Opioids have been the subject of controversy over the past several years. The increase of opioid addiction and overdose has led to a crisis that threatens public health in the United States. The opioid crisis is thought to be tied to an increase in the prescription of legal opioids combined with an increase in illegal opioid trafficking.
Two drugs are at the center of the opioid crisis: heroin and fentanyl. Heroin has been the most popular illicit opioid for recreational use for decades, but fentanyl is relatively new in illicit markets, and it has made a huge impact in the last few years. But what’s the difference between these two opioids? How strong are they, and how easily can they cause a life-threatening overdose? Learn more about heroin, fentanyl, and how they compare.
What’s the Difference Between Heroin and Fentanyl?
Heroin is a much older drug than fentanyl. The Bayer Pharmaceutical company created it in 1898, and it was thought to be a viable alternative to morphine, which had already seen wide use. Heroin is known as a semi-synthetic opioid, which means it’s created by altering naturally occurring opiates. Heroin is created from morphine, which can be found in opium poppy plants naturally.
Morphine is chemically similar to another opiate that’s found in human brains called endorphins, which are important in regulating your body’s pain response. Because morphine and endorphins are similar, morphine and similar opioids like heroin can bind to opioid receptors in your brain to have pain-relieving effects.
Morphine is stronger than your endorphins, and heroin is stronger than morphine, so the drug’s effects can be potent. Plus, when heroin is broken down in the body, it converts into morphine, which continues the pain-relieving effects. Like other opioids, heroin can offer effects beyond pain relief. It can also have a sedating effect and a potent, euphoric sense of bodily warmth, well-meaning, and comfort. These effects make it a popular recreational drug and give it a high potential for misuse, dependence, and addiction.
Unlike morphine, which is completely natural, and heroin which is made from a natural substance, fentanyl is a completely synthetic substance. That means that it was made by people in a laboratory, not found in nature or altered. Fentanyl was first created in 1959 in Belgium by Paul Jensen of the company Janssen Pharmaceutica.
Where Do They Come From?
Heroin was once used for medical purposes in the United States, but it’s since been replaced by other opioids. The majority of heroin that’s available in the United States is illicit, and it’s traded on the black market. Unlike heroin, fentanyl is used as a medication today. It’s used to treat severe acute pain in hospital settings and in the military. It’s available in many forms, including transdermal patches and lozenges.
However, much of the recreationally used fentanyl in the United States also comes from illicit sources. According to the Drug Enforcement Administration’s 2020 Drug Threat Assessment, fentanyl is manufactured by Mexican transnational criminal organizations in illegal laboratories in Mexico. Mexican authorities have reported an increase in pill presses that can make fentanyl into tablets that appear to come from a legitimate source.
The DEA also reports that Mexican criminal organizations are also responsible for the production and trafficking of heroin into the United States, which comes over the southwestern border of the U.S. Fentanyl is also shipped to the U.S. directly from China, but the supply of fentanyl that comes from China has been surpassed by Mexican cartels in recent years.
Of the DEA’s 23 field divisions across the United States, 17 of them reported that the availability of fentanyl was high in both 2018 and 2019. These field divisions also reported that heroin availability was high. In 2018, almost 70 percent of overdose deaths in the United States involved opioids, many of them involved synthetic opioids like fentanyl.
How Potent Are Fentanyl and Heroin?
Heroin is a fairly potent opioid, and it’s estimated to be between two and three times as potent as morphine. However, the power of an opioid is relative to the effect it causes. In other words, its pain-relieving power and its power to cause an overdose may be two different things. Still, it’s clear that heroin is more potent than morphine. It’s possible for a 30-milligram dose to be fatal in the average person.
However, fentanyl is much stronger than heroin, and it’s estimated to be 50 to 100 times more powerful than morphine. Fentanyl could cause a fatal overdose in a dose as small as 3 mg (milligrams) in the average person. The exact size of a fatal overdose of either of these drugs can depend on a number of factors. Someone that takes an opioid for the first time will be vulnerable to a lower dose than someone that has a long-term dependence on opioids. Heroin and fentanyl can both be even more dangerous when they’re mixed with other drugs.
Opioids can lead to overdose more quickly when they’re mixed with other opioids or central nervous system depressants. Both opioids and depressants like alcohol can cause your central nervous system to slow down. In high doses, they can slow down important functions of your brain, like your breathing and heart rate. As your breathing gets slower, you can experience oxygen deprivation that causes you to pass out and experience brain damage. It can also lead to a coma or death. When opioids are combined with other opioids or depressants, their respective nervous system suppressing effects can potentiate, leading to overdose even with relatively moderate doses of each individual drug.
Whether you’re using an opioid like heroin or fentanyl as a recreational drug or a prescription, you should always be careful when mixing it with other substances, especially ones that have sedation effects.
Is Fentanyl Strong Enough to Absorb Through Your Skin?
Since fentanyl availability and prevalence are increasing, stories have arisen that it’s so powerful that it can cause a fatal overdose just by touching it. These stories come from accounts from both police officers that encounter the drug in their profession and from civilians that run across the drug by accident.
The claim may seem even more credible since fentanyl can be taken via a transdermal patch. However, it’s unlikely that contact with small amounts of fentanyl powder on your skin will allow the drug to enter your body. According to a 2017 report from the Journal of Medical Toxicology, fentanyl powder that gets on your skin is likely to just sit on the surface, and it can be safely brushed or washed off.
Fentanyl patches are specially designed to transfer the drug through your skin in a way that wouldn’t be plausible when you encounter powder or pills. Officers and civilians that experience fentanyl-related effects after an encounter with the drug may have specific experiences. For instance, if they’re investigating an enclosed space like a car that has a large amount of fentanyl in it, they could breathe it in. Liquid or moist fentanyl that remains on your skin for hours can also be more dangerous than a brush with dry fentanyl.
Who Uses Fentanyl and Heroin?
Fentanyl can be used for medicinal purposes, and it’s often used for its ability to stop moderate to severe pain symptoms quickly. However, it’s becoming more and more common as an illicit recreational drug like heroin. Heroin users rarely start by using heroin as their first opioid. According to the National Institute on Drug Abuse (NIDA), as much as 80 percent of heroin users report starting with a prescription opioid.
People that take an opioid prescription for too long or misuse prescriptions may develop a dependence or addiction to the medication. However, it’s difficult to obtain opioid prescriptions once you run out, especially if prescribers suspect that you’ve developed opioid use disorder (OUD). Plus, prescription opioids can be expensive, and as you develop a chemical dependence on them, you may feel like you need more frequent or higher doses.
Heroin is cheaper and easier to get than prescription opioids. While “hard drug” use seems like an extreme next step for most people, opioid addiction can rewire your brain to prioritize finding and using drugs. Illicit heroin is highly available all over the United States, but drug traffickers have found that fentanyl is even cheaper and easier to transport than heroin. Since fentanyl is so powerful, a small package can be equally as potent and profitable as a package of heroin that’s many times larger.
Heroin is still popular, so fentanyl is often mixed into adulterated heroin to increase profits and potency at the same time. However, the addition of fentanyl can make the drug much more powerful, leading to a deadly overdose. Addiction can start with recreational use, but it can also start with legitimate pain management that lasts for too long. For that reason, opioid addiction can affect anyone and needs effective prevention and treatment strategies.