Fentanyl vs. Heroin

Heroin and fentanyl are opioids that have caused increasing numbers of overdose deaths during the past decade. Fentanyl is 25 to 50 times stronger than heroin. Mixing the drugs creates a deadly combination.
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Heroin is an illicit drug that has no medical use. Fentanyl is a prescription drug that has medical use, but it’s also illicitly manufactured and sold to drug traffickers. Both drugs have a high potential for abuse and addiction. But fentanyl is about 50 times stronger than heroin. When heroin is mixed with fentanyl, the combination usually causes an overdose.

Side-by-Side Comparison of Fentanyl and Heroin
Heroin Fentanyl
Type of Drug Semi-synthetic opioid Synthetic opioid
Legal Status Schedule I Schedule II
Origin Derived from morphine Man-made
Form White or brown powder Patch, pill, liquid or powder
Method of Administration Smoked, snorted or injected Smoked, snorted, injected, transdermal, and sublingual
Potency Two to three times stronger than morphine 100 times stronger than morphine
Street Names Big H, black tar, hell dust, horse, negra, smack, thunder Apache, china town, goodfellas, jackpot, murder 8, Tango & Cash
Side Effects Drowsiness, dry mouth, slowed breathing, confusion, nausea, vomiting Drowsiness, dry mouth, slowed breathing, confusion, nausea, vomiting
Symptoms of overdose Blue nails or skin, pinpoint pupils, coma, extremely slow breathing Blue nails or skin, pinpoint pupils, coma, extremely slow breathing

Effects of Heroin and Fentanyl

Fentanyl and heroin affect parts of the brain in charge of pleasure, pain relief and sedation. Common side effects of the drugs include slowed breathing, drowsiness, nausea, constipation, dry mouth and heartburn.

People may use the drugs illicitly to self-medicate pain, relieve stress or get high. The high from heroin can feel like a rush followed by sleepiness and extreme relaxation, according to the Drug Enforcement Administration. People who use heroin enjoy an effect called “nodding,” which describes a drowsy state between consciousness and semiconsciousness.

The high from fentanyl is similar if it’s taken in low enough doses. Most people overdose and pass out shortly after taking fentanyl. Depending on the purity of the drugs, fentanyl is between 25 and 50 times stronger than heroin.

It takes a very small dose of fentanyl to overdose and an even smaller dose to get high. Finding the right dose is difficult because people who buy drugs on the street never know the strength of the drugs that they’re purchasing. When the drugs are mixed together, it’s nearly impossible to calculate a safe amount.

Few people seek fentanyl on the street. Heroin is sufficient for most people to achieve the effects that they desire. However, individuals with severe opioid addictions and very high tolerances to opioids may seek heroin mixed with fentanyl to curb cravings.

Heroin Addiction vs. Fentanyl Addiction

Heroin and fentanyl cause dependence, tolerance and addiction in the same way. The brain adapts to repeated exposure to any opioid by becoming dependent on the chemical to function normally. All opioids manipulate the pleasure and reward systems in the brain, increasing the chance of addiction. However, stronger opioids usually cause dependence and addiction more quickly than weaker opioids.

Fentanyl can quickly turn a mild heroin addiction into a severe opioid addiction. Few people are addicted to fentanyl specifically. They may have a high tolerance to opioids because they’ve used heroin laced with fentanyl. But few people use street fentanyl as their primary drug of abuse.

Treatment for heroin addiction is the same as treatment for fentanyl addiction. Heroin treatment begins with detox. Some medications, such as methadone or buprenorphine, may be used during heroin detox or later stages of treatment.

Medication-assisted treatments are valuable recovery tools that can ease opioid cravings and withdrawal symptoms. When combined with counseling and therapy, MATs can help individuals live healthy and productive lives.

Recovery from fentanyl addiction may be more difficult than recovery from heroin addiction because of fentanyl’s powerful impact on the brain. A person used to mixing heroin and fentanyl will probably require more intensive treatment than a person addicted to heroin alone.

Medical Uses of Heroin and Fentanyl

Scientists created heroin in an attempt to develop a safer version of morphine. However, they ended up creating a chemical that was two to three times more potent than morphine, according to a PBS report. Heroin was the brand name of a prescription drug marketed by Bayer in the early 1900s. But heroin was eventually outlawed when its addictive potential was realized.

Doctors prescribe medications containing fentanyl to treat severe pain. Prescription drugs containing fentanyl include Abstral, Actiq and Fentora. Other chemicals used in prescription drugs have been derived from fentanyl, including sufentanil, alfentanil, remifentanil and carfentanil.

The DEA has placed more than a dozen fentanyl derivatives in Schedule I. Schedule I drugs have no accepted medical use. Schedule I derivatives of fentanyl include acetyl fentanyl, acryl fentanyl and furanyl fentanyl.

How and Where Heroin and Fentanyl Are Created

Heroin is derived from the naturally occurring opiate morphine. That means heroin is a semi-synthetic opioid. The scientific name for heroin is diacetylmorphine. Some drug tests can’t differentiate morphine from heroin because heroin is metabolized into morphine in the body.

Most drug traffickers grow opium and process morphine into heroin before shipping it into the United States. Colombian traffickers used to control the U.S. heroin market, but Mexican drug traffickers are now the primary heroin suppliers to drug dealers in the United States, according to the DEA’s National Heroin Threat Assessment Summary.

These organizations make heroin in different ways. As a result, different types of heroin are smuggled into different parts of the country. Black tar heroin and brown heroin are more prevalent in western states, and white powder heroin is more common on the East Coast.

Fentanyl is a synthetic opioid. Reputable scientists create fentanyl in laboratories for pharmaceutical companies. A small portion of street fentanyl comes from diverted prescriptions.

A larger portion of fentanyl on the street is created by criminal scientists. Many of these crooked chemists create fentanyl in Chinese or Mexican labs and ship it to the United States, according to the DEA.

These traffickers have also created chemicals similar to fentanyl, such as furanyl fentanyl and acetylfentanyl. One fentanyl analogue called alpha-methylfentanyl is sometimes referred to as China White. These chemicals vary in potency but are generally much stronger than heroin.

Mixing Heroin and Fentanyl

Throughout the early 2000s, rates of prescription opioid addiction increased drastically, according to the Centers for Disease Control and Prevention. As more people became exposed to opioids through prescription drugs, more people began using heroin.

A 2014 study published in JAMA Psychiatry found that 75 percent of people who used opioids in the 2000s were introduced to them via prescription drugs. Researchers believe that increased availability, reduced price and increased purity of heroin contributed to growing rates of heroin use.

As heroin use increased, many dealers sought ways to increase their profits. Fentanyl is easier for drug traffickers to produce, which makes it cheaper for dealers to buy. Dealers began mixing fentanyl into their heroin supplies and selling the mixture to unsuspecting buyers as pure heroin.

The strength of the mixtures was unknown to the dealers or the buyers. Illicit chemists have no way of knowing the exact potency of the fentanyl that they create, and dealers don’t know or don’t care about the strength. When a person takes a drug that’s at least 25 times stronger than what they’re used to consuming, the odds of overdosing increase substantially.

Heroin and Fentanyl Overdose Stats

Between 2010 and 2014, rates of heroin overdose deaths more than tripled, according to the CDC. As the opioid epidemic worsened, more people started dying of fentanyl overdoses.

Many of these people thought they were buying a weaker opioid. Between 2014 and 2015, deaths from synthetic opioids other than methadone increased by 72 percent. Experts attribute most of those deaths to fentanyl, according to the CDC.

Deaths from heroin overdoses increased by 21 percent during the same time frame, according to the most recent national CDC report published in December 2016.

The primary difference between heroin and fentanyl is potency. Fentanyl is much stronger than heroin, so the drug is associated with greater risks. Like all opioids, heroin and fentanyl can cause life-threatening side effects when abused. They both cause addiction that requires intensive rehab to treat.

Medical Disclaimer: DrugRehab.com aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Chris Elkins, MA
Senior Content Writer, DrugRehab.com
Chris Elkins worked as a journalist for three years and was published by multiple newspapers and online publications. Since 2015, he’s written about health-related topics, interviewed addiction experts and authored stories of recovery. Chris has a master’s degree in strategic communication and a graduate certificate in health communication.

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