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.


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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  • How about Luther the Pembroke academy NH. Teacher/Dean of students gets three months, for bringing FETENYL TO SCHOOL.

  • The live free and die state it’s awesome here the white Dragon tar or ice is real cheap and get caught spend a few months in then back chasing the dragon

  • Has it occurred to anyone that this is an epidemic targeting white people? I went to the County jail to visit my son who is a heroin user and is currently doing time. I noticed everyone in this jail was white and my son informed me they were all on heroin or a form of it. Maybe, folks need to look at what is happening around them in a new light. White people are being targeted by these drugs. White people are dying at an alarming rate! This is no longer just an ethnic problem. It is an AMERICAN problem. We demand that our government gets it get solved now.

    • Christina, I am not a racist.
      I only stick to facts. You are correct. herion/herion laced with fetenoyl /meth seems to be a white man’s drug. Our jails are filled with mostly white user’s. But our pushers out of mass bringing it to NH. Are Dominicans /Jamaicans their the hub in Lowell and Lawrence mass. sometimes they use a white runner to bring it to NH. or if supply is low the young whites will go to mass to get it. But our NH state prison seems to be mostly black, spanish. I feel sorry for you ,and your son. A twenty eight day rehab is of no help. It takes a person about three years of not useing with the help of meds so their brain wont crave the drugs. Your son will be out soon. They only keep them two to six months. If he did other crimes , record real bad . He’ll be out in nine months. Worse case scenario. There is no help. Probation is useless and over loaded. 125 users for one probation officer.

    • Christina
      The only way to get your son off herion is first he has to want to quit. After he’s released he has to check in with probation that takes ten minutes. Then bring him to a suboxone clinic. That is the only thing that works. Or the shot so he can’t get high from herion. The state of NH. government won’t help you at all. I have been told from hundreds of addicts the state wants us to die. This is how their dealing with the opioid crisis. They just want to bust us to take our money and chiba. Then release us back to use again.

  • Fetenoyl, herion, meth is almost legal in NH. Your first time charged with possession or small time dealing your bail starts at 10,000 just before two months its dropped to 500. Then when you go to court, after drying out in county it’s time served your released free . No fines . If the superior court is really busy you might have court shortly after two months and released. No fines, your Free. Only a big time dealer caught with lots will get federal charges. They might get six years if that. But released early for good behavior. But you don’t have to behave in the penn. You’ll still get good time.
    Rarely do they ever charge for internal posession. They only charge for internal posession if they know your dealing ,but they can’t catch you, and you’ve been caught many times for internal posession, and your nasty ,violent to police. NH. has the highest death rate from fetenoyl in the country. Don’t listen to the Ayotte news, phoney laws, they sound tought. First offence two months. Second offence four months. Third offence four to six months. fourth offence four to six months. Same with 5 th 6th I’ve seen some get arrested 15 times. Never did more than six months. If probation catches you no new charges only a thirty day set back. If your ordered to go to rehab you don’t have to go. Or complete it as you don’t have 30 grand to pay for it. Or your insurance don’t cover it, or they don’t cover the full 30 day’s.

    • Bosco, With all due respect your numbers seem a little high for the time a person does for fetenyl posession in NH. It’s usually the first time caught with fetenoyl they do two months. If caught many times after, its usually a 30 day bid. It only shows as a probation set back on their record. If the person with fetenoyl posession does do more than two months , its because they have other charges with the fetenoyl posession. Dealers with hundreds of grams May get 5 years. The superior court judges say drugs are not a crime, their an addiction.
      I did read Kelly Ayotte passing a law or,bill. If caught first time with fetenoyl. The penalty is five years. 2nd time was more time. 3rd time was life. This is the propaganda machine working so the politicians get reelected. At the state level courts. I’ve never seen anyone get these high numbers for fetenoyl. Never any time over 6 months and, that’s with breaking probation and other crimes mixed in.

  • Bobby NHSP is a nice prison. They have rehab. More counseling, Better free instant access to health care than anyone on the street. Most of the county jails in NH. Are state of the art with rehab. Their rehab in county jail is not long enough, because their only sentenced for two to six months for fetenoyl in NH. The person has to want rehab, the person’s brain has to want to quit. Rehab does not work. I’ve seen these kids complete their 28 day programs over ten times some programs cost 30,000 a month. Their recovering addicts ,not cured. they’ll have this addiction for life. I’ve worked with thousands of these kids. they all go back to drugs. With in less than a month of completing rehab. Herion, fetenoyl, meth the big three change/damage the receptors in their brains. They will always crave this drug. They go back to their friends/ age group. And it is so available their useing again. This cash flow theory I don’t believe. As third world countries in Asia with no cash flow have a worse Drug problem. Don’t legalize drugs. If you do that you’ll have more addicts / more deaths. Wait until Flakka hits NH. We think we have a problem now. I saw in Florida a person on flakka ate the flesh off another person’s face, and worse. It’s the closest to a zombie apocalypse. anyone who says legalize drugs is usually some sort of a drug user. They need the 2500 bed state hospital back. Make them stay for at least a few years on meds that take away their cravings. also make them take the shot that blocks their receptors so they cant get high. In twenty years every family will loose at least one member to drugs in NH.

    • First, I’m glad NH is attempting to set the example of what rehab should be.
      Neuro Receptors, you speak my language.
      A person whose receptors are hitting the pleasure center of the brain are then hard wired for more illicit drugs. Therefore, you are correct 2-3 years of rehab for the individual brain is a must even if the person doesn’t desire it because their individual brain can not recognize anything other than its next fix.
      Norway has 2-3 years of intense rehab and Sweden too with some still returning back to the pleasure side of the brain that may or may not be shut off from a specific street drug.
      Referring to removing cash flow was recommended by CIA agents / operatives through 3 conflicts. Vietnam CIA was moving heroin to USA. In Panama, CIA was moving Cocaine into USA, in now Afghanistan CIA moving opium into USA.
      USCG missed 500 incidents because of lack of manpower and equipment and Trump just cut the USCG budget when that story broke in 2017. Other countries like Mexico and China are sending carafentynyl and Clean Meth in by the Kilos.
      I understand the death and seen it first hand over 20 years.
      I can recall one country is doing safe use of heroin centers however that’s an idea to keep needles out of parks, streets, etc.
      I can say what the USA is doing is enabling the sells. There is not enough of experienced counselors, proper rehab facilities, DEA, law enforcement to keep up the supply coming into the USA.
      The United Postal Service can’t scan for illicit drugs.
      Based off other countries and what we are doing we are not creating a positive outcome.
      I’m all about strategy and tactics and providing help or forced help as the brain becomes hard wired for the illicit drug and 30 days is not enough.
      Flakka is great to be informed about.
      As your aware Meth just cuts off blood circulation to area parts of the brain as proven by brain scan.
      I can say I’m glad to see NH is advancing. If there is a way the rest of the USA could advance rehab in away it’s human kind and educational for a 2-3 year rehab commitment then there maybe hope.
      In the mean time non violent drug users that are not fortunate to have adequate rehab are going to continue to go back as its brain driven.
      The legal and DOC are over loaded and for what time out until the addict finds the next fix?
      Portugal has seen a 60% drop from legalize all drugs.
      Just an Idea, take one state in the USA, create state of the art rehab with 2500 beds like you mentioned with the best and brightest in brain health and see what happens in 5 years keeping big pharma out it! Great idea for hope!

    • If NH. Is not going to provide a long term three year rehab NH. Needs a way for the users to get clean needles.
      You would not believe the number of kids and adults that get hepatitis / AIDS from useing used needles. I’ve seen thousands of new cases. New Hepatitis casees in NH. from dirty needles every year is in the thousands. The new AIDS cases from dirty needles is also in the thousands. I can’t believe NH. won’t at least try to control these diseases with giving clean needles. As most of our parolees work in restraunts, where we all eat. Including the politicians. You don’t want to know what some disgruntled parolees told what they did to the restaurant food.

    • Mike, I can believe it regarding the needles and the epidemiology.
      I need to make a correction from my previous statement. It’s the United States Postal Service that does not scan for illicit drugs not UPS.
      The angry phase of parolees is part of the healing process that a 2-3 year rehab would help them manage in real world with little to lesser anger or frustration.
      It’s great to hear from peers like you as I’ve seen the addicts dead and diseased. In most cases, if only they had a stable job to help or prevent going down ruining their lives.
      Every brain is different with exposures they as patients may not understand. Stressed brains and bodies doesn’t create positive outcomes.
      Thank you for your recognition in a problem has a easy solution however shrowded in capitalism at its worst.
      Enjoy the week.

  • @Boscoe @Mike @Anyone Illicit Drug fentanyl, Heroin, Meth, Clean Meth, is a National problem. Unfortunately the historical markers began, if not earlier, during WarOnDrugs from Nixon in or around 1971. Reference History Channel and series War On Drugs documentary. I will summarize; “The USA has a cash flow addiction not a drug addiction. Remove the cash. reduce the addiction.”
    Capitalism has a dark side. Countries like Norway, Portugal have legalized all drugs and have seen near 60% drop in addiction for illicit drugs.
    Countries like Sweden and Norway are humanitarian and try to get people better coming out of jail when knowing the people going in have a lot of problems that caused them to go to jail. Google a Sweden jail and then google the USA archaic jail.
    The USA incarcerated more people than any other country. Yet, we don’t use rehab and we don’t give second chances to a non violent felon. Meaning, we are enabling the process of the non violent criminal to go back in.
    The USA with prison over crowding causes foster care over crowding. Then the foster children are not treated with full on love, mentors, guidance, and given minimal opportunities with exception of adoptions that desire to guide a life on solid ground.
    This illicit drug problem is not going away. Until we the people address the illicit cash flow problem.
    Where we see the drug problems increasing is areas where companies left counties, towns, in ghost town like conditions, for other countries. Leaving skilled workers behind and know where to go. Drugs move in and the USA has a problem. Locking them up also drains state and federal budgets to where teachers, firefighters, police, troopers, correction officers, paramedics, fish and game, not receiving cost of living increases on the job or retirement because our prisons are overloaded.
    If you go down the path that it started with doctor to prescription opioids that is only a very small percentage compared to illicit drugs. The responsible patients that are engineers, electricians, high paying jobs that have to have prescription to function not dysfunction are being yanked off the opioid prescription and treated like drug addicts when their medical problem can only be managed by what works. Some of them are committing suicide because our new doctors don’t get any of the history. Yes there are pockets of where the makers of OxyContin dropped millions of opioid pills in small towns of 400 and coal mines or companies shut down. Now that’s big pharma at work in the greed market.
    I don’t see the cash flow addiction going away. Several months ago, New York busted 193 pounds of fentanyl. That’s enough to kill everyone in New York and New Jersey 11 times over.
    My suggestion, 1) legalize drugs 2) prisons need rehab / teaching facilities to get the person better than what they came in with. Reference Sweden Norway etc. 3) Foster Children need not be in over crowding and helped, loved, guided, and college educated for free. Sweden covers medical and college costs for most of there people tax based.
    The USA needs to evolve because this is not working.

    • Bobby, you seem intelligent, would you know if parents loose a child to an overdose would the parents have a good law suite against the state,courts,judges,probation? A law suit would not bring the child back, But if this went public maybe the State would do something about this drug crisis NH. is in. You must first know the circumstances. It’s documented with the hospital the child overdosed six times. The child was arrested six different times with fetenoyl, meth, herion in their system and , in their posession. The courts keep releasing this child to probation. Probation allows the child to give dirty urine tests,show up with infected swollen track marks (black holes) that need medical attention. Probation lets them go back on the street, the child may not check into probation for weeks, probation does nothing. Probation never does home checks any more to anyone. If the po. Is out on a leave or vacation for weeks, this child does not have to check in. Then child gets caught selling drugs does two months and is released back on the street then the 20 year old child overdoses and died.
      This is facts , I left out a lot of the charges. And some have been arrested for drugs fifteen times, also theft, fraud, assaults etc. But they never did more than six months.
      I just saw a man slumped over his steering wheel, car running , he’s overdosed. this happens often ,every Day.
      Donald Trump is correct, I believe I heard him call NH. a drug Den.

    • Hey Mike,

      Thank you for the compliment. I try to use common brain sense, environment exposures, behavior patterns, to see where anyone ends up. Hopefully thriving and successful on all accounts.
      Q.: If Parents lose a child to an overdose would the parents have a good law suite against the state, courts, judges, and probation?
      A.: Each case is individual in evaluation. Much like the human brain it’s individual and unique and hardly any the same. Filing legal action against any of the previous you will have to prove “Negligence” or Malicious Intent. With Negligence it’s the following; 1) Duty 2) Breach of Duty 3)Causation 4)Damages.
      The child overdosed 6 times. Was the child of legal age or over the age of 18? Second the hospital was the end point to a behavior problem that appears to have already existed from around the age of 9 or 10. I will reference the book Brain Rules by John Medina as a easy to understand starting point.
      Arrested for meth, heroin, and fentanyl, possession, court releases child to an responsible educated adult to manage all these layers of brain issues and behavior problems. My guess reasonably.
      If this were a true child under the age of 18 or an appointed guardian would need to make sure this child’s wounds were cared for properly in the best interest of the child. This would fall back on the parent or guardian to ensure this was completed by mere laws of nature.
      Probation is a checks and balances point for the criminal justice system. Most probation officers are overloaded with hundreds of cases so it’s difficult to see where, what, how, all the things mentioned without requesting the drug user’s file.
      First, I’m very saddened by the loss of any human life and one that seems dear to you over drug abuse or addiction.
      I will say ask yourself if this child had issues in elementary school, behavior changes during teens, stressed, life changing moments like a death or abandonment of parents, trauma, anxiety, depressed, family history of mental illness or addiction? As we know everything your pointed out about courts, judges, probations, urine test, hospitals, arrests, multiple drug use, multiple charges that infringe on the rights of others, these are all symptoms of multi layer behavior issues that might have been caught in this child / adult’s youth. These are all the end result issues that stem from a pivotal moment in time where a child didn’t feel like he or she had a safe place to fall or a real parent not a friend to engage and just listen to the child before the drugs began. Meth is one brain cell killer of a drug. Heroin and Fentanyl in combination is a death sentence combined or Fentanyl in large 1-4 mg quantity.
      So you are aware, This is happening in every state. Yes, not uncommon to see a person down on the street, in a car, with snoring respirations, or on the verge of death and police, fire, or paramedics giving narcan to reverse the cause in some cases there is not enough narcan onscene to reverse the overdose landing the patient in the emergency room or ICU for further treatment and evaluation.
      If you or anyone can go back in time in this child’s life and figure out a turning point when things began to change in behavior you might find your answer as to the cause. Counselor or psychiatrists or psychologists, need to see the children before they are 12-14 with any mental issues or behavior changes that should be of concern to parents, grandparents, or guardians.
      The illicit drugs are not going away. The illicit supply is coming in larger than ever before because of the dark side of capitalism and it’s in every state. Illicit drugs is like being on a treadmill. It takes a special educated professional that understands the illicit drugs, behaviors and brain science, child to adult history to pull each user of illicit drugs off the treadmill.
      As you and I agreed on, the 2-3 year stay in a rehab hospital to address the 7-8 problems the person has before the drug use problem again and creating new neuropathways in the brain to bring the drug user around to somewhat of a normal life.

    • @ Bobby I agree with you, sadly its going to take decades before legalization and demonetization ever gets implemented,,partly due the misconceptions by most that control and punishment works,,It really shines a light on just how little awareness the general public has on the subject,, because sadly its gotten to the point in many small towns where the drugs are the primary source of income for not only the sellers but also the local court systems,, revolving doors have evolved to basically keep a steady stream of income from generation after generation of addicts who once they are caught up in these situations,,fines and fees of course help feed this judicial machine,,wich sadly kinda places addicts between the sellers and the system with drugs putting money into the local courts as well as everyone tied to them,,,keeping as many addicts paying fines and on probation as possible on these revolving door situations points out that even our very system becomes dependent on the very thing it was meant to deter and in some places in small town america is the driving source of income above all else.

    • @Grizzly63, I like name. lol
      You nailed the american legal system and revolving door. Perfectly!

    • The “cure” starts with education and support of children BEFORE conception. Sex education for all children, free birth control and nutrional, educational and medical support as a mandate for all citizens. Instead of investing in corporations, our country should be investing in it’s children since no one “gets out alive” and no one can use “money” when dead.

  • This is so true Boscoe. NH. Is a drug den. I know first hand probation lets their addicts shoot up. If probation finds them with drugs they don’t get new charges, if they feel like doing something they get only 30 days in county jail. Even if the person over doses six times. We used to have a 2500 bed state hospital for these people. Now the hospital is luxury state offices. Rehab some times works if the person really wants to quit. The courts don’t give anytime to drug users , drug dealers, or for the crimes a person comits while under the influence. An armed robber with a gun only does one year, Only in NH. At the federal level, a big time dealer gets 6 years. Out in 2.5 for good behavior. NH. Used to be strict on drugs. Not anymore. Now it’s a joke. I hear the kids say I’ll be out in 3 months. I can’t even take my grand children for a walk with out seeing a drug needle on the ground. I think NH. Wants them all to overdose and die to solve this problem. The medics and police and hospitals are doing more than their job to only have the courts release them. I’ve witnessed many over dose deaths in NH. Many are drug related deaths ( heart valve infection etc.) that does not count to their statistics. NH. Needs to step up or we will loose a whole generation to addiction. Maybe it will change if the all the judges loose a child to drugs.

  • How come NH. does not lock up people who have been caught 10 or more times with meth, fetenoyl, herion. Their doing crimes too while on these drugs. Probation lets them shoot up. The most probation only gives them a 30 day set back . Our useless courts gives 2 to 6 months in county that’s it. So we have junkies arrested 15 times for these dangerous drugs before the age of 21.

  • I have rheumatoid arthritis and have been using pain medication (Ibuprofen, Naproxen, Tramidol, Methotrexate and sulfisaiizine since 1990 and have never abused their use. I believe abuse is a choice, not an accident.

    • vern:
      I’ve been a CPP (Chronic Pain Patient) since mid 1998. I started taking OTC pain relief for several years until it finally got to the point I was literally crying in pain, awake AND asleep.
      I started on Tylenol w/Codeine #3 and was on that for 5-7 years. Unfortunately, my metabolism is such that after so many years, meds just stop having any use. So I then had to upgrade to Tylenol #4s somewhere between 2002/3.
      My doctors had finally given me my diagnosis: Severe Fibromyalgia Syndrome (SFMS) in late 1999, so at least I knew what I was dealing with.
      However as the years past I could not get my doctor to alter my pain mgmt protocol! So here I am 15 years down the road with increases of pain in the hundreds of %, yet no change in pain control. Until more doctors discovered I have MS, Degenerative Disc Disease (genetic, NOT arthritic), chronic acute anxiety disorder, panic attacks and since Christmas 2013, when my husband inexplicably died in my arms, in our house, in our basement from a brain aneurysm, I’ve now also been diagnosed with PTSD.
      My doctor finally sent me to a pain clinic, although neither of us thought it would help due to mitigating circumstances. Sure enough, pain clinic could not help me because I have bizarre, really bizarre, reactions to those kinds of treatments.
      I did try 2 treatments from them: an epidural and a spine block. But, after each, I ended up in hospital due to such reactions they had to put me in medical induced coma.
      Now, entities which have NO power over prescribing regulations are issuing rules, regs, & procedures and to be quite honest scaring Hell out of doctors.
      So I understand why CPPs go to streets to find relief. Don’t agree with it, would NEVER do it (I lost a son in 2012 to heroin), but I can totally understand it.
      How can I understand it? Because my pain mgmt protocol cannot really be altered due to my doctors being scared to death!!
      In their haste and eagerness to put an end to this “stupidity epidemic” (that’s the way I look at it lol), they are drawing doctors into breaking their oaths and leaving a Hell of a lot of long suffering, long documented CPPs out in the cold in extreme suffering.

  • I have been using opioid drugs since 1965, when I had my first surgery (breast augmentation). Through the years, and the many operations I’ve had, opioids have been there, like an old friend, to hold my hand through the recovery process.

    Unlike the mindless and weak who make up the majority of those with prescription addiction problems, I have never once had a problem with abuse. I took them as long as my pain lasted, and then immediately ceased using them when I was healed. What’s with these people? Every one of them I’ve seen in the various documentaries all begin with something like: “I started by using it recreationally”.

    Umm….DUH! What did you think was going to happen? That’s not an accident. That’s not the result of an inherent illness. That’s no great misfortune that sadly fell upon you through no ones fault.

    That’s just good ol fashioned extreme stupidity and ignorance, with a side order of self-control deficit, impulsive behavior, and laziness, served on a fluffy bed of irresponsibility.

    I can’t speak to those cases where the drugs were taken under the care and advice of a physician. I’m only speaking about the mental-midgets who did this to themselves, who seem to make up the largest percentage of those who are addicted.

    Also, why are all so many of the earlier comments from people named Phyllis? That was strange.

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