For some people, fentanyl can be a life-saver, easing profound pain. But outside of a doctor’s office, the powerful opioid drug is also a covert killer.
In the last several years, clandestine drugmakers have begun experimenting with this ingredient, baking it into drugs sold on the streets, most notably heroin. Fentanyl and closely related compounds have “literally invaded the entire heroin supply,” says medical toxicologist Lewis Nelson of New York University Langone Medical Center.
Fentanyl is showing up in other drugs, too.
The severity and speed of the problem raises the question: How did fentanyl come to take so many lives?
As a synthetic opioid, fentanyl and its variants fall into the same chemical class as heroin and prescription opioids like oxycontin. Originally intended to manage severe pain before and after surgery, fentanyl is much stronger than heroin. As Compton tells me, “a teaspoon of fentanyl is about equivalent to a cup of a heroin.” More precisely, 3 milligrams of fentanyl is as potent as 30 milligrams of heroin.
Deaths due to fentanyl have not been as well documented as deaths due to heroin. And, given that fentanyl is often mixed with other drugs like cocaine and benzodiazepines, it’s been even harder to keep record. Compton says the first significant outbreak of fentanyl use that researchers were aware of happened in 2006. Both Compton and Sarah Wakeman, the head of the Substance Use Disorders Initiative at Massachusetts General Hospital, locate the true uptick of overdoses that involve fentanyl-like drugs around 2011.
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A comparison of lethal doses of heroin and fentanyl.