We all know the opioid epidemic takes so many lives each year. In just December of 2023 alone, almost 400 Tennesseans were hospitalized from an opioid overdose. This excludes heroin, which caused over 60 hospitalizations in the same timeframe.
What about those fellow Volunteers who were not as fortunate? How many more numbers out there were fatalities that month? How many can’t even be counted because they haven’t been identified or couldn’t make it to the hospital?
At ReVIDA® Recovery, we understand the seriousness of the opioid epidemic, which is why our facilities specialize in opioid use disorders. Our blog is here to educate and bring awareness to families and loved ones looking for hope and answers.
Let’s discuss heroin and fentanyl, their similarities, their differences, and how they are affecting our loved ones.
Table of Contents
Understanding Heroin: The Precursor
Heroin has been around for centuries, since the discovery of the poppy plant and opium became relevant in B.C. times. All opiates are derived from the poppy plant, and most opioids are as well. Heroin is a semi-synthetic opioid and contains trace amounts of the plant. However, because it goes through chemical processing, heroin is more potent than natural opiates, such as morphine.
Understanding Fentanyl: The Predecessor
Fentanyl is a fully synthetic opioid meaning that it is man-made in a laboratory. When made legally, fentanyl serves a purpose for pain management in medical settings. However, illicit labs make fentanyl without government regulation or any regard for medicinal purposes. All opiates share a chemical structure, changing slightly at the end to variate between morphine or chemically synthesized opioids. Fentanyl follows this same chemical structure, but does not require the poppy plant to be made.
Similarities Between Fentanyl and Heroin
Heroin and fentanyl share many similarities, being that both are opioids. They produce similar effects and carry the risks of developing dependence. They are also chemically similar. Let’s look at these further.
Opioid Family
Both fentanyl and heroin are in the opioid family. Though opiates are also derived from the poppy plant, they are not technically the same as opioids. This is because opioids contain little to no natural remnants of the poppy plant and require some form of chemical synthesizing. Opioids like heroin and fentanyl are often taken illicitly for the effects they produce.
Shared Effects
Being both opioids, heroin and fentanyl produce similar effects. Heroin and fentanyl attach to opioid receptors within the brain, slowing the central nervous system. The initial dose causes a rush of euphoria followed by drowsiness, dizziness, slowed breathing, and nodding in and out of consciousness. Both substances share the risk of causing an overdose when the central nervous system is slowed too much. Breathing can stop and become life-threatening.
Dependence Risks
Heroin and fentanyl carry the risk of developing dependence and can result in a substance use disorder as well. Fentanyl does have pharmaceutical purposes but can still lead to dependence when taken long-term. The brain adjusts to having fentanyl or heroin in the system, resulting in chemical changes. Dopamine is our brain’s reward chemical, and both heroin and fentanyl trigger its release. However, the brain does not understand why it is being released because there is no perceived reward. Therefore, the brain decreases dopamine levels when heroin or fentanyl are not present. The result? The brain sends signals showing its need, causing withdrawal symptoms.
A doctor can taper a patient off of fentanyl to minimize withdrawal and manage dependence. However, those taking fentanyl or heroin illicitly do not have that support, and will take more of either substance to prevent withdrawal. Behaviors will change to accommodate the need for the substance, which is the cycle of a heroin or fentanyl use disorder.
Differences Between Heroin and Fentanyl: Appearance and Uses
Despite being similar substances, there are differences between heroin and fentanyl. Their purpose, appearance, potency, and the way they are taken all vary. Let’s take a look at the key differences between the two substances.
Heroin comes in different forms but one of the most common is a white, off-white, or brownish powder. This powder can be snorted, smoked, ingested, or dissolved in water to make an injectable liquid. Black tar heroin is a sticky, tar-like version of the substance that can be smoked or injected. Heroin’s appearance can have different color variations as dealers use cutting agents to dilute the product and make it last longer. They also use cutting agents to enhance the effects of the person taking it, making them come back for more.
Fentanyl often comes in a white or off-white powder and can be dissolved in water to form a liquid. However, fentanyl has become one of the most popular cutting agents among dealers throughout the U.S. due to its cheap cost and the effects it produces. Therefore, fentanyl can be present in pills (both real and fake), other powdered substances (cocaine, meth, etc.), and other liquid substances. Fentanyl has no taste or smell and is very difficult to distinguish between other substances.
As we mentioned above, prescription fentanyl does have medicinal purposes. However, both illicit fentanyl and heroin serve no medical purpose and have no regulations about what goes into them. This increases the risks of negative effects and potentially life-threatening side effects.
How Does Potency Change Outcomes?
Heroin and fentanyl are both more potent than morphine but at different levels. Because heroin is semi-synthetic, it is only about 50 times more potent than morphine. Fentanyl is fully synthetic and chemically produced, increasing its potency to up to 100 times more than morphine. This means it will take more heroin to overdose than it would fentanyl. The overdose potential of fentanyl is exponentially higher than that of heroin, but that does not make heroin “safer.” Taking either substance can result in a possibly fatal overdose.
Dangers of Heroin and Fentanyl Use Disorders: Physical and Mental Effects
Heroin and fentanyl use disorders affect the person physically and mentally. Long-term opioid use can lead to depression, anxiety, and mood swings that put a strain on relationships. The person may become more withdrawn and give up activities they once loved. Heroin and fentanyl use disorders can become consuming, worsening mental health and making the person feel alone.
The physical effects of heroin and fentanyl use disorders can vary depending on the method of use. Those who smoke either substance will have breathing difficulties including lung infections and chronic coughing. Injecting heroin or fentanyl can result in collapsed veins, scarring at the injection sites, and abscesses. Sharing needles can lead to developing HIV/AIDS or hepatitis C. Prolonged heroin or fentanyl use weakens the immune system, making it difficult for the body to heal from constant infections.
Fentanyl-Laced Heroin
We talked about fentanyl being one of the most common cutting agents above, and that includes being mixed with heroin. With both substances being opioids that are far more potent than morphine, mixing the two in one sitting exponentially increases the risk of an overdose. Opioid overdoses are serious medical emergencies that require immediate attention. Narcan® (naloxone) can reverse the effects of an opioid overdose. However, if fentanyl-laced heroin is ingested, it can take more than one dose to counteract the effects. Even after Narcan® (naloxone) is given and the person regains consciousness, medical attention is still needed.
Fentanyl test strips can be used to test any substance for its presence. These strips are widely available through pharmacies, county health departments, online retailers, and more. They work to prevent accidental overdoses by informing the person if fentanyl is in their substance.
Get Help for Opioid Use Disorder in Tennessee
No one takes opioids – whether fentanyl, heroin, or both – and hopes to develop an opioid use disorder. However, it happens, and that does not mean there is no hope of stopping. Rehab for heroin and fentanyl addiction treatment are available and will give you the tools needed to leave opioids behind. Your journey will include therapy and coping skill development as well as medication-assisted treatment. These will arm you with everything you need to be successful to move forward with your life – opioid-free.
If you or someone you love is managing a heroin or fentanyl use disorder, we are here to help. ReVIDA® Recovery is a leading provider of Suboxone treatment paired with flexible, outpatient therapy. We understand you may have hardships causing difficulties with seeking treatment. Our substance use care coordinators are here to assist with transportation, housing, and more. Call us today at 423-631-0432 to learn more about our program offerings.
Reclaim your life.
