Why Fentanyl Is Deadlier Than Heroin

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Each year, fentanyl plays a role in half of all overdose deaths in the U.S.1 Sadly, many people don’t realize how deadly fentanyl is. In 2020, almost 43,000 Americans died after a fentanyl overdose. Experts believe that fentanyl deaths are on the rise in 2021.1

In This Article:

 

What Is Fentanyl?

man sitting in corner

Fentanyl is 50 times more potent than heroin, accounting for half of all overdose deaths in the U.S.

Fentanyl is a synthetic opioid.2 Opioid drugs relieve pain and produce a sense of well-being. These drugs help people struggling with severe pain. However, opioids carry a high risk of dependency and addiction.2

In most cases, medical providers use fentanyl to treat cancer pain and post-surgical pain. Doctors may prescribe fentanyl injections, topical patches, or lozenges. Hospice facilities may also use fentanyl to ease extreme pain in patients with a terminal illness. In rare cases, doctors may prescribe fentanyl for patients who don’t respond to other opioid pain-management drugs.2,3

Medical providers are advised not to prescribe fentanyl for long-term treatment of chronic conditions due to the adverse effects it can cause, including breathing problems, constipation, fractures, worsened stress response, and overdose.3

How Potent is Fentanyl?

Fentanyl and heroin are sometimes grouped together because illegal fentanyl and heroin are both sold as street drugs. Both heroin and fentanyl are opioids that bind to the same receptors in the brain. However, these substances are not comparable in potency. Fentanyl is about 50 times more potent than heroin.4

Most individuals will never have occasion to be prescribed an opioid medication as potent as fentanyl. Not only is fentanyl more potent than heroin, which is an illegal opioid with no medical or therapeutic uses, fentanyl is more potent than any other prescription opioid—up to 300 times more potent than morphine.1

How Deadly Is Fentanyl?

Fentanyl can prove fatal even at comparatively lower doses than any other opioid, including some of the strongest prescription drugs like OxyContin and illegal opioids like heroin. It takes far less fentanyl than heroin to trigger an overdose.5 Just 2-3 mg of fentanyl can prove fatal to an adult male.1 The accepted average fatal dose of heroin is approximately 30 mg—10 times the weight of the fatal dose of fentanyl.

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Why Is Fentanyl So Deadly?

In addition to the relatively low dose of fentanyl necessary to cause serious side effects that can result in permanent injury or be life-threatening, many individuals use illegal sources of fentanyl. There can be a significant difference between the potency of fentanyl that is manufactured legally versus illegally.  When manufactured for medical use, fentanyl is made with strict oversight. Staff members at pharmaceutical companies undergo rigorous training and inspections to ensure patient safety. Technicians calibrate manufacturing equipment to provide accurate dosages.6

But illicit drugs are manufactured in unauthorized labs. People who produce these drugs may lack professional training. They may contaminate the drug with other substances or lack accurate measuring equipment.

When illegal fentanyl is manufactured, it may be mixed into a wide range of illicit drugs, including heroin and cocaine. MDMA and methamphetamine may also be cut with fentanyl. If drugs are cut with fentanyl to boost the effects, a fatal dose may be introduced without an individual even knowing that they are buying and using fentanyl.7 Street drugs may contain other contaminants too. Tainted drugs can cause organ failure, muscle damage, and other life-threatening health problems.8

When purchased illegally, there’s no way for someone to be certain about the drug they are buying and how potent it is. Other drugs that are also white powders may be cut with fentanyl. The DEA has seized counterfeit pills with a wide range of fentanyl doses—some as high as 5.1 mg, twice the fatal dose.4

Is Fentanyl Addictive?

Fentanyl is classified as a Schedule II controlled substance by the U.S. Drug Enforcement Agency (DEA). Schedule II controlled substances have a high potential to result in dependence and addiction.1

Along with its pain-relieving effects, fentanyl produces relaxing and euphoric effects. These effects may be profound if the drug is taken when the person is not in acute, intense pain. People who experience these effects may start to misuse opioids and increase their dosage beyond their doctor’s prescription to recapture the “high” they felt. But as tolerance builds, they find it harder to achieve the same effects.9 As they experience a weaker effect from the drug, they may take higher doses that can be life-threatening.2

Because fentanyl is so powerful, it’s easy to quickly become dependent on the drug. If you try to stop taking it “cold turkey,” you may experience physical withdrawal symptoms that can occur as soon as a few hours after the last dose.2,9 Some people also develop symptoms of psychological addiction that include powerful cravings or a compulsion to keep using opioids.10

A person who develops an addiction to fentanyl will be diagnosed as having an “opioid use disorder.” At this point, professional help will likely be needed to end their fentanyl misuse.10 If they try to stop on their own, they will likely experience uncomfortable withdrawal symptoms.

A person withdrawing from fentanyl may experience:2

  • Muscle pain
  • Twitching or spasms
  • Anxiety or depression
  • Sleep disturbances
  • Diarrhea
  • Vomiting
  • Chills

If you’re dependent on opioids, treatment can help. Medical providers can offer medication to ease withdrawal symptoms. A rehab facility can help you taper off the drug and regain control of your life.10

What Are the Signs of Fentanyl Overdose?

When a person overdoses on fentanyl, life-threatening symptoms can set in quickly. The person may lose consciousness or stop breathing. Without treatment, the person may suffer permanent brain damage or death.2

Fentanyl overdose symptoms include:2, 11

  • Drowsiness
  • Dizziness
  • Cold, clammy skin
  • Blue lips or fingernails
  • Slow breathing
  • Loss of consciousness
  • Decreased heart rate

If you suspect an overdose, call 911 right away. Don’t try to take the person to the emergency room. Fentanyl overdoses are medical emergencies that require professional care.11

Emergency responders will use a medication called naloxone to treat a fentanyl overdose. Naloxone can rapidly restore breathing to a person and save their life.11

Keep in mind that naloxone will not work with overdoses caused by drugs other than opioids. Naloxone also doesn’t treat medical problems like a heart attack or stroke.13

In some states, naloxone is available without a prescription.11 You might be able to keep naloxone nasal spray at home. Ask your doctor or pharmacist where you can access naloxone, which is available under the brand names of Kloxxado and Narcan.

If you choose to keep naloxone on hand, seek training on how to use it. A pharmacist can instruct you, or some community agencies may offer free training on how to use naloxone to treat an opioid overdose.

Naloxone is only a short-term treatment to temporarily restore normal breathing in a person with respiratory depression due to opioid overdose.11 People who have overdosed will need additional care and may experience respiratory distress again if not seen by medical professionals. If you successfully use naloxone to revive someone after an opioid overdose, you should still call 911. The person who overdosed will need to be monitored for several hours and may require further medical care.

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How Is Opioid Addiction Treated?

Naloxone can provide lifesaving help during an overdose, but it’s not a cure for addiction.11 Rehab centers provide specialized medical care for individuals struggling with opioid use disorder. During rehab, you work with a clinical team led by a psychiatrist to receive a diagnosis and treatment.

Treatment starts with withdrawal management, during which time you will safely detox from fentanyl use. Clinical specialists will provide medication and support to ease withdrawal symptoms and reduce drug cravings. Specialists at many residential treatment centers also can treat other conditions like chronic pain, anxiety, depression, or bipolar disorder.13,14

You can also expect to take part in counseling, or behavioral therapy, as part of your treatment plan. Therapy can guide you in changing your thought patterns in positive ways. Many rehab facilities also offer family counseling. Counseling can help the family recover from the trauma and pain of their loved one’s opioid use disorder.

Some residential treatment centers may also offer alternative therapies, including yoga and physical therapy, that can help address any ongoing physical pain you may have.15, 16

After rehab, joining a recovery support group like Narcotics Anonymous (NA) can help you maintain sobriety.17 These groups provide peer support and encouragement from others on the path to recovery. Recovery is a lifelong journey. You will likely need ongoing support to avoid relapse.

Are you interested in seeking support for opioid dependency? Call 800-407-7195(Who Answers?) to speak to a treatment specialist to explore available treatment options.

References

  1. National Center for Drug Abuse Statistics. Fentanyl Abuse Statistics.
  2. National Institute on Drug Abuse. (2019). Fentanyl DrugFacts.
  3. Baldini, A., Von Korff, M., & Lin, E. H. B. (2012, February 9). A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide. The Primary Care Companion for CNS Disorders, 14(3).
  4. Drug Enforcement Administration. Facts about Fentanyl.
  5. Centers for Disease Control and Prevention. (2021, January 26). Drug Overdose Deaths.
  6. Hasselbalch, B. (2014). FDA Drug Quality Regulation CDER Small Business―Regulatory Education for Industry (REdI). S. Food and Drug Administration.
  7. Centers for Disease Control and Prevention. (2021, February 16). Fentanyl.
  8. Centers for Disease Control and Prevention. (2018, April 4). Facts About Strychnine.
  9. National Institute on Drug Abuse. (2017, January 12). Tolerance, Dependence, Addiction: What’s the difference?
  10. NIH News in Health. (2015). Biology of Addiction.
  11. National Institute on Drug Abuse. (2019, September 11). Naloxone DrugFacts.
  12. Centers for Disease Control and Prevention. (2018, October 5). Using Naloxone to Reverse Opioid Overdose in the Workplace: Information for Employers and Workers.
  13. Substance Abuse and Mental Health Services Administration. (2012). Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders.
  14. National Institute on Drug Abuse. (2018, August 1). Comorbidity: Substance Use Disorders and Other Mental Illnesses DrugFacts.
  15. National Center for Complementary and Integrative Health. (2020). Yoga for Pain: What the Science Says.
  16. National Center for Complementary and Integrative Health. Chronic Pain: In Depth.
  17. Roozen, H. G., De Waart, R., & Van Der Kroft, P. (2010). Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment. Addiction, 105(10), 1729–1738.

the Take-Away

Fentanyl misuse can have dangerous consequences. If you have symptoms of fentanyl addiction, do not try to detox on your own. Get help to recover safely.