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Heroin and fentanyl are opioids that caused increasing numbers of overdose deaths between 2010 and 2017. 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, and it has a much higher chance of causing 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

As with all opioids, the major effects of heroin and fentanyl are pain relief and relaxation. Common side effects 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 both drugs 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 main difference between fentanyl and heroin is potency. 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 buying.

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 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 may cause dependence and addiction more quickly than weaker opioids.

Treatment for heroin addiction is the same as treatment for fentanyl addiction. 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 addicted to fentanyl will probably require more intensive treatment than a person addicted to heroin.

Learn more about the opioid rehab process

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.

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.

Heroin and Fentanyl Overdose Stats and Causes

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.

Between 2010 and 2014, rates of heroin overdose deaths more than tripled, according to the CDC.

Learn more about what caused the opioid epidemic

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.

Many people began dying of fentanyl overdoses because they 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.

Learn more about the states most affected by the opioid epidemic

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.

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