Opioid overdoses have been on the rise for several years in the United States. The National Institute on Drug Abuse (NIDA) reports that about 115 Americans every day die of an opioid-involved overdose.
As of 2016, NIDA publishes that synthetic opioids became the No. 1 culprit in drug overdose deaths in the United States, killing nearly 20,000 Americans, which is close to half of all opioid-related overdose deaths that year. In comparison, just more than 15,000 Americans died from a heroin-related overdose death in 2016.
Heroin use has been mounting all over the United States. The U.S. Centers for Disease Control and Prevention (CDC) reports that in 2017, close to half a million adults admitted to past-year heroin use.
Heroin is an illegal opiate drug that is manufactured from morphine and opium poppy plant. Many different additives and substances are used to cut heroin during the manufacturing process.
Fentanyl is increasingly appearing in the heroin supply. The CDC publishes that in reports on seized drugs, fentanyl is showing up more and more often.
Fentanyl is between 30 and 50 times more potent than heroin. It can be deadly in much lower doses, as small as 0.25 milligrams, CNN warns. Fentanyl-related doubled every year between 2013 and 2016. Heroin-related overdose deaths tripled between 2011 and 2016, NPR reports.
Heroin laced with fentanyl is an extremely dangerous and often fatal combination.
Heroin is a plant-based opiate, which requires a particular climate and environmental aspects to make. Fentanyl, on the other hand, is synthetic and can be made in a lab virtually anywhere.
According to information published by NBC News, there is a heroin shortage in growing regions, which includes South America and Mexico, and fentanyl is increasingly more available. It is cheaper and lighter; therefore, it’s easier to transport and often more profitable than heroin. Fentanyl is much more potent than heroin in much smaller batches, which makes it easier to traffic in and out of the United States illegally.
Fentanyl is a prescription medication, but most of what is appearing on the American market is illicit fentanyl, made illegally in underground or clandestine laboratories and coming from Mexico or China.
The U.S. Drug Enforcement Administration (DEA) publishes that reports from laboratories testing seized drugs found more than 8,000 exhibits containing the combination of fentanyl and heroin in 2016 — an increase from just more than 3,000 the year before and almost none at all just three years prior.
The rise in overdose deaths involving fentanyl is another indicator that fentanyl is becoming more common in the United States. Many individuals who are taking heroin or other drugs like cocaine, methamphetamine, or even prescription opioids recreationally may not even realize fentanyl is a factor.
Adulterants are commonly used to stretch heroin and street drugs for distribution, to increase profits. As an even more potent opioid, fentanyl is increasingly being used to make heroin go further.
The fact that it is even more powerful and, therefore, more highly addictive may also play a role in drug distributors wanting to use fentanyl in their heroin supply to gain repeat customers. Heroin is itself highly addictive, but fentanyl is even more so. It will take fewer doses to become dependent on fentanyl.
The flip side is that individuals who use heroin laced with fentanyl without knowing it can overdose more quickly and be more difficult to revive after an overdose. Without question, fentanyl-laced heroin can be a deadly combination.
The journal Emergency Medicine News publishes that when fentanyl is involved in an overdose, the opioid overdose reversal drug naloxone may not be as effective in the same doses as it is for a heroin overdose. It may not work as quickly or even at all. An overdose involving fentanyl and heroin can cause coma, brain damage, or death.
It is considered to be extremely hazardous.
Fentanyl can be difficult to detect in heroin as both are often white powders. Fentanyl is absorbable through the skin on contact. This makes it even more dangerous to handle as it can enter your bloodstream just by touching it.
There are several test strip kits on the market that Brown University publishes are being administered as harm reduction efforts to minimize fentanyl-related overdoses. These test kits are often given out by local harm reduction programs, or they can be purchased online.
A fentanyl test kit works by dissolving a bit of the drug into water and then dipping the strip into the water. If one red line shows up, fentanyl is in the sample.
If heroin has been laced with fentanyl, the drug is going to be much more potent, and a much lower dose will have bigger effects than heroin on its own. Fentanyl-laced heroin should be avoided.
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If you have taken a dose of heroin that you suspect has been laced with fentanyl, seek immediate medical attention if any of these symptoms appear:
An opioid overdose is a medical emergency. When fentanyl is involved, swift intervention is even more important. It may take more than one dose of naloxone (Narcan) to reverse an overdose involving fentanyl.
Fentanyl-laced heroin can lead to a potentially life-threatening overdose more quickly than heroin by itself. Again, it requires immediate medical aid. Call 911 as soon as an opioid overdose is suspected.
(May 2018). FDA Approves the First Non-Opioid Treatment for Management of Opioid Withdrawal Symptoms in Adults. U.S. Food and Drug Administration. Retrieved January 2019 from https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm607884.htm
(December 2018). Today's Heroin Epidemic. Centers for Disease Control and Prevention. Retrieved January 2019 from https://www.cdc.gov/drugoverdose/opioids/heroin.html
(July 2017). Prescription Behavior Surveillance System (PBSS) Issue Brief. Centers for Disease Control and Prevention. Retrieved January 2019 from https://www.cdc.gov/drugoverdose/pdf/pbss/PBSS-Report-072017.pdf
(November 2018). What You Need to Know About Fentanyl. CNN. Retrieved January 2019 from https://www.cnn.com/2016/05/10/health/fentanyl-opioid-explainer/index.html
(December 2018). Fentanyl Surpasses Heroin as Drug Most Involved In Deadly Overdoses. NPR. Retrieved January 2019 from https://www.npr.org/sections/health-shots/2018/12/12/676214086/fentanyl-surpasses-heroin-as-drug-most-often-involved-in-deadly-overdoses
(December 2018). Why Would Anyone Cut Heroin With Fentanyl? It's Cheap These Researchers Say. NBC News. Retrieved January 2019 from https://www.nbcnews.com/storyline/americas-heroin-epidemic/why-would-anyone-cut-heroin-fentanyl-it-s-cheap-these-n943796
(2017). Drugs of Abuse A DEA Resource Guide. Drug Enforcement Administration. Retrieved January 2019 from https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf#page=42
(April 2014). InFocus: Fentanyl-Laced Heroin A Deadly Combination. Emergency Medical News. Retrieved January 2019 from https://journals.lww.com/em-news/fulltext/2014/04000/InFocus__Fentanyl_Laced_Heroin_A_Deadly.5.aspx
(October 2018). Fentanyl Test Strips Prove Useful in Preventing Overdoses. Brown University. Retrieved January 2019 from https://www.sciencedaily.com/releases/2018/10/181018095403.htm