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The Potency Difference Between Heroin and Fentanyl Shown in a Single Photo

  1. Beenthere2Hippie
    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.

    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.”

    By Allison Bond - STAT/sept. 29, 2016
    Photo: Ohio State Police
    Newshawk Crew

    Author Bio

    BT2H is a retired news editor and writer from the NYC area who, for health reasons, retired to a southern US state early, and where BT2H continues to write and to post drug-related news to DF.


  1. DeepGreenSea
    This article mostly hits the mark...

    Except even in the hands of Experienced Professionals Fentanyl can be dangerous. Everything is hunky dory the next second everything is beeping like mad and your patients lips are BLUE. In that setting, getting them back is usually pretty easy but not always. So-Fentanyl frankly is on my shit list no matter who is dispensing it, no matter the reason.

    Anyway-take note all your possible surgery candidates out there. Discuss the methods of anethesia that may be used, discuss whether your surgeon knows who will be handling your anesthesia or if it will just be whoever is on duty in the OR that day. Ask questions. Let your surgeon know that you are aware of where the dangers may be-they might resent it but it will put them in a position to pay attention to your case.

    Ok. I'm off the Nurse Paranoia High Horse.
  2. Hardstepa
    Fentanyl is pretty much unheard of in the UK but let's hope the dealers don't start it here. I'm surprised it hasn't as it is fairly easy to get hold of for everyone, not just big time dealers. One thing that worries me is that in the UK if a warning goes out about some strong batch of heroin somewhere people will go looking for that same source. Let's hope they don't start knowingly buying fentanyl as the dealers will be very happy to supply.
  3. Apple.brain
    Such bullshit
  4. Name goes here
    You're going to have to be a little more specific. The article? Dealers cutting heroin with fentanyl? The number of deaths?

    The article is accurate. The dope running around New England can be anything from a trace of fentanyl to only fentanyl and no heroin. Scary time to be a heroin addict.
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