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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    • Even if right now you see so much darkness in your life that you don’t want to be here anymore, there is always light out there. From personal experience, even at the bottom of the pit, you can always bring yourself to the ladder up. Life is beautiful and you deserve to be happy, love yourself and be loved by others.

    • So Henry Leech, does this mean you’re going to kill yourself? I don’t understand what you meant in that statement.

  • Tubby your a dragon chasing like me but as you know we beg borrow steal for the next fix that all that matters is next fix our family disowned us we let our kids go with out we can’t see our kids wife’s left us now we’re pimpin use ing junk box hoes and you think herion should be legal I know I wrecked my life family too I’m good for nothing now open your eyes Tele tubby

    • Boscoe, and everyone else here that is asking for help… Come to the Suboxone talkzone forum. Sign up as a free member, keep your name as Boscoe & write about yourself in the introduction section I will find you & I will make sure that you get help.

  • Mike Browse wroteI was wondering if probation did not allow these repeat dealers/users to shoot fetenoyl. They would still be alive. Someone needs to be held accountable for these deaths that could have been prevented. The ones that should be held accountable is the politicians, and the Conservative laws of the establishment, if you think about it, the only one being harmed is the person taking the “drug” so where is the crime? Usually someone being harmed by another is a crime, but harming yourself why is that a crime? I can drink myself to death and no-one could stop me, but if I inject heroin (which is less harmful if it is pure, than both alcohol and tobacco) I am a criminal. Did say someone say lobbyism? If we decriminalise all illegal recreational substances and made it an industry, no-one would die of overdoses and ratpoison (yes, sometimes heroin is actually cut/laced with strychnine) because they know exactly what and how much they are injecting, at the same time there would alot money saved on police, the DEA etc. It can be regulated and taxed just like alcohol and tobacco, even more money to our society, and best of all the real criminals, the organised crime syndicates that makes the money of everything illegal, would be without anything to sell, so maybe they will just get a job since crime doesn’t pay anymore.

    • Tubs I agree with you about the fat cat politicians. You write as if your a user or, your ok with users. Think about all the lives ruined by drug users. The crimes the users commit to pay for their habit. The worse of all is seeing all these kids dieing every day from drugs and having to tell the parents. I’ve seen hundreds of family’s torn apart , parents never the same again from loosing a child, loved one to drugs. If you don’t care about loosing a loved one to drugs what’s wrong with you? It bothers me seeing hundreds of overdoses every week. Seeing our future generation walking around homeless zombies, their our future

  • Tonight’s second shift I saw three overdoses, two died. I was wondering if the judges stopped releasing these repeated dealers/users they would still be alive.
    I was wondering if probation did not allow these repeat dealers/users to shoot fetenoyl. They would still be alive. Someone needs to be held accountable for these deaths that could have been prevented.
    I know they have been revived many times in the past. Caught dealing more than a few times. All on probation
    Rest in peace your fight is over. is this our mentality ? Now the system don’t have to deal with them. Are we Nazi’s? Are we letting them just die off?

  • It took for ever to get someone to answer the door at concord fire dept they check my vitals d let e go I ask for help they said take my advice stop useing and shut the door locked me out I thought fire stations give help

  • How do I contact you are you sure you know what I’m going through I just saw my p.o. cc stone yesterday I was tweaking she said alset you can leave they don’t care prove you care how do i contact you for help

    • Boscoe, before it’s too late, come to the talkzone site. Go to google, type in Suboxone talkzone forum no & click on the first link. We will be more than happy & capable to help you!

  • There is help out there and people who do care you can quit you can get away from that decease of a drug I believe in you I do know the pain and struggle please try to contact me let me help you free yourself from that decease of addiction you are loved there is no reason why should have to die if you hold out your hand for help il reach out back and help

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