Why fentanyl is deadlier than heroin, in a single photo

Opioid crisis getting worse, partly due to new types of drugs are still finding their way in streets.

is deadly, because it is much stronger than heroin, as shown in the above photograph, which was taken at the Forensic Laboratory of the New Hampshire State Police. To the left is a lethal dose of heroin, equivalent to about 30 milligrams; to the right is a dose of 3 mg of fentanyl, enough to kill an adult male of average size.

Fentanyl, according to the Centers for Disease Control and Disease Prevention, is up to 100 times more potent than morphine, and often heroin.

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drug users usually do not know when their heroin is laced with fentanyl, so when your usual amount of heroin, which can inadvertently taking a lethal doses of the substance are injected. In addition, while dealers try to include fentanyl to improve potency, its measuring equipment is usually not sufficiently refined to ensure that they remain below the levels that could cause users to overdose. In addition, fentanyl sold on the street almost always done in a clandestine laboratory; It is less pure than the pharmaceutical version and therefore its effect on the body can be more unpredictable.

Heroin and fentanyl are identical, and drugs purchased on the street, “they do not know what you’re taking,” Tim Pifer, director of the Forensic Laboratory of the State Police of New Hampshire, said in an interview STAT . “You are injecting himself with a loaded gun.”

New Hampshire, like the rest of New England has been particularly affected by the epidemic opiates. The State recorded a total of 439 drug overdose in 2015; most were related to opioids, and about 70 percent of these deaths related to opioid fentanyl involved. The state has seen 200 fatal opioid overdose this year so far, Pifer said.

Fentanyl was originally used as an anesthetic. Then doctors realized how effective it was in pain relief in small quantities and started using it for that purpose. In the hands of trained professionals – and with laboratory quality equipment – fentanyl actually has a very wide therapeutic index, or range within which the drug is effective and safe

.

The difference in strength between heroin and fentanyl arises from differences in their chemical structures. The chemicals in both the mu opioid receptor binding in the brain. But fentanyl arrives faster than morphine – the product almost instantaneously when the body breaks heroin – because more easily passes through the grease which is abundant in the brain. Fentanyl also embraces the receiver so hard that a small amount is enough to start the molecular chain of events that instigates opioids’ effects on the body.

This stronger affinity for the opioid receptor also means more naloxone – or Narcan -. It may be necessary to combat an overdose of fentanyl overdose of heroin

“In an overdose of fentanyl, may not be able to revive fully the person with the narcan doses he has,” said Scott Lukas Director Research Laboratory of Psychopharmacology Behavior in the McLean hospital in Belmont, mass. “naloxone out easily hits morphine receptor, but does at least fentanyl.”

Alex Hogan / STAT
Matt Ganem, a former addict, explains the excruciating process of opiate withdrawal.
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