In May 2017, an Ohio police officer assisted in a traffic stop. When he opened the vehicle, he noticed that its interior was coated with white powder. An hour after that traffic stop, some of the substance got on his shirt. When he went to wipe it off with his bare hand, he collapsed to the floor.
He would later say that it felt like his body was shutting down. He heard himself talking, and it sounded weird. The stuff on his shirt sent him into a debilitating, life-threatening overdose.
The substance that was responsible was fentanyl, the mega-powerful opioid that can be lethal at 2 milligrams, which in quantity resembles grains of table salt. If it weren’t for a few doses of naloxone, which is used to reverse opioid overdoses, that officer would have died.
Fentanyl and its analogs are fueling the latest iteration of the opioid epidemic, the deadliest drug scourge in U.S. history. Previous waves of this crisis were driven by the willful ingestion of prescription medications like OxyContin and illicit drugs like heroin. Now, fentanyl and its chemical cousin carfentanil are claiming lives, but most of those cases are due to accidental exposure.
Fentanyl was responsible for 46 percent of opioid deaths in 2016, a threefold increase from 2010, according to The Journal of the American Medical Association (JAMA). What this means is that synthetic opioids have overtaken prescription medication as the largest killer in the ongoing opioid crisis.
What’s more, there are newer classes of opioids, far stronger than fentanyl, that authorities believe could help drive more overdose deaths into the near future.
What is Fentanyl?
Fentanyl was intended for the pain management treatment of cancer patients. It was developed by a Belgian doctor in 1960 and was approved for medical use in the U.S. in 1968. The fentanyl patch for people with cancer pain is included in the World Health Organization’s List of Essential Medicines, which details the safest and most effective medicines needed in a health system.
Fentanyl comes in the form of a lozenge or lollipop, nasal spray, patch, and injectable solution. It also comes in tablet form, to be placed under the tongue or between the cheeks and gums.
Like other opiates, fentanyl binds to the opioid receptors in the brain, which produces a surge in dopamine levels that impact reward areas. This gives users a profound sense of euphoria and relaxation, much like heroin.
Fentanyl is cheaply produced as a powder or counterfeit tablets for illicit use. Drug dealers use it as an additive in heroin and cocaine to stretch their product. For example, instead of selling a gram of heroin for $55 in a state like Florida, a dealer can “cut” the heroin with fentanyl and move it for the same price. Experts say that because there is a shortage of heroin, fentanyl is being included more and more. The result is a product that, despite being adulterated, is even more powerful and potentially lethal.
It also helps that the white powder form of fentanyl is typically indistinguishable from cocaine or heroin.
However, dealers have turned to substances more powerful than fentanyl to endow their product with even more potency, enough to kill a large animal let alone a human being. Some have even taken to formulating designer drugs laced with outrageous amounts of different drugs.
These Drugs Are Stronger Than Fentanyl
Gray death. It has an ominous name that often delivers on its promise. Gray death is an astonishingly potent mixture of substances that resemble concrete mixing powder. Medical experts have not been able to detail all of the specific contents that compose this drug cocktail. It is known that two of the primary gray death substances are heroin and fentanyl. A third added ingredient, carfentanil, makes it stronger than fentanyl. Carfentanil is one of the most powerful, commercially available opioids.
Carfentanil is increasingly being mixed with heroin despite the fact it is only supposed to be used as a tranquilizer for large animals such as elephants, moose, and buffalo. Its toxicity has been compared to nerve gas, and it is obviously not intended for human consumption.
Carfentanil, which is 10,000 times more powerful than morphine, is so potent that even touching a small amount of it can trigger overdose or even death. In fact, the U.S. Drug Enforcement Administration has issued warnings to law enforcement agencies about the dangers of fentanyl and carfentanil exposure. The federal agency issued warnings to officers and emergency service workers to take appropriate measures when handling substances.
“Carfentanil is surfacing in more and more communities,” warned a DEA official in a 2016 statement. “We see it on the streets, often disguised as heroin. It is crazy dangerous.”
An opioid called 3-methylfentanyl is four times as potent as fentanyl and is also being added to heroin. The designer drug acrylfentanyl is also more powerful than fentanyl.
Another synthetic opioid painkiller, sufentanil, is said to be five to 10 times more potent fentanyl. The U.S. Food and Drug Administration (FDA) recently approved a medication that contains 30 micrograms of sufentanil, setting off new fears that it could make the enduring opioid epidemic worse. Medicines that contain sufentanil are used in hospital settings to treat episodes of acute pain like a gunshot wound or a shattered bone.
Signs of Heroin Addiction
When carfentanil, sufentanil, or fentanyl is present in a batch of heroin, a single dose can cause death. For people addicted to heroin, it’s not a matter of “if” they will be exposed to one of those deadly synthetic opioids, it is only a matter of “when,” particularly if they live in certain regions.
If you suspect that you or a loved one is addicted to heroin and faces the possibility of accidental exposure to carfentanil, sufentanil, or fentanyl, then it is critical that you are aware of the signs and symptoms of addiction.
The signs of heroin intoxication can include shortness of breath, dry mouth, dilated pupils, disorientation or confusion, droopy and lethargic appearance, and fatigue. Addiction can manifest as observable compulsive behaviors that center on obtaining and using heroin even in the face of adverse health, professional, or legal consequences. Those behaviors include:
- Lying about drug use
- Struggling work or school performance
- Withdrawal from normal activities
- Loss of motivation
- A sudden change in friends
- Changes in weight
- Lack of attention to personal hygiene
- Lack of self-esteem
- Hiding needle marks with long sleeves and pants
- Drug paraphernalia like burned spoons, needles, syringes, burned straws
These days, heroin is more likely to be cut with a dangerous synthetic opioid now more than ever, making fatal overdose almost certain. The best chance you have at avoiding such a tragic outcome is by entering into professional addiction treatment.
How Professional Addiction Treatment Can Help You
When people become addicted to heroin, especially when it is laced with substances like fentanyl and carfentanil, it is vital that they undergo medical detoxification, the first step of professional treatment. Detox will rid your body of the heroin and opioids safely and comfortably. You will receive medications and around-the-clock care to ensure that the chemistry of your body and brain are restored.
A typical detox consists of three stages:
- Evaluation: Doctors conduct a general physical and mental health exam and screen you for co-occurring disorders. They also measure substance levels in the bloodstream and use this data to determine the best treatment plan for you.
- Stabilization: Stabilization involves keeping you safe as you withdraw from heroin. This procedure will minimize any pain, cravings, or discomfort you feel during the process. It also involves helping you manage any other unforeseen symptoms or ones that are extreme, such as seizures, which can be life-threatening.
- Transition: In this last step of detox, you receive resources and information about how to proceed with your addiction care.
The next step after detox is to receive ongoing care at a treatment facility. At Ocean Breeze, you will have the option of enrolling in a partial hospitalization program (PHP) or an intensive outpatient program (IOP). If you have been exposed to heroin that has been cut with fentanyl or another powerful opioid, PHP will be your best, most effective option. In PHP you will have access to intensive therapeutic treatment and clinical services. With IOP, you will receive comprehensive addiction treatment while you live at home. These programs will help you get to the root cause of your heroin addiction. You will also be armed with effective strategies to prevent relapse.
Heroin addiction can be pernicious and menacing. Thus, aftercare is a critical hedge against relapse and re-addiction. After detox and ongoing care, it is recommended that you engage in aftercare through an alumni program. Such a program will allow you to stay connected, inspired, and supported by a recovery community that consists of individuals who are dedicated to achieving lifelong sobriety. They know the dangers and threats of heroin and the health complications that can result from opioid addiction.
How Dangerous Are These Other Drugs?
At a large enough dose, heroin can be lethal. With fentanyl, sufentanil, and carfentanil, lethality can come with just a few grains. These synthetic opioids are ridiculously dangerous, especially carfentanil. Two milligrams of carfentanil, which is equal to about 34 grains of salt, is enough to sedate an elephant. That amount can also kill a human being.
The symptoms of carfentanil exposure include:
- Clammy skin
- Pinpoint pupils
- Respiratory depression or arrest
The symptoms can present themselves within minutes of exposure. Multiple doses of naloxone will be needed to reverse an overdose. The U.S. Justice Department recommends that overdose victims be given a dose of naloxone every two to three minutes until they resume breathing on their own for 15 minutes or until emergency medical services (EMS) arrives.
Fentanyl and Carfentanil Statistics
- According to The Journal of the American Medical Association, 50 percent of all deaths involving synthetic opioids included another opioid.
- Carfentanil is 100 times more potent than fentanyl.
- In 2019, there were 36,359 deaths involving synthetic opioids, according to the National Institute on Drug Abuse (NIDA).
- In 2014, 80 percent of fentanyl seizures took place in 10 states: Ohio, Massachusetts, Pennsylvania, Maryland, New Jersey, Kentucky, Virginia, Florida, New Hampshire, and Indiana.