Heroin is a major culprit in the opioid epidemic that’s led to a dramatic increase in opioid addiction and overdose of the last decade. But another opioid called fentanyl is also implicated in the spike in overdose rates. Which drug is stronger? How many people are affected by these drugs? Why is heroin illegal while fentanyl can be legally prescribed in the United States? Learn more about heroin, fentanyl and how they can affect you.

What Is Heroin?

Heroin is one of the most common illicit drugs in the United States. It is a brand name for a drug that was once sold by the Bayer pharmaceutical company but has since fallen out of legitimate use. Heroin is also a name for a drug called diamorphine, which is an opioid. It’s a semi-synthetic opioid, which means it’s made by altering naturally occurring opioids. In this case, heroin is derived from morphine, a drug found in opium poppy plants. 

Heroin is stronger than morphine. According to a 1981 study, heroin was found to be around twice as strong as morphine when it came to pain-relieving properties in cancer patients. However, it’s important to note that this doesn’t mean it would take twice as much to cause fatal overdose symptoms. Different drugs can cause effects at different doses. 

Heroin is similar to other opioids in the way it works in the brain and body. As an opioid, it binds to opioid receptors throughout the body to block pain signals from being sent and received by nerve cells. This can stop moderate-to-severe pain, but it also causes some other potent effects. Heroin is able to cause a feeling of intense euphoria, physical warmth, and a mental and physical sense of well-being. It can also cause you to feel relaxed, drowsy, or sleepy. Because of these powerful euphoric effects, heroin can quickly lead to misuse and substance use problems. 

Is Heroin Dangerous?

Heroin can also cause chemical dependency. When it’s used several times, or in high doses, your brain and nervous system can adapt to it. When you try to cut back or quit, you’ll feel uncomfortable withdrawal symptoms. Withdrawal is commonly compared to a particularly bad case of the flu, causing nausea, vomiting, sweating, and diarrhea. Withdrawal can present a serious barrier to treatment and sobriety.

In high doses, heroin can cause a fatal overdose. Like many opioids, heroin can slow down your breathing, which is called respiratory depression. During a heroin overdose, you may pass out, and your breathing and heart rate will slow down. It may be difficult to wake you up. In fatal cases, a person’s breathing can slow or stop, causing oxygen deprivation, coma, and death. 

What Is Fentanyl?

Fentanyl is a powerful synthetic opioid. Unlike heroin and other semi-synthetic opioids, fentanyl is entirely made in a lab, not from altered naturally occurring substances. Like other synthetic opioids, fentanyl is more powerful than other options. Fentanyl is used in medical settings, but it can also be found in illicit drugs like heroin. It’s used to treat moderate-to-severe pain symptoms that are caused by things like surgery, labor and birth pains, and injury recovery. Fentanyl is used in several forms, including as a patch, epidural, or intravenous injection, or drip. It’s even available in lollipop form for use in combat situations. 

Is Fentanyl Dangerous?

Fentanyl is estimated to be 50 to 100 times more powerful than morphine, which means it’s considerably stronger than heroin as well. As little as 2 to 3 mg (milligrams) is enough to cause a fatal overdose in the average person. That’s a fatal dose around the same weight as a snowflake. Fentanyl’s danger comes from its power and the fact that it’s often mixed into other drugs without the drug user knowing. 

Heroin and Fentanyl Statistics

heroin vs fentanyl

Heroin is one of the easiest illicit drugs to get after marijuana. Because it’s relatively cheap and available, heroin is a commonly used drug in the United States, despite its legal status. Illicit drug sources from outside the U.S. have increased the amount of heroin that is shipped all over the country in the past several years. 

In combination with the rise in opioid prescriptions, the influx of heroin has led to an opioid crisis. People who take prescription opioids for too long or misuse them as recreational drugs can quickly develop dependence and addiction. According to the National Institute on Drug Abuse (NIDA), around 80% of people who use heroin start by taking prescription opioids. 

Heroin overdose death rates have been on the rise for over a decade until they peaked in 2017. In 2019, there were 14,019 overdose deaths that involved heroin. However, the rate of heroin overdose deaths without any other opioids involved has fallen since 2015. Fentanyl has increased in prevalence in the United States, often making its way into heroin supplies. Despite the fact that fentanyl use in the country legally, the fentanyl that’s used illegally typically comes from illicit sources outside the country. 

Fentanyl is created in clandestine labs overseas and shipped to the United States illegally. The powerful synthetic drug is cheap and easy to make and ship. Since the drug is so potent, small, and difficult to detect, packages can be profitable to transport and distribute. The drug is often used to increase the perceived quality of drugs like heroin.

 Heroin may be adulterated to increase profits, but adding fentanyl can boost its potency. However, fentanyl can be deadly, even in small amounts. Adding fentanyl to another drug can create a deadly overdose without the user ever knowing they aren’t only taking the drug they purchased. According to NIDA, synthetic opioids like fentanyl and its analogs were involved in 36,359 overdose deaths in 2019.

Which Drug Is Stronger?

Fentanyl is considerably stronger than heroin and 50 to 100 times stronger than morphine. That means it requires a much smaller dose of fentanyl to be effective, to cause uncomfortable side effects, and to lead to a fatal overdose than heroin does. 

Fentanyl is thought to be among the strongest opioids available. However, it has many analogs, which are chemicals that have slight variations and possess many of the same properties as fentanyl. Many of these analogs could be similar in strength or stronger. 

In fact, the strongest opioid available is carfentanil, an analog of fentanyl. Carfentanil is estimated to be 100 times stronger than fentanyl and 100,000 times stronger than morphine. 

If Fentanyl Is more Dangerous, Then Why Is It Legal?

Heroin is considered a Schedule I drug in the United States, which means it is regulated at the highest level. Meanwhile, fentanyl is Schedule II, which means it can be legally prescribed by a doctor. Heroin is very similar to a variety of prescription painkillers that are considered safe and well-tolerated by patients. However, if you were given an appropriate dose of heroin by a doctor, it would work in a way that’s similar to other prescription opioids. Its side effects would be similar, too, including constipation, itching, and chemical dependence. 

If that’s the case, why is fentanyl allowed to be used for medical purposes when heroin is not? 

The U.S. drug scheduling system has been used since the passing of the Comprehensive Drug Abuse Prevention and Control Act of 1970. It determines the legality of certain substances on the federal level. The five-tiered schedule system determines the level of control the government has on a drug. The system is controversial since it was determined with very little attention to chemistry. Some criticize the system for having arbitrary rules. 

Still, it’s important to note that the schedules aren’t a measure of how powerful or dangerous a drug is. If that were the case, drugs with high toxicity like chemotherapy drugs would be at the top of the list. Instead, the drugs in the scheduling system are placed based on a drug’s potential for misuse, the potential for addiction, and accepted medical uses. 

When the act was passed, the current abuse statistics of the time were a major factor. Drugs like heroin, which make it into the Schedule I category, are known to have a high potential for misuse and addiction and don’t have accepted medical uses. While heroin could be used as an effective painkiller, other opioids are more commonly used. 

This is partly because the drug has had a reputation for causing addiction for decades, and it has been banned from being sold, imported, or manufactured since 1924. When the Controlled Substances Act was passed in the 1970s, the vast majority of heroin use was illicit. 

Fentanyl was first synthesized in 1959 and began to be used as an anesthetic in 1968. In the 1990s, a transdermal patch was introduced that could provide continual pain relief over a period of several days. These unique medical uses make fentanyl a helpful drug in the treatment of pain and other issues. Fentanyl’s potency also means producing smaller, cheaper amounts of the drug can be just as effective as larger amounts of other opioids. 

Still, while fentanyl can be safe when a medical professional prescribes or administers it, its power makes it extremely dangerous when it’s misused. Since a tiny amount can cause a fatal overdose, it’s difficult for drug dealers and untrained illicit drug manufacturers to measure out safe doses. When the drug is mixed into heroin, it can easily lead to an overdose.

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