How does fentanyl compare to heroin or other opiates?

Overview

• Fentanyl is an extremely potent, synthetic (man-made) opioid. It is about 50 times more potent than heroin and 100 times more potent than morphine. In contrast, heroin is 2 to 3 times more powerful than morphine.
• Fentanyl is a legally prescribed drug for pain in the U.S. and is classified as Schedule II controlled substance when used for legitimate purposes. Heroin is illegal in the U.S. and is classified as a Schedule I controlled substance.
• Another illegal opioid, carfentanil is a super potent fentanyl analog used as a tranquilizer in large animals like elephants. It is 10,000 times more potent than morphine. Carfentanil has NO medical use in humans.
• Heroin can be injected, smoked, or sniffed or snorted. High purity heroin is usually snorted or smoked. Fentanyl is typically injected, snorted or sniffed, smoked, taken orally by pill or tablet, and spiked onto blotter paper. Regulatory authorities warn that today most illegal drugs from the street or online contain some amount of fentanyl.

^{Source: DEA, 2022 Lethal doses of heroin, carfentanil, fentanyl}

Illegally-manufactured fentanyl and analogs are a major contributor to fatal and nonfatal overdoses in the U.S. It is commonly found in drugs sold on the street like heroin, cocaine, fake pills, crystal meth, and other drugs. It is also found in fake pills sold online on the Internet.

• Many people unknowingly consume fentanyl and die because they are not used to its potent effect.
• It is most commonly encountered for sale on the streets or online as either a white powder, in counterfeit tablets, or as a nasal spray. It is sold alone or found in combination with other drugs such as heroin, cocaine or methamphetamine.
• Users may not be aware that the product they purchase contains illegally made fentanyl.

Heroin is derived from morphine, which is a natural substance that is gathered from the opium poppy plant. Like heroin, it has a quick onset of action and one dose can be fatal.

• Heroin is usually sold on the streets as a white powder, a light brown powder, or as a black sticky substance known as “black tar heroin”.
• Most street heroin is “cut” with other drugs or with substances such as sugar, starch, powdered milk, or quinine, or with fentanyl, which has led to a steep rise in overdoses.

Learn more: Heroin: Commonly Abused Drugs

Both heroin and fentanyl are extremely dangerous. The risk of death can be higher with the use of fentanyl compared to heroin due to its high potency. Errors during illicit production can occur due to the small microgram (mcg) dose.

• Deaths due to overdoses of heroin in 2020 decreased by 7% compared to 2019, but 13,000 people still died due to heroin. Nearly 20% of all opioid deaths involved heroin.
• Deaths due to illegally-made fentanyl continue to rise in the U.S. In 2020, more than 56,000 deaths involved synthetic opioids like fentanyl. Synthetic opioid-involved death rates increased by over 56% from 2019 to 2020 and accounted for over 82% of all opioid-involved deaths in 2020.

Much of the heroin found on the streets today contains fentanyl, or is all fentanyl. There is no way to tell how much illegal fentanyl is in a product simply by looking at it.

Street names for illegally-manufactured fentanyl include:

• Apache
• Dance Fever
• Friend
• Goodfellas
• Jackpot
• Murder 8
• Tango & Cash

Street names for heroin include:

• Big H
• Black Tar
• Chiva
• Hell Dust
• Horse
• Negra
• Smack
• Thunder

Most other opioids are naturally-occurring opiates (such as codeine or morphine) or are semi-synthetic opiates (such as oxycodone or hydrocodone). Semi-synthetic opioids are partially derived from opium and partially man-made. These are prescribed legally in the U.S. by healthcare providers for moderate-to-severe pain, and are considered controlled substances.

They are less potent but can still be deadly due to respiratory depression (breathing that has slowed or stopped) if recommended doses are exceeded, or they are combined with alcohol, benzodiazepines or other CNS depressant drugs.

Today, illegally-manufactured pills that often look exactly like the prescription opioid pills (for example, Oxycontin) are sold on the street or online. These pills often contain some or all fentanyl because it is much cheaper to make and results in greater profits for dealers.

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