For more than a century, heroin has been a dangerous drug of abuse. For years, people have been attracted to the substance’s ability to produce a relatively inexpensive, rapid-onset, and intensely euphoric high.^1,2 While the drug’s high holds a strong appeal for its users, chronic heroin abuse is almost certain to have several physical or mental health repercussions in those who become addicted to it.

Aside from the damage incurred from repeated use, it’s important to know that any time you use heroin, you risk your life. This statement has never been more true, as the drug is becoming increasingly adulterated by other powerful narcotics, making deadly overdose an all-too-common occurrence.

Why Is Heroin So Dangerous?

The dangers of heroin use are not new, but over the last few years, there has been a shift. Different people are using heroin, and the drug itself is changing. According to the Centers for Disease Control and Prevention (CDC), the number of people addicted to heroin doubled from 2002 to 2013. Most notably, use has increased significantly across many demographics, including women and those with higher incomes.³

The increasing prevalence of heroin has been accompanied by alarmingly high rates of severe or fatal heroin overdose in recent years. In fact, the number of overdoses skyrocketed between 2010 and 2015.⁴ The comparison is shocking—fewer than 4,000 people died from a heroin overdose in 2010, but by 2015, the drug was responsible for killing nearly 13,000 people in the U.S. alone.^1,4

Mixing Heroin With Other Substances

While the surge in heroin use across most demographics explains some of the increased number of overdose deaths, it doesn’t account for them all. In reality, the change in heroin itself (or rather, the drugs being sold as or combined with it) is a key reason for the alarming rise in deaths attributed to this substance.

Pure heroin is frequently mixed with other substances with the goal of producing larger amounts of the product or a stronger high.^1,2,5 Prior to being sold on the illicit market, it was frequently mixed with other substances with the goal of increasing end-product amount and therefore profit. To achieve this, the drug was mixed with sugars, powdered milk, starches, quinine, or other bulking agents. Now, however, the emphasis has shifted to creating a more powerful product in order to more thoroughly ensnare repeat business from addicted individuals. To this end, heroin has, more recently, been ‘cut’ or ‘laced’ with dangerous substances that can introduce their own hazards—ranging from severe illness to irreversible overdose.^1,2

Why “Heroin” Isn’t As Simple As Before

With various substances being combined with the drug, heroin really isn’t just one drug anymore, and users cannot count on any one batch being the same as the last. So, a user who has developed an increased tolerance to the drug may think that they’ll be fine taking a dose equal to or similar to their normal dose, but because of ever-changing ingredients and potencies, they could experience an immediate overdose and die.

A bag full of whitish powder can contain any number of harmful drugs and chemicals. At times, the mixture may contain no heroin at all.

Currently, many of the substances mixed with heroin fit into the category of synthetic opioids. These drugs work similarly in the body to produce the same kind of high, but they are often much more potent and can lead to a treacherous slowing of several physiological processes such as breathing. Some of these substances are used for medical reasons, while others are not approved for human consumption at any time.⁵

Drugs commonly mixed with heroin include:

Fentanyl.
Carfentanil.
Xylazine.
U-47700 (commonly called “Pink”).

Fentanyl

Fentanyl is a manufactured opioid drug available with a prescription and used in the treatment of severe pain, such as that which is related to cancer.⁶ Fentanyl is up to 100 times more potent than morphine and up to 50 times stronger than heroin.^5,6Due to the difference in strength, fentanyl can have a higher risk of fatality compared to heroin. Someone ingesting only 2 milligrams of fentanyl can experience a deadly overdose.⁵ Fentanyl is so potent that a normal, appropriate dose for someone with a medical need is a mere microgram (equivalent to a few granules of table salt).⁵

Fentanyl is sometimes sought after by people seeking an intense high, and it is sometimes sold in or as heroin to unsuspecting buyers. Either way, its presence on the street is unprecedented. From 2013 to 2014, the amount of fentanyl acquired by law enforcement increased by about 3.5 times.⁷ Most of this is illicitly manufactured fentanyl or non-pharmaceutical fentanyl,⁸ which is produced in clandestine labs and distributed illegally. In 2013, about 550 people died from fentanyl overdoses. Only one year later, that number rose above 2,000.⁶

The presence of fentanyl-laced heroin appears to be concentrated in certain regions and is associated with a string of deaths in the Northeast, Midwest, and Southeast U.S.⁸ This may be due to fentanyl mixing easily into the powder form of heroin that is more commonly seen in these regions vs. the ‘black tar’ form often found on the West Coast.

Carfentanil

Like fentanyl, carfentanil is a synthetic opioid substance. While it is chemically similar to fentanyl, carfentanil is much more potent—fentanyl is strong, but carfentanil is 100 times stronger. When compared to morphine, it is an astounding 10,000 times more potent.⁷ Carfentanil is so strong that it is used to tranquilize large animals (particularly elephants).⁵

The amount of carfentanil needed to cause a lethal overdose in humans is not known, but even insignificant amounts can be harmful based on the drug’s strength. The DEA encourages all people to be cautious of exposure to carfentanil.⁵ One exposure to even a tiny amount of carfentanil through the skin or by inhalation may be fatal.⁵

Carfentanil led to several overdose deaths in Ohio during the second half of 2016.⁸ The substance is expected to appear in more areas throughout the country in the future.⁸ Since the drug is a white powder, it may be easily disguised in a batch of heroin or cocaine.^5,8

Pink

“Pink” is the name used to refer to the substance U-47700.⁹ The nickname for the substance comes from its slight pinkish color.

This product is illegal in the U.S., as it currently has no approved medical use.⁹ Though not intended for human consumption, the drug is purchased over the Internet as a “research chemical” and is abused for its desirable opioid-like effects.

The substance is encountered on the streets as a powder in envelopes or plastic bags. It may be found alone or in combination with other drugs like heroin and fentanyl.⁹ In some cases, it is sold in bags with logos that make it look like heroin.

To date, a limited number of studies have revealed little about U-47700’s potency or toxic impact, apart from its powerful potential to produce overdose.⁹ Pink is associated with at least 15 overdose deaths across 5 states in 2015 and 2016.⁹ North Carolina felt the biggest impact, with 10 of the 15 deaths occurring in this state alone.⁹

Xylazine

Unlike fentanyl, carfentanil, and “Pink,” xylazine is not a synthetic opioid. Instead, it is an adrenergic receptor antagonist, similar to clonidine. It is used in veterinary medicine as an analgesic, sedative anesthetic, and muscle relaxant.¹⁰Xylazine may be an effective horse tranquilizer, but it is not approved for use by humans. On the streets, xylazine is sometimes mixed directly in with heroin and is sometimes sold to users with heroin separately (in a different package) as a modifier to enhance its effects.¹⁰

Xylazine abuse has been observed mainly in Puerto Rico. However, there have been reports of the substance in other locations, including Pennsylvania,¹⁰ and it may continue to spread as dealers look for ways to increase profits and buyers search for new ways to enhance their highs.

Overdose: Easier to Do and Harder to Reverse

Overdose on heroin can happen to any user at any time and on any use of the drug. Whether it is their first use of heroin or the person has a long history with the substance, the next hit could be the last. There is no way for a person to know with certainty what they are getting and how strong it is.¹¹

A person who has repeatedly abused heroin or other opioids will develop a tolerance, meaning they will come to need increasing amounts of the substance to feel the wanted effects.¹ Should a person—even one with a high tolerance—unknowingly use heroin from a batch laced with fentanyl or another potent adulterant, the combination of substances could easily overwhelm their body because it is so much stronger than normal heroin.

Using a large amount of heroin or using it combined with a stronger substance increases the high, but also the potential to experience dangerous physical heroin side effects. Opioids and other depressants severely impact breathing and in the case of overdose, breathing could become dangerously slowed or stopped completely.¹

Other signs and symptoms of heroin overdose include:¹¹

Dry mouth.
Tiny pupils.
Disorientation.
Drowsiness.
Delirium.
Weak pulse and low blood pressure.
Blue lips and fingernails.
Loss of consciousness.
Coma.

Abuse of even more potent drugs like fentanyl and carfentanil increases the likelihood of opioid overdose.

Perhaps the best tool used in managing overdose is naloxone (Narcan). Administered via an injectable solution, a nasal spray, or an autoinjector pen, this substance is an opioid antagonist that displaces and blocks the heroin from the opioid receptors to reverse symptoms and prevent overdose death.^1,8,11

Unfortunately, synthetic opioids and other drugs mixed with heroin make it more difficult to reverse an overdose on this drug. An overdose involving adulterated heroin may require multiple doses of the antidote to be effective, but medical/law enforcement professionals, friends, and family members may not have the knowledge or the supply of the medication needed to properly treat an overdose of this type.^5,8,9

Think It’s Just Heroin? Pills Are Deadlier Too

People may view prescription painkillers as a safer alternative to heroin, but the risks associated with abusing these substances is also increasing due to the emergence of counterfeit pills on the streets.¹³ Illicit labs located overseas will produce high volumes of fentanyl and other synthetic opioids and sell the product to drug traffickers in North America.¹³ From there, the substance may be mixed into heroin or formed into pills that closely resemble legitimate prescription drugs.¹³

In early 2016, officers in Ohio seized 500 synthetic pills that mimicked a 30 mg oxycodone prescription. Instead of oxycodone, though, the pills contained “Pink.”¹³ Any drug purchased on the street or through an unregulated online pharmacy could be counterfeit or laced with unknown substances. It is best to avoid these completely or risk overdose and death. The availability of synthetic opioids like fentanyl and “Pink” has resulted in higher rates of opioid overdose deaths. The number of people killed by synthetic opioids increased by almost 80% from 2013 to 2014, according to the Drug Enforcement Administration.¹³

Heroin Addiction Treatment Types

Heroin addiction is a serious problem that destroys the lives of those suffering with it. There is good news, though. Professional heroin addiction treatment is helpful in reducing cravings, improving well-being, and setting the stage for long-term recovery.¹⁴ Treatment can consist of various stages that promote recovery, like:¹⁴

Supervised detoxification—This is the initial segment of treatment, in which an individual can safely process the substance from their body in a supervised, supportive environment while receiving medical attention when needed.
Inpatient/residential treatment—Inpatient and residential treatments allow people with significant addictions and limited supports to escape from their negative habits and routines by living in a treatment center. Treatment and supervision will be intense, with a focus on therapy and life skills training.
Outpatient assistance and care—Less intense than inpatient care, outpatient programs allow individuals to receive treatment while living at home and maintaining their responsibilities. During outpatient therapy, the addict can attend individual, group, or family therapy sessions to learn how to prevent relapse and extend recovery.
Prescribed medication—Various forms of medication-assisted treatments are available to reduce discomfort and encourage abstinence. Some medications will block the effects of opioids like heroin to deter continued abuse, while others will help to manage withdrawal and cravings by eliciting similar opioid effects in a safe, controlled way.

Using drugs from sources on the street or the Internet is not safe, and the danger is growing each day. Seek treatment before you fall victim to these insidious substances which are spreading across the country. If you are ready to commit to recovery before it is too late, please call American Addiction Centers (AAC) free at to speak with a treatment representative about available options today.

Why Is Heroin So Deadly Today?