Often, I feel like the only thing I have been writing and teaching about the last few months is how bad fentanyl really is, how many people it is killing, and how it is increasingly becoming an alarming and dangerous situation. Nonetheless, I still feel compelled to write this newsletter article on fentanyl, because the situation with fentanyl is becoming worse by the day.

Hopefully, by now, everyone in America knows that fentanyl is the causal factor responsible for the ever-increasing overdose death rate from people using street drugs, especially heroin. Everyone needs to be and should be aware that fentanyl is probably the most dangerous addictive drug ingredient ever invented, that it is now readily available on our streets, and it is being mixed with heroin and other substances to increase potency.

Fentanyl is a new synthetic opioid that can be made very cheaply in labs and smuggled into America. It does not need to be made from poppies or any other plant material. It can be made by just putting a few chemicals together in a lab. And, fentanyl can deliver a much more intense high than even pure heroin. We have heard over and over from addicts who say they are “bored with heroin” and the thing they want more of is fentanyl. It is incredibly dangerous, since fentanyl is 50 times stronger than heroin. A lethal dose is about the size of a grain of rice and is less than 1 milligram - compare that to a baby aspirin, which is so tiny but contains 81mgs!

It is almost impossible to know the amount of fentanyl and so easy for anyone to accidentally consume too much and have a serious or fatal overdose. People buying powder on the street have no idea if what they are buying is too weak and a waste of money, or if it is the dose that is so powerful it will kill them. It has been determined that fentanyl was what led to the death of Prince. It was most likely fentanyl that killed Tom Petty.

But now the situation is even worse. We are now hearing that drug dealers are mixing fentanyl into other street drugs. There have been multiple deaths where people were not even trying to use heroin. People have died from fentanyl when they thought they were buying Xanax®, Percocet®, or other drugs and sedatives. People have died from fentanyl when what they thought they were buying was amphetamines or speed. We have even heard of people who bought pot and it turned out to have fentanyl mixed in with it.

It is bad enough if people are looking for a high from opiates and they get fentanyl mixed in with the heroin, but it is even worse when this incredibly dangerous drug is mixed in with other drugs. I am not sure there is an easy solution. People who are using or considering using any kind of street drug need to be much more aware of this situation and recognize the real danger and potential consequences.

Peter R. Coleman, MD