Why is Mixing Fentanyl with Heroin So Dangerous?

The present-day illegal drug landscape does not mirror previous times. The US is seeing a surge in fake drugs, including fake fentanyl. In 1959, fentanyl was created in a laboratory. The history of fentanyl includes it being beneficial as a pain reliever and anesthetic. Since fentanyl is an opioid, it is susceptible to abuse.

While some individuals may be able to obtain pharmaceutical-grade fentanyl on the street, a lot of the fentanyl that is available on the illicit drug market is fake. In some instances, users think they are buying heroin but they are in fact buying fentanyl or heroin that is laced with fentanyl. This is incredibly dangerous, as fentanyl (including fake fentanyl) can be 40-50 times more powerful than heroin, and 50-100 times more potent than morphine.

The Danger of Fentanyl Mixed with Heroin

It is critical to keep in mind that individuals may not intentionally be mixing heroin and fentanyl. Rather, some street dealers are cutting heroin with fake fentanyl. Drug dealers have a profit incentive to do this; they can dilute their heroin supply and then try to make the drug more potent with the use of fake fentanyl, which is cheap.

The result is that their customers may be buying drugs that are potentially far more potent than anything they have taken. Those who buy heroin may actually be buying fentanyl, and they do not have a tolerance for fentanyl.

Oftentimes, fentanyl can be so powerful that no one could possibly have achieved tolerance at the level needed to allow for ongoing use.

It is not surprising, therefore, that the Partnership for Drug-Free Kids has reported that the combination of fentanyl and heroin on the streets is causing US drug overdose rates to rise. From 2013 to 2014, at least 700 people in the US experienced a fatal drug overdose that involved fentanyl.

Understandably, the public may question why fentanyl is so much more potent than heroin. The answer lies in the chemical structure of fentanyl. Both fentanyl and heroin are called non-polar molecules, which means they are fat-soluble rather than water-soluble. The body has a region known as the blood brain barrier. This barrier helps to keep harmful substances away from the brain. The more non-polar a molecule is, the quicker it can get through the barrier and have an impact on the central nervous system. Fentanyl is more non-polar than heroin.

Looking at fentanyl from this perspective, it makes sense that this drug is used as an anesthetic or when a person is in excruciating pain because the pain can be managed very quickly. But when this drug, in its pharmaceutical and fake form, is abused, the risk of an overdose is acute. Short of a fatal overdose, even just one fake fentanyl pill or heroin-fentanyl combination can cause a person to experience severe side effects, such as paralysis.

In an effort to help educate the public, PBS has posted a photo of a lethal dose of (pure) heroin versus fentanyl. The amount in the shown heroin vial can roughly be compared to half a packet of sugar granules, such as those found on tables at a restaurant. Alarmingly, the amount of fentanyl granules could actually be counted – that is how few are needed to induce a fatal overdose. In fact, fentanyl can be so dangerous that, while it is addiction-forming, some individuals who knowingly or unknowingly take this drug may not even reach the point of an addiction. Stories abound about individuals who have experienced a fatal overdose after even taking one fentanyl pill or heroin-fentanyl combination drug.

individual mixing fentanyl and heroin in a syringeFor instance, a member of the Florida Department of Law Enforcement advised the public that street-level fentanyl products are, for all intents and purposes, “death pills.” In Florida (and elsewhere), there is concern that individuals who are experiencing an addiction to prescription opioids are turning to the illicit drug market to buy similar narcotics, including heroin and fentanyl. It is well established that addiction can dramatically impair a person’s reasoning abilities; therefore, a person may not be able to accurately assess the risks of buying heroin on the street – heroin that could contain a lethal dose of fentanyl.

In short, fentanyl is only raising the risk of heroin abuse. It has always been advised that anyone who abuses heroin should seek help from a rehab center or other qualified facility because of the risk of overdose, of possibility contracting a disease, and due to the general degeneration associated with long-term abuse. But there’s another incentive now, and an extremely significant one: Heroin is more dangerous to use than ever because of the possibility that it is laced with fentanyl, an even more dangerous drug.

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