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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. It no longer has any recognized medical purpose or safe way to use it in the United States. 

Unlike heroin, fentanyl continues to serve a medical purpose. It was developed to help manage significant pain in cancer patients. For those patients, a fentanyl patch is applied to the skin. 

Its pharmaceutical use remains legal. Illegally, however, fentanyl has become a widely abused and highly dangerous substance. 

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. 

Basic Facts on Heroin & Fentanyl

Heroin and Fentanyl are two opioid drugs that share similarities as well as differences. Discover 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. 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.

Risk of Overdose 

There is a high risk of overdose for both heroin and fentanyl. The risk is even greater with fentanyl, however, as it is a stronger substance, and users are often unaware they have taken it in conjunction with other substances, including heroin. 

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

  • Stupor and drowsiness
  • Cold, clammy skin
  • Bluish tint to the fingers and lips
  • Change in pupil size 
  • Coma
  • Respiratory failure 

If someone you know is at risk of heroin or fentanyl overdose, monitor them for the above symptoms. Call 911 immediately if they are having an overdose. 

When administered in time, 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.

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 May 1, 2023
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  4. Heroin Drug Facts. (June 2021). National Institute on Drug Abuse.
  5. Naloxone Drug Facts. (January 2022). National Institute on Drug Abuse.
  6. Opiate and Opioid Withdrawal. (April 2022). National Library of Medicine.
  7. Fentanyl Overdose. (December 2022). JAMA.
  8. Hidden Fentanyl Is Driving a Fatal New Phase in US Opioid Epidemic. (December 2022). Bloomberg News.
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