Why Is Fentanyl So Dangerous to Mix?


Fentanyl is a synthetic (man-made) opioid drug that is 50-100 times more potent than semisynthetic morphine, the National Institute on Drug Abuse (NIDA) warns. It is a powerful analgesic drug that is used to manage surgical, severe, or sometimes chronic pain in people who are tolerant to other opioid drugs.

It is manufactured as a sublingual tablet (Abstral), as a “lollipop” or oral transmucosal lozenge (Actiq), a sublingual spray (Subsys), an effervescent buccal tablet (Fentora), as a transdermal patch (Duragesic), a nasal spray (Lazanda), and in injectable forms. The Drug Enforcement Administration (DEA) classifies fentanyl as a Schedule II controlled substance and warns that it is regularly diverted from licit channels and abused.

It is also commonly manufactured in clandestine laboratories for illicit distribution. Fentanyl may be “cut” with other drugs or substances in order to make the drug go further, in an effort to “stretch” out the product. It is also laced into other drugs or used as a cutting agent in drugs, such as heroin or cocaine. Mixing fentanyl into heroin makes it cheaper, stronger, and potentially more desirable, ABC News reports; however, individuals who are unaware of the presence of the more potent fentanyl in their heroin risk fatal respiratory suppression and overdose.

 Mixing fentanyl with other substances, particularly those that are also central nervous system depressants, is extremely dangerous and often results in rapid and fatal overdose.

High Rate of Fentanyl Overdose

As a central nervous system depressant drug, like other opioids, fentanyl slows breathing, lowers blood pressure, slows heart rate, and also lowers body temperature. Even in small doses, fentanyl can be lethal. Just a quarter-milligram of fentanyl can be deadly, CNN warns, and the drug can be absorbed through the skin or inhaled, increasing the potential hazards. A police officer in Ohio brushed fentanyl powder off his uniform with his uncovered hands and within minutes suffered an overdose.

In 2015, drug overdoses reached an all-time high in the United States. The Chicago Tribune reports that deaths involving fentanyl and other synthetic opioids jumped nearly 75 percent in just one year, as over 9,500 people died from a synthetic opioid overdose that year. Fentanyl overdoses doubled from 2013 to 2014, killing 4,200 people in the United States, NBC News publishes.

In the case of fentanyl overdose deaths, the drug is commonly found mixed with marijuana, other opioids (like heroin), and cocaine, the Daytona Beach News-Journal reports. It is highly likely that a person may often not even know that fentanyl is contained in the illicit drug they are taking, which can result in a person unwittingly taking too much and suffering an overdose.

Dangers of common fentanyl drug combinations are highlighted below:

Fentanyl and Heroin

Individuals who abuse heroin are unable to detect whether or not the product also contains the more potent, and therefore highly dangerous, drug fentanyl. Heroin and fentanyl have similar methods of action on the brain and body as both are opioid drugs. They bind to opioid receptors in the brain and slow vital and life-sustaining functions.

Fentanyl may be made in a lab, whereas heroin is extracted from the opium poppy plant and therefore must be cultivated and then harvested. Fentanyl may therefore then be easier to come by and slid in to cut heroin or used as a substitute for it altogether.

Fentanyl can be lethal in as little as one dose, even to someone who regularly abuses heroin. Between 2005 and 2007, USA Today reports that over 1,000 people died in Philadelphia, Detroit, and Chicago from a fentanyl-laced heroin overdose.

Fentanyl and Cocaine

In the same respect as with heroin, fentanyl may also be laced into cocaine and used as a dangerous adulterant to increase profits from the illegal drug by using an alternative that is easier to get and less expensive. The New York City Health Department issued a warning to people who use cocaine regarding the possibility of the drug also containing fentanyl. NIDA reports that 37 percent of overdose deaths contained both fentanyl and cocaine in 2016. Almost half of all drug overdoses in New York involved fentanyl in 2016, as the drug was involved in 1,300 overdose fatalities.

Cocaine is a stimulant drug that speeds up the functions that fentanyl and opioid drugs slow down. Working together, the two drugs may counteract each other, potentially leading to cardiac and respiratory complications that can become life-threatening quickly. Individuals who are not tolerant to opioids are particularly at risk for an overdose of the cocaine-fentanyl combination; therefore, the potent drug can rapidly overwhelm the system with potentially toxic consequences. For those who are used to taking cocaine and unwittingly end up with cocaine laced with fentanyl, the results can be tragic.

Fentanyl and Marijuana

The Dayton Daily News reports that health officials are issuing warnings to residents of the Miami Valley to watch out for marijuana that may be laced with fentanyl. This dangerous drug combination may be an effort by drug dealers to “hook” young clients on highly addictive drugs.

Marijuana is also a partial central nervous system depressant and can therefore exacerbate and accentuate the side effects of fentanyl. A user who isn’t aware that fentanyl is present in their marijuana can be at risk for a potentially life-threatening overdose and also for developing an opioid dependence and/or addiction.

Fentanyl and Prescription Medications

Fentanyl may be made to resemble other prescription medications like the benzodiazepine medication Xanax, or other opioid painkillers like Norco (a combination hydrocodone/acetaminophen medication) or oxycodone. These drugs are then passed off to users as legitimate prescription drugs.

A large shipment of fake oxycodone, which was actually fentanyl, was seized in early 2016 as it was being smuggled in from Mexico, the United States Department of Justice publishes. Several dozen overdoses were documented in Sacramento, California that involved people taking what they believed to be Norco, only to discover too late that it was actually fentanyl.

Taking prescription medications that are not obtained through licit channels (i.e., from a medical provider via a prescription) can be potentially dangerous. It can be impossible to know if the medication is actually what it is purported to be.

Additional Mixed Fentanyl Drug Complications

Not only does mixing fentanyl with other drugs raise the risk for overdose, whether or not the combination was intentional, it also can make it tougher to treat the overdose. Drugs can interact with each other in unpredictable ways, which can differ from person to person.

 When medical personnel attempt to reverse an overdose, they need to know what medication to use in order to do so. If a person is not sure that the drug they took contained fentanyl, this can make first responders jobs more difficult.
Narcan (naloxone) is the drug used to reverse an opioid overdose as it blocks the opioid receptors and “kicks out” the opioid analgesic. Since fentanyl is so powerful, it may take multiple doses of Narcan to reverse the overdose.

Fentanyl mixed with other drugs can also increase the rate of dependence and possible side effects of withdrawal. Polydrug (multi-drug) abuse can also complicate addiction treatment methods and the medications that are used during detox to manage withdrawal symptoms and cravings.

Fentanyl is a dangerous drug by itself, and when mixed with other drugs, the odds for an adverse reaction go up exponentially.

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