+ manmade chemicals floating about in our spaceship’s biosphere, was originally expected sometime between 2030 and 2050. In the 40 Year Update of Limits To Growth, their research confirmed that the tipping point was in 1975, and that it would become obvious NLT 2024, aka, any time now.

      Can you imagine the pain and suffering of watching family members dying of starvation? Don’t have to go very far to see it happening here in the U$. There being no such option as a “Black Mariah,” how likely is it to find a lethal dose of fentanyl?

      I suspect that choice is the only option for those of us who remember: “Solve The Problem; Failure is not an option,” and know that we are not able to adapt/evolve an effective survival strategy for the 6th Mass Extinction. That’s why it is called a mass extinction. Unlike an on/off switch, a dimmer switch with multiple short circuits should be expected.

      We all know that we are not getting out of here alive, but becoming extinct boils down to sooner rather than later. I’d rather not make the choice of a Twin Towers leapers, ie, splat vs a BBQ. Bridges, ropes, hoses, guns, Sepuku, kool-aid, cops or X, knowing that my transition to whatever is really next need not be painful. In fact, I can imagine a “wake” whilst still alive, shared with friends before climbing into a casket to be put into a canoe and set ablaze into the receding tide has a romantic atmosphere about it, don’t you think?

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