Why Fentanyl Is Deadlier Than Heroin

Fentanyl is much more powerful and even more deadly than heroin, but how much more?

Heroin’s synthetic cousin fentanyl has the street name of Friend (among many others). The opioid is far from being anyone’s friend, however. That’s because the man-made drug is extremely potent, and therefore extremely dangerous.

How much stronger is fentanyl than heroin? Potentially, fentanyl is 50 times stronger than heroin and 100 times more powerful than morphine.

How potent is Fentanyl?

A 30-milligram dose of heroin can kill an average-sized adult male; by contrast, only 3 milligrams of fentanyl can be fatal to your average adult male.

As a visual, imagine a pinch of salt — literally pinching several grains of salt between your fingers. That is roughly equivalent to this small dose, and it is one reason why is fentanyl so dangerous. (More on that in a bit.)

Fentanyl was originally devised as an anesthetic, and it works extremely well to ease pain — and very small quantities are enough to do the job.

It works very well for severe suffering, such as the kind that occurs in advanced cancers, after surgery, or for end-of-life pain. It also can be used for chronic discomfort, in particular when people have grown used to other opioids.

When measured correctly and administered properly, fentanyl tends to be effective and safe. Doctors typically prescribe fentanyl as transdermal patches, tablets, nasal sprays, or lozenges under various brand names, such as Actiq, Duragesic, and Sublimaze.

Why is Heroin and Fentanyl so Addictive?

Fentanyl and heroin both bind to the brain’s opioid receptors, which are found in the areas that control pain and emotions.

Opioid drugs affect the brain’s limbic system, which commands emotions. Opioids include prescription medications as well as street drugs such as heroin. Using them can produce feelings of euphoric pleasure or extreme relaxation.

In addition, opioids affect the brain stem, which regulates actions like breathing. They reduce pain and curb coughing spells — both helpful when someone needs to heal. Opioids can also slow breathing, however, which can be dangerous. Deadly, even.

The spinal cord is also affected. Opioids lessen the feeling of pain, which is particularly effective after a serious injury.

Opioids attach to the brain’s opioid receptors, but in the case of fentanyl, the drug arrives there almost instantly, so the effect is swift. That’s one danger of use.

Another risk with taking these kinds of drugs is that over time, opioids change the brain’s functioning. The nerve cells adjust to the opioids, so when doses are missed or stopped, flu-like symptoms occur. Aches, fevers, sweats, shaking, chills, and more may occur once withdrawal begins.

Street illegal

Looking at the answer to the question, how strong is fentanyl, it’s clear to see where the risks lie. It’s concentrated, it’s extremely potent, and when it’s sold on the streets, added dangers join the mix.

Some dealers include fentanyl in their product to boost drug potency, selling it for its heroin-like effect.Street names include Apache, China Girl, China White, Dance Fever, Friend, Goodfellas, Jackpot, Murder 8, and Tango & Cash.

Trafficked fentanyl tends to be made in secret, so it’s less pure than lab fentanyl and it can be more dangerous and unpredictable. Nonpharmaceutical fentanyl is also referred to as illicitly manufactured fentanyl (IMF). It can be mixed with cocaine and/or heroin, or pressed into counterfeit pills.

That can make for a deadly cocktail. Especially when it’s extremely easy to measure wrong and overdoses can occur.

Prevention

Because fentanyl can kill so quickly, the Centers for Disease Control and Prevention has suggested a three-pronged approach to better detect fentanyl outbreaks:

• Public health departments should find more ways to quickly detect overdose trends.
• Medical examiners and coroners should screen for fentanyl in suspect cases.
• Law enforcement should be on the lookout for increases in trafficking and use of illegally produced fentanyl.

When someone is overdosing, experts recommend administering the drug naloxone, which is a safe antidote for opioid overdoses. It works by reversing the effects of fentanyl and quickly restoring breathing function. It can be injected, auto-injected (Evzio), or administered via nasal spray (Narcan).

It’s best to call 911 immediately during overdoses, in part because naloxone only remains active in the body for 90 minutes at the most. It can also wear off in as little as 30 minutes.For overdoses of more potent opioids such as fentanyl, multiple doses of naloxone may be needed, sometimes administered every few minutes.

Authorities and researchers suggest giving naloxone to some patients on opioids to reduce risks of overdosing. The CDC has recommended coprescriptions of naloxone and opioids for some cases.Some states permit the sale of naloxone in pharmacies without a prescription. To find a provider or learn more how to potentially save a life, visit Get Naloxone Now.

Deadly statistics

How much more potent is fentanyl than heroin? The data is grim.Using heroin, especially when sharing needles, runs risks such as contracting HIV or hepatitis C.

Fentanyl, because dealers often mix it with other drugs, can easily be taken any number of ways, so the risks of dirty needles or snorting too much are genuine risks. It’s also linked to some alarming statistics.

Discussing the top drugs involved in overdose deaths, the Centers for Disease Control and Prevention reported that fentanyl-associated fatalities are on the rise:

• 2011: fentanyl was 10th, responsible for 1,662, or 4% of deaths
• 2012: it was 9th, 1,615, or 3.9% of deaths
• 2013: 9th, or 1,919, or 4.4% of deaths
• 2014: 5th, or 4,223, or 9% of deaths
• 2015: 2nd, or 8,251, 15.7% of deaths
• 2016: 1st, or 18,335, 28.8% of deaths

National Public Radio reported at the end of 2018 that fentanyl has steadily overtaken oxycodone (another opioid) as the drug most linked to overdose deaths.

The Drug Enforcement Administration (DEA) says the numbers could actually be higher. Many coroners and crime labs do not test for fentanyl or its analogs (like a drug’s fraternal twin, rather than its identical one) unless they have a reason to do so.

Fentanyl addiction and withdrawal

Fentanyl is often sold illegally because it produces a heroin-like effect.

It appears that people typically do not take fentanyl alone, though. Many times, common drugs were found combined — cocaine and fentanyl were mentioned in close to 4,600 deaths in 2016; fentanyl and heroin factored into approximately 5,900 deaths that same year.

Most often, fentanyl is mixed with heroin or cocaine — sometimes without the user being aware of this mixture — a combination that boosts the drugs’ euphoric effects.

Opioids such as fentanyl can be extremely hard to quit, and withdrawal can be agony. Symptoms of fentanyl withdrawal include:

• Muscle and bone pain
• Sleep problems
• Diarrhea and vomiting
• Cold flashes, goosebumps
• Uncontrollable leg movements
• Powerful cravings

Treating fentanyl addiction

Medication paired with behavioral therapies has proven to be effective in treating fentanyl addiction. Typically medicines such as buprenorphine and methadone help. They bind to the same opioid receptors in the brain as fentanyl, curbing cravings and easing withdrawal symptoms.

Behavioral therapies address managing a person’s triggers and sources of stress. They can also address behaviors that lead to drug abuse. Other forms of therapies implement rewards for healthier choices or work on a person’s reluctance to change.