Deadlier than Heroin: How Fentanyl is Becoming Public Health Enemy No. 1

For the first time in the city’s recorded history, more than 1,000 New Yorkers are expected to die from a fatal drug overdose in 2017. Key to this record-breaking statistic is the increased abuse of fentanyl, a cheap synthetic opioid up to 100 times more powerful than heroin. Relatively unknown to the general public until recently, this drug’s astounding lethality is tearing across the country as deaths related to fentanyl and other synthetic opioids surged more than 70% from 2014 to 2015. So where did this drug come from, and why are so many people dying because of it?

Fentanyl has been utilized in medical settings since the 1960s. Its most common uses include treatment for chronic pain in cancer patients and as surgical anesthesia. But as the opioid abuse crisis rages on, fentanyl is becoming infamous for its unsettling presence in a growing number of fatal overdose toxicology reports. In some parts of the Northeast, fentanyl has even surpassed heroin as the most commonly detected drug in fatal overdoses.

Several factors combine to make fentanyl an effective killer. For one, its extreme potency makes it very easy to accidentally overdose on, even in miniscule amounts. Non-pharmaceutical fentanyl is also much easier and cheaper to manufacture than heroin, making it a more cost effective product for drug dealers looking to stretch a batch of heroin and increase their profits. This means that some people ingesting fentanyl don’t even know they’re using the deadly drug, setting people up for reckless use with life-ending consequences.

Adding fentanyl to heroin also plays into a key component of addiction: escalation. The first time someone abuses an opioid like heroin or Oxycodone, the brain responds by dumping feel-good neurotransmitters like dopamine into the user’s neural reward pathways, producing feelings of euphoria and well-being. As an individual’s brain and body become accustomed to the drug over time, the brain stops responding as strongly, encouraging the user to seek out stronger and stronger substances. For long-term heroin users, adding fentanyl to their dope helps them reach those first-time highs again, but at the risk of losing their life.

Given the high likelihood of an overdose when using fentanyl, it’s more important than ever to make sure you have the opioid overdose-reversal medication naloxone on hand. But because of the potency of fentanyl, a single shot of naloxone may not be enough to revive someone who has overdosed on it. Depending on the amount of fentanyl that’s been introduced to the body, naloxone may not work at all.

Based on its insidious presence in heroin, resistance to overdose-reversal drugs and record-breaking fatalities, fentanyl is well on its way to becoming public health enemy number one. We must continue to fight the opioid epidemic with greater public education, an ongoing supply of naloxone for first responders and householders, and increased access to quality addiction treatment services for those ready to get help. As the New York City’s records show, this epidemic of drug abuse will not get better on its own; in fact, it’s getting worse.