Opioids are well known killers in our society. They have monopolized the headlines in the news and public attention the way some serial killers have in the past. Everyday it seems we wake up to another story about the creative ways opioids like heroin and fentanyl have been used or have inadvertently harmed people due to ignorance in the way the substance was handled, not knowing the substance was present in another drug like a stash of heroin cut with fentanyl unbeknownst to the user, or a first responder’s surprise engagement with the drug at a crime scene or other emergency situation. It seems like every government report or scientific study comes out with more and more disturbing numbers.

Though the opioid epidemic is founded on the frequency with which opioid prescription pain pills are prescribed and the smooth pipeline of prescription opioid addicts to the devastating heroin or fentanyl opioid addiction. As the opioid epidemic rages on we have seen heroin, which has for years been the opioid that induced fear into the public, take a back seat to the even more potent fentanyl. Fentanyl, in fact is known to be up to fifty times more potent than heroin. Fentanyl has been used as a prescription drug but is generally only prescribed for the most grievous situations.

What is Heroin

Heroin is a narcotic analgesic that has been the star of the opioid family for years. It is a drug that, like all opioids alters the mental state of the person taking it in order to lessen pain, induce a feeling of calm and contentment in the user of the drug.


Heroin comes in a spectrum of color from a pure white to a muddy brown. The color indicates the purity of the stash. The more pure the drug the more white the stash the less additives are cutting it. The more brown the more the drug dealer added to the drug to stretch it and allow for higher capital. Heroin is a dangerous drug for so many reasons and one of them is this process of cutting the drug with other elements.


Heroin is usually cut with:

  • Talcum powder
  • Rat poison
  • Baking soda
  • Caffeine
  • Flour
  • Fentanyl
  • Laundry Detergent


If the fact that heroin is sometimes cut with rat poison or laundry detergent doesn’t deter a person perhaps the fact that in order to consume it people snort it, inject it and smoke it. These three all come with their own intense side effects. Snorting heroin can create real respiratory problems. It takes away track marks as an easily identifiable sign of heroin abuse and because of that is a method on the rise with people struggling with a heroin addiction today. Some people smoke it, a method otherwise known in some circles as “chasing the dragon”, can also cause severe respiratory issues as well as pulmonary tissue deterioration. Of course the most commonly thought of way to administer the drug is via injection. Injecting the drug can cause complications like blockages in or a collapsing of the blood vessels.


These side effects of the way people consume the drug, and the horrific substances that often cut heroin are often indeed not enough to stop people from picking up heroin for the first time. Much of that is due to the fact that many people, in fact as many as four out of five people, come to heroin already addicted to opioids. They started with a prescription pain medication and are now in desperate straights looking for a drug that can pick up where oxycodone, or hydrocodone left off. These drugs easily lead to heroin for a stronger fix. And once heroin isn’t enough to feed the person’s growing tolerance, Fentanyl is there to take them where they want to go. If they have survived thus far. Heroin overdoses are all too common. The United States Center for Disease Control and Prevention reports that  “In 2016, nearly 948,000 people in the United States (12-years old or older) reported using heroin in the past year, which is an estimated rate of 0.4 per 100 persons.  And in 2015, 81,326 emergency department visits occurred for unintentional, heroin-related poisonings in America, which is an estimated rate of almost 26 per 100,000 people.” (https://www.cdc.gov/drugoverdose/data/heroin.html)


What is Fentanyl

Fentanyl was initially introduced to the United States in the 1960’s. It was administered via injection as an anesthetic in medical, often surgical situations. The problem really started with the drug when it became more available to the public via prescription in forms easily administered at home.  When the 1990’s came fentanyl was able to be used in a patch form for transdermal treatment. Contemporarily it is available in a common tablet form, sublingual sprays and tablets, lollipop form, nasal spray, and transdermal patches to the public via prescription It has claimed the lives of many and came into prominence through the death of superstars Michael Jackson and more recently, Prince.

Discovery InstituteThe United States Center for Disease Control and Prevention reports that though fentanyl is used as a pharmaceutical to manage severe pain like the pain someone may experience after a major surgery, or used as an anesthetic before surgery, the majority cause of deaths have been, perhaps obviously, when people use the drug illicitly. The opioid narcotic analgesic is more powerful than most people seeking out illicit drug experiences can really comprehend.

“Most of the increases in fentanyl deaths over the last three years do not involve prescription fentanyl but are related to illicitly-made fentanyl that is being mixed with or sold as heroin—with or without the users’ knowledge and increasing as counterfeit pills. In July 2016, the Drug Enforcement Administration (DEA) issued a new nationwide report indicating hundreds of thousands of counterfeit prescription pills have been entering the U.S. drug market since 2014, some containing deadly amounts of fentanyl and fentanyl analogs. The current fentanyl crisis continues to expand in size and scope across the United States”



Most recently Fentanyl has been used intentionally by the Nebraska state government as a means to carry out state sanctioned death sentences. It’s the first time Fentanyl has been used in this way and also the first death sentence carried out for the state in years, likely due to the controversy that halted many state death sentences, around the medications used to lethally inject inmates. States consistently ran into trouble with drugs not working, or taking hours of torture before the inmate actually succumbed to death. It should be a sign of how strong and menacing this drug is that a state like Nebraska decided to take back up its death penalty activities because it was able to trust in Fentanyl to effectively kill a person.

Heroin & Fentanyl, Both Opioids, Both Public Enemies

Pitting the two drugs, heroin and fentanyl, against each other to discover which is killing more than the other is the wrong question to ask. The right question should be, how do we stop both. The two work together in the opioid prescription to illicit drug overdose pipeline. They are different steps in the same terrifying trajectory. Even as fentanyl is the drug in the spotlight these days, based on studies and reports coming out as well as information commonly known about opioids, we know that one opioid leeds to another. The number of opioid prescription pain killers out there is high and continues to grow, it is only a matter of time until those people currently becoming addicted to the opioid in their medicine cabinet end up turning to the next step in their addiction.Just like we should not underestimate drugs like oxycodone and hydrocodone, it is vital that in the face of fentanyl we remember as well, that heroin is just below the surface and is often used as a mix with heroin, but is also dangerous in its own right.  Each drug needs to be considered a danger to society, indeed to public health.


Drug Rehab Centers in NJ

Discovery InstituteDiscovery Institute has some of the top rated drug rehab centers in the state of New Jersey. Our licensed medical staff and qualified therapists are there to support every patient through their individual process of detoxification and rehabilitation to help them through the difficult withdrawal symptoms that come with an opioid addiction and to help them learn the life skills necessary for sober living. New Jersey is doing more and more for its citizens who are suffering from opioid addiction and so are the medical insurances that cover individuals in the state and across the country.

Call your insurance today and see if you qualify for coverage of treatment for substance use disorder. If you have questions about how to navigate the sometimes confusing world of substance abuse recovery, call Discovery Institute today and we can answer your questions.

Reviewed for Medical & Clinical Accuracy by Dr. Jeffrey Berman, MD

Dr. Jeffrey Berman is a psychiatrist in Teaneck, New Jersey and is affiliated with Robert Wood Johnson University Hospital. He received his medical degree from State University of New York Upstate Medical University and has been in practice for more than 20 years. He also speaks multiple languages, including French and Hebrew.

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