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Explaining Fentanyl

By Melissa Riddle Chalos

A major headliner in U.S. media, the opioid crisis is now beyond epidemic, reaching pandemic proportions. Opioid overdoses now kill more people each year than breast cancer,1 more than the Vietnam War2 — reaching a record-setting high in 2016, up 20 percent from the previous year.1

Many experts suggest that overdose rates are skyrocketing because Fentanyl use is on the rise.

What Is Fentanyl?

According to the National Institute on Drug Abuse (NIDA), Fentanyl is a “synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent.”3 A schedule II prescription drug originally prescribed by physicians for severe pain before and after surgery, it is now prescribed for patients with chronic pain or for those who do not tolerate opioids well. Fentanyl is also known as Actiq®, Duragesic® and Sublimaze® and comes in three different forms: injection, transdermal patch or in lozenges.3

But this is not the form of fentanyl drug enforcement experts are seeing in connection with the opioid overdose epidemic. This non-pharmaceutical fentanyl, created in illegal laboratories, is sold as a powder or “spiked on blotter paper; mixed with or substituted for heroin or as tablets that mimic other, less potent opioids.”3
Street names for fentanyl or for fentanyl-laced heroin include:

  • Apache
  • China Girl
  • China White
  • Dance Fever
  • Friend
  • Goodfella
  • Jackpot
  • Murder 8
  • TNT
  • Tango and Cash3

This illicit form of fentanyl — 50 times more powerful than heroin — was found in more than half of the overdose deaths in 10 states in 2017, spiking the death by overdose rate in Connecticut alone by 420 percent.4

Why Is This Happening?

Because illicit fentanyl isn’t a stand-alone drug, but rather one that is mixed with other drugs like heroin, cocaine or benzodiazepines, its entry into the drug market is hard to pinpoint. But according to some experts, it can be traced to the uptick of overdoses that begin around 2011 and have been steadily rising ever since.5

In the U.S., there are many plausible theories for the rise of illicit fentanyl:

  • It’s potency. Some forms of fentanyl, such as the synthetic analog form carfentanil, can be up to 10,000 times stronger than morphine.
  • It’s price. Fentanyl is cheaper than morphine or heroin, giving drug manufacturers and dealers who cut other drugs with it higher profit margins.
  • It’s potential. Fentanyl is not easily detected by routine urine drug screen tests like morphine, codeine and heroin.6

Why Is Fentanyl So Potent and Dangerous?

Handdrawn questions marksSimilar to heroin, morphine and other opioid drugs, fentanyl adheres to the brain’s opioid receptors, increasing dopamine and producing a state of euphoria and relaxation. Like the aforementioned drugs, fentanyl can also cause drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, and unconsciousness.3

The spike in overdoses that involve fentanyl is largely attributable to its potency. Users aren’t aware that the cocaine or heroin they are taking has traces of fentanyl. Opioid receptors in the brain, when exposed to potent traces of fentanyl, can cause breathing to stop completely, which can lead to death.3

And while some researchers believe the growing surge of fentanyl in cocaine is more a contamination issue than intentional malice, drug enforcement officials and others speculate there is an effort by drug cartels to “expand the market of people addicted to opioids.”4

Fentanyl enhances the high in such a way as to make whatever it’s mixed with even more addictive to the user. So, those who were using opioid-laced cocaine are more likely to use more frequently until they are unable to stop. Or, if fentanyl is involved, until it kills them. To take opioids without a tolerance to them is considered to be opioid-naive. “If you’re opioid-naive and you take fentanyl, there’s a good chance you’ll die,” says Albie Park who co-founded HRH413 to offer Naloxone and harm reduction training to agencies in Massachusetts.4

How to Get Help Now

Fentanyl is the bullet in the Russian roulette of addiction. These days, there is potential for it in every batch of cocaine and in every hit of heroin. Every time you use — even if you think you know the source of your substance — you risk your life. This is why it is important to reach out for help with addiction now, while you still have a choice. Your life is worth more than you can even imagine, and here at Michael’s House, we can help you rediscover all the reasons why.


1 Kounang, Nadia. “US Drug Overdose Deaths Reach New Record High.” August 8, 2017.

2 Lopez, German. “Why America’s Cocaine Problem is Now a Fentanyl Problem Too.” May 4, 2018.

3 “Fentanyl.” National Institute on Drug Addiction (NIDA). June 2016. Accessed June 17, 2017.

4 Bebinger, Martha. “Fentanyl Laced Cocaine Becoming a Deadly Problem Among Drug Users.” March 29, 2018.

5 Frankel, Joseph. “The Hard to Trace Ingredient Behind Skyrocketing Cocaine Deaths.” The Atlantic. May 2, 2018.

6 Haney, Stephanie. “The Opioid Epidemic’s Biggest Culprit Isn’t Heroin Anymore — It’s Something Deadlier.” June 17, 2018.