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Fentanyl vs. Heroin

Fentanyl test strips test for the presence of the powerful synthetic opioid which causes overdose and death. These test strips can detect fentanyl in street drugs, reducing the risk of accidental overdose as a harm reduction tool.

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Heroin vs. Fentanyl: Breaking Down Both Opioids

Heroin is an illegal opioid drug that produces pain-relieving effects. It can be injected, sniffed, snorted, or smoked in order to achieve the desired rush. 

Initially developed as a pharmaceutical alternative to morphine for the treatment of coughs and respiratory infections, heroin quickly became abused. Legislators tried to change that. Per the Controlled Substances Act of 1970, heroin is classified as a Schedule 1 drug. That means it has no FDA-approved indication and can’t be used as a medical treatment.

Fentanyl is different. Pharmaceutical-grade fentanyl is FDA approved for severe pain—typically caused by significant illnesses, like cancer. Most medical fentanyl is prescribed in the form of patches or lozenges.

According to the Drug Enforcement Administration (DEA), fentanyl is increasingly added to heroin to make it more potent. Fifty to 100 times stronger than morphine, fentanyl easily leads to overdose, especially in people who are unaware that they have purchased fentanyl.

There is a high risk of overdose for both heroin and fentanyl.

Both heroin and fentanyl create similar intense, short-term effects, including these:

  • Sense of relaxation
  • Euphoria
  • Pain relief
  • Sedation and sleepiness 
  • Confusion
  • Drowsiness
  • Dizziness
  • Nausea and vomiting 
  • Constricted pupils 
  • Respiratory depression

As users develop a tolerance to heroin and fentanyl, they may seek to consume greater quantities of the drugs to achieve the same pleasurable effects. Such behavior increases the risk of dependence, addiction, and overdose. 

Legal Ramifications of Possession

Possession, use, or distribution of illicit drugs is explicitly prohibited by federal law. Both heroin and fentanyl can be considered illegal substances.

As a Schedule I drug, heroin is always illegal. You could face legal challenges for holding the drug, possessing paraphernalia used to take the drug, or attempting to sell the drug. Sometimes, those penalties involve prison terms. Sometimes, they can involve seizing your property, cutting off federal benefits, and more.

Fentanyl is legal with a valid prescription from a doctor. However, someone with prescription-grade drugs and no prescription is breaking the law. Similarly, someone with illicit fentanyl bought from a dealer is also breaking the law. A conviction could mean jail time, loss of benefits, and more.

Basic Facts on Heroin & Fentanyl

Heroin and fentanyl are two opioid drugs that share similarities as well as differences. Here are basic facts about the two drugs, as outlined by the Drug Enforcement Administration (DEA): 

Heroin comes in the form of white or brown powder or a sticky black substance, called black tar.Pharmaceutical fentanyl is available as oral lozenges, tables, nasal sprays, transdermal patches, and injectables. Illicit fentanyl is sold as a powder or counterfeit tablets. 
Most heroin is now laced with substances like sugar, starch, or powdered milk.Illegal fentanyl can be sold alone, though it is often mixed with heroin or cocaine.
Heroin can be injected, smoked, or snorted.Fentanyl can be injected, snorted, smoked, swallowed as a pill or tablet, or taken off blotter paper.
A heroin high is described as a rush followed by a period of being in and out of consciousness.A fentanyl high produces euphoric effects, including relaxation, pain relief, and sedation. 
Heroin is a Schedule I drug, with no recognized legal recreational or medical use.Fentanyl is a Schedule II drug approved for medical use as a painkiller.
Heroin users, particularly those who inject it, put themselves at risk for skin, blood, and heart infections as well as contracting diseases such as hepatitis and HIV.Individuals who inject fentanyl, like heroin, put themselves at risk for all complications related to intravenous drug use. 

Fentanyl has become an increasingly dangerous drug due to its potency and how frequently it is laced into other substances, such as heroin. In one six-month period, authorities found fentanyl-laced drugs more than 8,600 times. The drug was found in all kinds of substances, including heroin, meth, and ecstasy.

Researchers say more than 150 people die every day from overdoses related to synthetic opioids like fentanyl. It’s likely that some of these people had no idea the drugs they were taking contained fentanyl.

Often, individuals searching for heroin, or other opioids like OxyContin, unknowingly purchase a product containing fentanyl, take far too large a dose, and accidently overdose.

Addiction to Heroin & Fentanyl 

Heroin and fentanyl are both highly addictive substances. Psychological and physical dependence on both drugs develops quickly, due to the euphoric and pain-relieving effects they produce. 

According to the DEA, fentanyl is 50 times more potent than heroin and 100 times more potent than morphine.

What Does an Overdose Look Like?

Both heroin and fentanyl can cause an overdose. The symptoms are almost identical, as are the steps you should take when you see them.

Signs of an overdose of both heroin and fentanyl include the following:

  •       Limp body
  •       Pale or clammy skin
  •       Blue- or purple-tinged fingernails and lips
  •       Gurgling noises
  •       Vomiting
  •       Extreme sedation or unconsciousness
  •       Slowed or stopped heartbeat

If you think someone is experiencing an overdose, call 9-1-1. If the person is not breathing, perform CPR (if you’re trained to do so). Stay with the person until help arrives.

Naloxone can reverse the life-threatening effects of an overdose. If you have it available, administer it promptly, even if you aren’t positive it’s an opioid overdose. If you don’t have naloxone, tell the responders when they arrive that you think this is an opioid overdose. They can provide the medication.

Most states have Good Samaritan laws that protect people from criminal prosecution if they call 911 to help someone experiencing an overdose. Don’t be afraid to reach out and ask for help. You could save a life.

Symptoms Caused by Opioid Withdrawal 

As both are opioids, sudden stopping use of heroin or fentanyl use can lead to similar withdrawal symptoms. After heavy use of heroin or fentanyl for a few weeks, withdrawal symptoms are likely to occur once use is stopped. 

Symptoms of opioid withdrawal include the following:

  • Anxiety and agitation
  • Muscle aches and pains
  • Increased tearing
  • Runny nose
  • Insomnia
  • Sweating
  • Increased yawning
  • Stomach cramping
  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • Nausea and vomiting 

Withdrawal symptoms vary from person to person depending on physiological makeup and the severity of opioid use. Typically, withdrawal symptoms begin within 12 hours of the last opioid use. Even reducing use in people who have been using opioids regularly for a long period of time can result in symptoms of withdrawal. 

Treatment Options & Addiction Support 

While difficult to overcome, opioid use disorder can be managed with effective treatment options. Behavioral, cognitive, and medical interventions are used to effectively support individuals struggling with opioid addiction. Treatment begins with the withdrawal phase, and there are medications available to safely support individuals through that period.

Opioid Detox

Opioid withdrawal can occur at home, in a treatment facility, or at a hospital, when symptoms are significant. Medication is often administered in each of these settings to minimize the intensity of withdrawal symptoms. Medicines currently available to treat opioid withdrawal include the following:

  • Methadone: Methadone alleviates symptoms of withdrawal and allows a person to safely enter recovery. It can be taken for the long-term management of opioid dependence, such as for many years, and use can be gradually reduced over time. 
  • Buprenorphine: Like methadone, buprenorphine reduces the severity of withdrawal symptoms and cravings. It can reduce the length of the detox period and be used for long-term maintenance of opioid use disorder.
  • Clonidine: Unlike methadone and buprenorphine, clonidine does not reduce cravings, but it does alleviate withdrawal symptoms. It helps to reduce feelings of anxiety, agitation, muscle pains, sweating, runny nose, and stomach cramping caused by opioid withdrawal. 
  • Naltrexone: Once opioids are no longer in the system, naltrexone can help to reduce cravings and prevent relapse. If taken when opioids are still in the system, however, sudden and intense withdrawal symptoms can occur. 

Therapy & Ongoing Support

Once someone has gone through the withdrawal period, therapy is needed to address the root issues that led to substance abuse. Therapy often takes place in both one-on-one and group settings, where clients work with therapists to develop coping mechanisms and begin to change thought patterns around drug use.

Ongoing addiction support is usually necessary to promote long-term sobriety. Individual counseling, alternative therapeutic approaches, and participating in support groups are common aspects of long-term treatment plans. For people with a history of opioid use disorder who are striving to stay sober, Narcotics Anonymous and SMART Recovery are two community programs that offer free meetings and resources to support individuals in recovery. The Substance Abuse and Mental Health Services Administration (SAMHSA) also maintains a free online Behavioral Health Treatment Services Locator for anyone looking for treatment support near them.

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Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More

Updated March 20, 2024
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