Fentanyl, more potent than heroin?
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Often times, the illicit drug heroin is thought of as one of the more powerful opioids on the planet. It might be surprising to hear that a relatively common prescription medication, fentanyl, is even more powerful. Furthermore, when the two are combined, it can become a fatal combination.

Heroin has been around since the late 1800s. It is a powerful semi-synthetic opiate derived from the opium poppy and is used illicitly as a recreational drug. Heroin delivers an intense rush or euphoria and is more powerful than most opioid analgesics. Although historically heroin was marketed as a cough suppressant, it has since become a Schedule I (illegal) substance in the United States.

On the other hand, fentanyl is a synthetic opioid compound created in the early 1960s. It is one of the few opioids that is even more powerful than heroin, yet available with prescription.

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Fentanyl is thought to be 25 to 50 times more potent than heroin. Under medical supervision, fentanyl is used as a painkiller, to treat severe pain, to manage pain after surgery, or to treat those suffering from chronic or cancer pain. Fentanyl can be administered in various forms: as a transdermal patch, lozenge, tablet or nasal spray. It can also be injected into a muscle or given intravenously by a medical professional. 

Regardless of method of administration or even type of opioid, both heroin and fentanyl have a similar mechanism of action.

The basic mechanism of opioid drugs, whether it be heroin or fentanyl, is working as an agonist at the mu opioid receptors (MOR). Activation of the mu opioid receptor by an opioid agonist may cause analgesia, the inability to feel pain. The same activation may also lead to feelings of euphoria and sedation. At the same time, opioids may also results in a host of negative effects as well, often triggering nausea, vomiting, and respiratory depression, which can be fatal. 

Although there may be medical and palliative uses for fentanyl, the potency of the drug is a distinguishing characteristic that makes it so dangerous.

Fentanyl was synthesized in a laboratory, and heroin is derived from the opium poppy. Whether it is synthetic or of natural origin, the key difference of fentanyl is that its chemical properties allow it to cross the blood-brain barrier more effectively than other opioids including heroin. Once in the brain, it binds very tightly to opioid receptors in the brain. 

Heroin is more potent than other opioids. Fentanyl is more potent than Heroin. Heroin and Fentanyl have a higher risk of being fatal.  

Sadly enough, today dealers are adding fentanyl not just to heroin but to counterfeit opioid painkillers, to create an even more intense high. In the last few years thousands of overdose deaths have been reported by the Drug Enforcement Administration, as a result of the mixture.

On April 21, we lost one of the most talented entertainers of our times, Prince. An abbreviated report released by the medical examiner on June 2 stated that “the decedent self administered fentanyl”. Just yesterday, an AP report by Amy Fortile a Minneapolis correspondent, cited that investigators found an Aleve bottle at Prince’s residence that contained pills marked “Watson 385”, which would typically correspond to Hydrocodone.

These investigators reported that these tablets actually contained the drug fentanyl, which is roughly 100 times more potent than the hydrocodone. 

These counterfeit painkillers are becoming more and more common in the market. Because of its unknown contents, drug users might underestimate its strength, ingesting more opioid than they are normally known to tolerate, causing a respiratory depression that leads to fatal overdose. Authorities are presently investigating from whom and how Prince obtained these drugs.

Hopefully the responsible parties will be found and properly charged so that loss of other innocent lives can be avoided.

As medical director of the Waismann Method, Michael Lowenstein M.D., is recognized as a leader in the field of opiate dependence. He is quadruple board certified from the American Board of Anesthesiology, the American Board of Pain Medicine and the American Board of Addiction Medicine. Most recently, Dr. Lowenstein completed a fellowship and earned board certification in Anti-aging, Regenerative, and Functional Medicine.


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