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Fentanyl vs. Heroin


Fentanyl and heroin belong to the same class of drugs and have very similar effects. However, fentanyl is a more potent opioid than heroin and can more easily lead to overdose when misused.
Both drugs are also very addictive, and treatment for an addiction to either drug involves therapy, medication, or a combination of both.

What’s the Difference?

Heroin syringe and spoon
Heroin and fentanyl are both opioids. However, heroin is a semi-synthetic drug made from the natural substance morphine, which comes from the seed pod of opium poppy plants,1 while fentanyl is a synthetic drug.2  

Heroin is a Schedule I drug, meaning it has no current medical use and a high potential for abuse. All heroin is illicitly manufactured for sale on the street market.3

In contrast, fentanyl is a Schedule II drug that can be prescribed to treat severe pain or to manage pain after surgery.2 However, fentanyl still has a high potential for abuse.3 Fentanyl is also 30–50 times more potent than heroin and 50-100 times more potent than morphine.4  Pharmaceutical fentanyl is legally manufactured for use in various medical and surgical settings. However, the drug can also be made illegally in illicit labs.2 Legally made fentanyl may also be stolen and sold; illegally distributed by patients, physicians, and pharmacists; or diverted through fraudulent prescriptions.5

Although heroin and fentanyl have many differences, they are both associated with high risks of overdose and addiction.1,2

Forms and Use

Heroin powder and syringe in cross form

Heroin and fentanyl come in different forms.

Heroin is typically a white or brown powder and can be injected, snorted, or smoked.  In certain regions, heroin is also encountered as a black sticky substance known as black tar heroin.1  

Fentanyl, when prescribed by a medical professional, is commonly administered via injection, an adhesive patch, or as lozenges.  Illicitly manufactured fentanyl is most commonly found in power or tablet form or mixed with other substances such as heroin. In its various forms, fentanyl can be swallowed, snorted, injected, or used to spike blotter paper, from which it is absorbed through the mucous membrane in the mouth.2

Along with the many forms and ways that these substances can be used, there are a variety of names that they can go by. Heroin is often known as Big H, Horse, Hell Dust, and Smack.1 When combined with cocaine, the mixture is often referred to as a speedball.1

Brand name, prescription formulations of fentanyl include Actiq, Duragesic, and Sublimaze. Street names for fentanyl, or heroin that has been laced with fentanyl, include Apache, China Girl, China White, Dance Fever, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.2

Heroin is sometimes cut with fentanyl without the user’s knowledge. Unwittingly using these adulterated samples can be extremely dangerous because fentanyl is much more potent than heroin and can more easily lead to overdose.4,5 If someone believes they are about to use heroin, when in fact they are about to use fentanyl, they may use an amount that is too much for their body to handle, leading to overdose.

Overdose is a very scary and potentially tragic consequence of heroin and fentanyl use, but there are other dangerous effects to be aware of as well.

Effects

Through their interaction with opioid receptors, both heroin and fentanyl impact key brain systems that control pain and emotions.1,2 They can both produce a relaxed and euphoric state in the user.2 However, there are many unpleasant and potentially dangerous effects associated with both acute and chronic use as well, including:1,2

  • Dry mouth.
  • Flushed skin.
  • Severe itching.
  • Stomach cramps.
  • Nausea and vomiting.
  • Constipation.
  • Heavy feelings in limbs.
  • Sedation.
  • Confused mental state.
  • Alternating between consciousness and semi-consciousness.
  • Insomnia.
  • Collapsed veins (from injection).
  • Infection of the heart lining and valves (from injection).
  • Liver disease.
  • Kidney disease.
  • Lung complications.
  • Mental disorders (i.e., depression).
  • Sexual dysfunction (for men).
  • Irregular menstrual cycles (for women).
  • Respiratory depression.
  • Respiratory arrest.
  • Coma.
  • Death.

Overdose

As mentioned before, both drugs have a high risk for overdose, with fentanyl having an especially high risk due to its potency.2,4,5 An overdose occurs when someone uses enough of either substance to create a life-threatening reaction or death.1
Man overdosed on heroin
Symptoms of overdose include:1,4

  • Pinpoint pupils.
  • Cold and clammy skin.
  • Stupor.
  • Coma.
  • Slowed breathing.
  • Stopped breathing.
  • Bluish-colored extremities (cyanosis).
  • Respiratory failure.
  • Death.

Opioid overdose is currently a major public health concern, as increasing numbers of people are dying from it. In 2015, almost 13,000 people in the U.S. died from heroin overdoses, and 9,580 people died from overdoses involving non-methadone synthetic opioids, which is a category dominated by fentanyl-related overdoses. Further, there was a 5.9-fold increase in overdose deaths due to heroin and non-methadone synthetic opioids from 2002 to 2015.6

If someone is overdosing, it is extremely important to help them immediately to prevent death.

  • The first step is to call 911.7 If you can, be prepared to provide information for the operator, such as how much heroin or fentanyl they took, and when they took it.
  • Perform CPR if necessary.7
  • If available, administer naloxone, a medicine that can block the effects of heroin, fentanyl, and other opioids in order to restore breathing1,2,7 In its various forms, naloxone can be administered by injection, handheld auto-injector, or nasal spray.1 The effective required amount will depend on the amount and potency of the opioid that was used (higher doses may be required if the user is overdosing on fentanyl).2
  • Monitor the person’s condition for a return of overdose symptoms for at least 4 hours after the last dose of naloxone. Most people return to normal breathing within 3 to 5 minutes after being given naloxone. The drug’s opioid-blocking effects may last for 30 to 90 minutes. But depending on the amount and potency of the opioid drugs already taken, some people may re-experience overdose symptoms after that.7

Addiction

Along with a high risk of overdose, both heroin and fentanyl are highly addictive.1,2 The signs of addiction are the same for both heroin and fentanyl and include:8

  • Spending significant amounts of time obtaining and using the drug.
  • Tolerance to the drug (i.e., needing to use larger amounts of the drug to achieve the same effect that was previously met with smaller amounts).
  • Experiencing withdrawal symptoms when drug use is suddenly stopped.
  • Continuing to use despite negative consequences (i.e., poor performance at school, job loss, relationship problems, financial concerns, legal issues).
  • Using more heroin or fentanyl than initially intended.
  • Repeatedly failing to cut back on use.
  • Not taking care of responsibilities at school, home, or work due to drug use.
  • Strong urges to use.
  • Continuing to use despite physical, mental, and social problems related to drug use.
  • Using in dangerous or risky situations.
  • Neglecting hobbies or activities the person once enjoyed because of drug use.

If someone is struggling with any of the symptoms described above, there are a variety of options for opioid addiction treatment. These include:

  • Medication-assisted treatment. Medications, such as buprenorphine or methadone, can be used to treat opioid addiction. Through careful dosing and regular administration, these treatment drugs work by binding to the same receptors as heroin or fentanyl, which helps reduce cravings and withdrawal symptoms, making it easier for someone to quit.1
  • Behavioral therapy. Behavioral therapy can help the user identify triggers that tend to lead to drug use, manage stress, and receive rewards for staying clean.1

While both medication-assisted treatment and behavioral therapy may be helpful on their own, it has been found that they are most effective when they are used simultaneously.1

If you or someone you know is addicted to heroin, fentanyl, or other similar opioids, hearing about the risks and potentially tragic consequences of using such substances can be quite scary. However, you do not need to continue living in fear. There are many treatment options available. Call to find the treatment that’s best for you.

Sources

  1. National Institute on Drug Abuse. (2018). Heroin.
  2. National Institute on Drug Abuse. (2016). Fentanyl.
  3. United States Drug Enforcement Administration. (N.D.). Drug Scheduling.
  4. United States Drug Enforcement Administration. (N.D.). Fentanyl FAQs.
  5. United States Drug Enforcement Administration. (2016). Fentanyl: (Trade Names: Actiq, Fentora, Duragesic).
  6. National Institute on Drug Abuse. (2017). Overdose Death Rates.
  7. Substance Abuse and Mental Health Services Administration. (2016). SAMHSA Opioid Overdose Prevention Toolkit.
  8. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. Arlington, VA: American Psychiatric Association Publishing.

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