While heroin adulterated with fentanyl has been in the news in recent years and the risks are well-known, there is a new danger on the streets, and it’s even deadlier. It is a frighteningly powerful combination of heroin and synthetic opioids known as “gray death.”
America’s battle with addiction is ever-growing and ever-changing. For many years, heroin has been one of the world’s most notorious substances—from suggestions that you can become addicted after the first use, to the high risk of overdose and death, it has long been perceived as one of the scariest drugs available.1,2 But in recent years, new dangers have arisen that have brought even more alarm to those familiar with the opioid crisis in America. Prescription painkillers (opioid medications) have come to the forefront of this epidemic, with record numbers of people abusing, overdosing, and dying from them.
According to the National Institute on Drug Abuse (NIDA), deaths from prescription opioids like OxyContin and fentanyl nearly doubled from 2002 to 2015.3 When you combine these drugs with an already potent opiate like heroin, the risks skyrocket. “Gray death” is the most recent face of a troubling trend of new and stronger synthetic opioids being added (with or without the user’s knowledge) to batches of heroin.
What Is Gray Death?
Gray death is the name given to a new street drug that began showing up in certain regions at the end of 2016 and early 2017. It contains a blend of opioid substances (such as heroin, fentanyl, and U-47700, or “Pink”). Combinations vary between samples and are typically so strong they can cause immediate death by overdose—not only by drug users but by anyone who touches it, such as first responders.4,5
The name of the drug comes from:4,5
- Its color. Gray death is a color that is often compared to cement or concrete. The substance can be found in a variety of textures and sizes. It can appear in larger rock-like chunks or a gray powder substance.
- Its power. Even in minuscule doses or with minimal contact, the effects of the drug are serious and can include immediate overdose.
Experts are struggling to understand what this drug is exactly. Reports of gray heroin have been made since 2012, but it was different from the current formulations seen today.5
One of the most frightening things about gray death is that the formulation differs from one batch to the next. In fact, 50 samples gathered in Georgia in the first half of 2017 show tremendous variation.5 People testing and studying the samples of this new heroin drug are often mystified by its contents and appearance and struggle to explain the substance’s signature gray color. 5
This new drug has appeared in several states in the eastern part of the country including Georgia, Alabama, Ohio, Florida, and Pennsylvania.4,5,6,7
What Drugs Are in Gray Death?
Although there is no set or standardized recipe used to create gray death, several opioids are likely to be found in a sample. They include:
- Heroin. Many samples of gray death will contain at least some heroin. The opioid substance produces a strong and rapid euphoric high. One of the greatest risks of heroin is that it can slow, or completely stop, the user’s breathing.1
- Fentanyl. Primarily used to manage cancer pain, fentanyl is extremely powerful. It is 100 times stronger than morphine and 50 times stronger than heroin.8,9 An amount as small as 0.25 mg can be lethal when consumed.10 Some fentanyl is diverted from legal prescriptions, with a growing amount of the drug being produced illegally, called “illicitly manufactured fentanyl (IMF)” or “non-pharmaceutical fentanyl (NPF).” 9
- Carfentanil. As a synthetic opioid that is used as a tranquilizer for large animals like elephants, carfentanil is 100 times more potent than fentanyl and 10,000 times stronger than morphine.8
- U-47700 (Pink). Pink has no approved use for humans but can be purchased in large amounts online as a “research chemical.” This substance is abused for its heroin-like effects and has caused numerous overdoses across the country.11
Why Is Gray Death Gaining Popularity?
Gray death is powerful and cheap, for both buyers and manufacturers.6 It can be purchased for as little as $10, and manufactures can make it with whatever ingredients they have available at the time.6
Another reason for the appearance of drugs like gray death is that foreign chemists producing drugs overseas and sending them to the US can quickly change their formulations to evade US drug laws. These evolving substances tend to get more and more potent, and with manufacturers adding these constantly changing drugs to heroin, users can never be sure what they’re getting.
Even with the known dangers, some opioid addicts may be enticed by the gray death’s ability to produce a high unlike other drugs out there.6 Unfortunately, this high can rapidly turn deadly.
Who Is Affected?
The main victims of the rise of gray death are those addicted to opioids. These people may intend to purchase heroin but unintentionally consume gray death.6 Heroin use has gotten increasingly dangerous in the last decade with so many adulterants being added to it, and gray death is only the latest manifestation of this extreme risk that opioid users face.
Not only are opioid users affected, but those who treat victims can become victims themselves. First responders like EMTs and law enforcement officers are at risk if they come into contact with it.6,7,8 Synthetic opioids can be absorbed readily through the skin or inhaled without the person’s knowledge. There have been reports of police overdosing with minimal contact.6,8
In one case, some fentanyl, a common ingredient in gray death, got onto an officer’s shirt at a traffic stop. Later in his shift, the officer brushed the powder off with his hand. Unaware that he touched fentanyl, he began feeling the symptoms of overdose just 10 minutes later.6 Due to the risk of overdose from skin contact, officials advise officers to bypass testing the substance at the scene and take the drug directly to a lab where it can be handled safely and tested for its contents.6,8
How Deadly Is It?
With the inclusion of fentanyl, carfentanil, and U-47700, gray death has the potential to be the deadliest drug on the street today. Because a dose that isn’t even visible to the eye can kill you (depending on what’s in the batch) someone trying to take the amount of heroin they are used to can die in minutes.5,7
Cases of overdoses and fatalaties from gray death are rising. However, the exact numbers are impossible to find; testing doesn’t always identify it as the substance ingested, especially because the synthetic opioids may have been added in such small doses that they don’t show up when tested.5
Fortunately, the same tools and methods used to reverse a heroin overdose can be used to reverse a gray death overdose, but the process is more challenging. A gray death overdose might require multiple doses of naloxone (Narcan). Some people will need up to 10 doses to recover,6 which can be a huge problem since family members or first responders may not have that amount on hand.
Gray death is arguably one of the most concerning drugs when it comes to the risk of overdose, but it might not even be the worst we see. Manufacturers are constantly producing new substances to evade the laws that struggle to keep up with a changing drug landscape. And unfortunately, heroin users end up unwittingly serving as the testers for these new products and often end up paying with their lives.