The synthetic drug fentanyl is far more potent and deadly than heroin, its naturally derived counterpart.

Fentanyl, about 50 times stronger than heroin, has only exacerbated the opioid crisis, inducing an inexorable toll on families and communities. Experts say that fentanyl and carfentanil, two synthetic opioids, have become the primary catalysts of the “third wave” of the opioid epidemic.

The damage fentanyl has wrought is extensive. For instance, fentanyl and its analogs were involved in almost half of the 72,000 drug overdose deaths in the U.S., according to the U.S. Centers for Disease Control and Prevention (CDC). Their use has resulted in unprecedented spikes in overdose deaths around the U.S.

In 2016 alone, Maine, Massachusetts, West Virginia, Ohio, North Carolina, Tennessee, Minnesota, Nevada, Arizona, and New Mexico saw between 50 to 100 percent spikes in overdose deaths. In one Florida county alone, the number of fatal opioid overdoses jumped 230 percent in two years, with fentanyl serving as the primary driver.

Even the anecdotal evidence of fentanyl’s toll is palpable. Take the case of a New Hampshire medical examiner who was profiled for an October 2017 New York Times article. His office had been so overwhelmed by opioid-involved autopsies that he retired from his position to enroll in divinity school. He intends to minister to young people to stay away from drugs.

“After seeing thousands of sudden, unexpected or violent deaths,” he told The New York Times, “I have found it impossible not to ponder the spiritual dimension of these events for both the deceased and especially those left behind.”

Although the number of new heroin users declined in 2017, the number of current drug users exposed to fentanyl is growing, according to a report published by Pew.

Fentanyl and its analogs differ from standard heroin in that they tend to be more potent and, ultimately, more lethal. Add to the fact that street heroin is being cut with fentanyl to boost its potency. This only muddies the distinction between natural and synthetic heroin.

There are other crucial differences between these types of substances. One thing is clear, though: Addiction to any of them can prove deadly.

What is Fentanyl and How Does it Differ From Heroin?

Before fentanyl gained its reputation as a nefarious, killer opiate, it had legitimate medical use as a pain reliever and anesthetic. It was first developed in 1959 and introduced a year later as an intravenous anesthetic.

It was hailed for its ability to treat severe pain, especially advanced cancer pain. In fact, the fentanyl patch for cancer pain is included in the World Health Organization’s List of Essential Medicines, which chronicles the safest and most effective medicines needed in a health system. Fentanyl comes in the form of a lozenge or lollipop, nasal spray, patch, or injectable solution. It also comes in tablet form, to be placed under the tongue or between the cheeks and gums.

It acts like other opioids in that it binds to opioid receptors in the brain, producing a flood of dopamine levels that act on the reward areas. This action will promote feelings of euphoria and relaxation in a user, much like heroin.

But chemically, it is quite different. Heroin is naturally derived from the resin of poppy plants. A milky opium substance is removed from a pod of the poppy flower and refined to form morphine. After that, it is further cultivated to form heroin.

Fentanyl is produced by manmade means. Because it is synthetic, it can be easily and inexpensively reproduced. In fact, it is cheaper than its natural counterpart — another marked difference.

Savvy drug dealers have seized on the fact that fentanyl allows them to produce a more potent form of street heroin while saving on heroin. They use it as an additive to stretch the 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.

What Exactly is Synthetic Heroin?

Fentanyl and carfentanil are synthetic opioids. Heroin that has been adulterated with man made substances is considered synthetic.

The list of opioids that could also be considered synthetic heroin include:

The Mysterious “China White”

“China White,” another form of synthetic heroin, is a fat-soluble painkiller believed to be stronger than heroin, morphine, or even fentanyl. The name “China White” used to be a slang term for heroin in the 1970s and 1980s. In recent times, it became known for something almost entirely different, and it has been causing fatal overdoses for years.

“China White” is composed of α-Methylfentanyl.

A New York Times article from 1988 reported that China White was responsible for 18 deaths in Western Pennsylvania. It also cited statistics where the drug was responsible for a rash of deaths in California, Arizona, and Oregon back then.

Unlike heroin and fentanyl, people are dying from China White because of the substance’s side effects, Dr. Carlos Ramos-Matos told Rolling Stone.

“People high on the drug who enter [an] emergency room may seem like they’re overdosing on heroin or another opioid, but the symptoms are more complicated because fentanyl derivatives are far more powerful,” according to that same article.

China White has seen a resurgence in use in places like Rhode Island and Pennsylvania.

The Overdose Symptoms of Heroin

Few substances are as potent and deadly as heroin. That’s even more so for fentanyl and its analogs. All it takes is just a minuscule amount of fentanyl or carfentanil to kill a human being. For example, 2 mg (milligrams) of fentanyl, which looks like grains of salt, is lethal.

Carfentanil, which is used to sedate large mammals, is even more lethal. It’s 10,000 times stronger than morphine, and just 2 milligrams is enough to sedate an elephant. Just a trace amount can kill a human.

Heroin is no slouch either. It can produce life-threatening overdose symptoms such as:

  • Slow, shallow or difficult breathing
  • Blue lips and fingernails
  • Clammy skin
  • Convulsions
  • Low blood pressure
  • Spasms of the stomach and intestines
  • Coma
  • Death

When heroin is adulterated with fentanyl or other common fillers like cornstarch, lead, barbiturates, benzodiazepines, or rat poison, fatal overdose is even more likely.

Overdose Symptoms of Synthetic Heroin

With fentanyl intoxication comes an intense euphoria and a depressed central nervous system. A user can quickly decline into overdose, however. They can exhibit the following symptoms, which can be more pronounced than those that come from heroin. Fentanyl overdose symptoms can include:

  • Drowsiness
  • Dilated pupils
  • Cold, clammy skin
  • Blue lips, nails, and skin
  • Significant mental confusion
  • Shallow/difficulty breathing
  • Nausea or vomiting
  • Slow pulse
  • Sluggish blood pressure
  • Weak heart rate
  • Muscle weakness or limpness
  • Dizziness
  • Trouble with balance/coordination
  • A potential loss of consciousness

As one of the deadliest substances in the world, carfentanil overdose almost always leads to death.

Synthetic Heroin’s Other Danger

The go-to medication to reverse an opioid overdose is naloxone, which is manufactured under the brand names of Narcan and Evzio. When someone who is overdosing on heroin, Vicodin, or OxyContin, an injection or a spray of naloxone can block their effects, effectively reversing the overdose.

“While it might take two doses of naloxone to reverse the effects of a heroin overdose, it can take a multitude of doses to reverse a fentanyl overdose. There are other instances where naloxone simply won’t work with synthetic heroin.   ”

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