Dangers of Mixing Fentanyl with Other Substances

Fentanyl is a powerful opioid prescription pain reliever that helps manage surgical and cancer-related pain or sometimes chronic pain in people who are tolerant to other opioid drugs.1

However, fentanyl carries a high potential for misuse/abuse and is often produced and sold illegally.1

Fentanyl can be risky when it’s misused by itself. When fentanyl is misused by mixing other drugs with it, it can be even more dangerous.  This page will provide a brief overview of some of the common and dangerous interactions between fentanyl and other substances.

Why is Fentanyl So Dangerous to Mix?

Fentanyl is a synthetic (manmade) opioid drug that is 50-100 times more potent than morphine and is lethal in very small doses.1 On its own, fentanyl abuse can cause:1, 2

  • Anxiety.
  • Difficulty sleeping.
  • Irritable moods.
  • Drowsiness.
  • Itchiness.
  • Fatigue.
  • Confusion.
  • Overdose.

Illicitly manufactured fentanyl (IMF) is relatively cheap to make and takes only a small amount to cause a powerful high, making fentanyl a common additive in other illicit drugs.1, 3

For example, fentanyl is often added to drugs including other opioids, cocaine, and benzodiazepines to increase the high. 1, 3 As a result, people who use these drugs may take fentanyl unknowingly, and risk experiencing a fentanyl overdose.1

Mixing other drugs with fentanyl is associated with new risks caused by the coinciding interactions of these mixed drugs and their effects on the brain and body.

Repeatedly mixing fentanyl with other drugs can lead to dependence because over time, the brain and body become reliant on fentanyl.  When dependence occurs, the individual is at risk of withdrawal.  As a result, mixing fentanyl with other drugs can complicate or worsen fentanyl withdrawal symptoms which occur when fentanyl use is suddenly decreased or stopped.4

Mixing other drugs with fentanyl can also complicate fentanyl addiction treatment since the individual may have to be treated for multiple substance use disorders.4

Dangers of Mixing Fentanyl and Heroin

Heroin and fentanyl are both opioids that have similar methods of action on the brain and body. They both bind to opioid receptors in the brain.1, 5 When used in combination, they not only increase the feeling of euphoria but can heighten the dangerous signs and symptoms of misuse and can also increase the potential for overdose.

Fentanyl misuse/abuse includes:6

  • Taking higher dosages of fentanyl than prescribed.
  • Taking fentanyl more frequently than prescribed.
  • Taking fentanyl for other purposes that prescribed (euphoria).
  • Taking someone else’s fentanyl prescription.
  • Using illicit fentanyl that is produced or sold illegally.
  • Mixing fentanyl with other substances.

Fentanyl is made in a lab, whereas heroin is a semi-synthetic opioid meaning that it is derived from morphine. Morphine is a naturally occurring (extracted from the opium poppy plant) and therefore must be cultivated and then harvested before it is made into heroin. Therefore, fentanyl is often easier and much cheaper to make.3, 5

Fentanyl is sometimes laced into heroin without any knowledge to the person using it. As a result, the individual is unknowingly using a much stronger opioid (fentanyl) when expecting heroin (a less potent opioid).1, 3

Fentanyl can be lethal in even the tiniest doses, even to someone who regularly uses heroin and has a high tolerance to opioids.1, 3

Risks of Mixing Fentanyl and Cocaine

Fentanyl may be mixed (laced) with cocaine to elicit a stronger high and increase cocaine profits.3 Fentanyl is much cheaper than cocaine so when it’s added to cocaine without the user knowing, the dealer can sell cocaine for the original price but for a smaller amount cocaine, since fentanyl is added. This practice has become so common that several state, city, and federal health and law enforcement departments have issued official warnings regarding the possibility of cocaine containing fentanyl.7, 8, 9

Cocaine is an illicit stimulant that speeds up the body system functions. Fentanyl and other opioids are downers, mean they slow the body systems down. These two substances act in opposite ways, potentially creating serious harm to the body and brain. When used independently from each other, cocaine and opioids, including fentanyl, can result in serious complications and even lethal overdose.10

When cocaine and fentanyl are combined, it is often known as “speedballing”. Generally, speedballing involves both substances being injected into the bloodstream, but they are sometimes snorted nasally together as well.12

These interactions may lead to heart, lung, and brain complications that can quickly become life-threatening. The dangers of mixing cocaine and opioids include:12

  • Confusion.
  • Paranoia.
  • Insomnia.
  • Uncontrollable movements.
  • Heart attack.
  • Stroke.
  • Respiratory failure.
  • Increased risk of a brain aneurysm.

When fentanyl is mixed with cocaine, the risk of cocaine-related overdose increases. This is most likely because the individual has zero tolerance to opioids, and the smallest dose of fentanyl can result in an overdose. Data compiled by the Centers for Disease Control and Prevention (CDC) have identified synthetic opioids (mostly fentanyl) as the primary cause of cocaine-involved overdoses.13

Dangers of Mixing Fentanyl with Other Prescription Medications

Mixing fentanyl with prescription drugs is also extremely dangerous, even if the individual is using these prescription drugs for valid medical conditions.

Using fentanyl and a medication that already contains a weaker opioid (such as codeine) heightens the risk of overdose in the same way fentanyl-laced heroin does.

The combination of benzodiazepines (e.g., Xanax, Klonopin) and fentanyl is also very dangerous, accounting for 16% of opioid-involved overdoses in 2019. Benzodiazepines and opioids slow the functioning of the central nervous system, causing sedation and slowed breathing. It’s dangerous to take benzodiazepines and fentanyl together, even if they are both prescribed to an individual for legitimate medical purposes.14

Fentanyl is sometimes found in counterfeit prescription medications made to look like benzodiazepines (e.g., Xanax, Valium, etc.), less-potent opioids (OxyContin, Vicodin, Norco, etc.), or other prescription medications.15

According to the Drug Enforcement Administration (DEA), approximately 26% of tablets seized by law enforcement contained a potentially lethal dose of fentanyl.3

Getting Help for Fentanyl Addiction

While fentanyl addiction—also known as fentanyl use disorder (FUD)—is a serious and potentially devastating chronic illness, it is treatable.16 There are evidence-based treatment methods that help individuals withdraw from fentanyl safely and comfortably, and also build the skills necessary to remain in long-term recovery.16, 17

Addiction treatment is covered by most employer-based, government-funded, or Affordable Care Act (ACA) marketplace health plans and many addiction treatment centers offer multiple ways to pay for rehab.18 Within minutes, you can find out whether your health insurance plan covers treatment at Oxford Treatment Center by using the or calling an admissions navigator at .

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