Mixing fentanyl with heroin creates a quick and intense “high,” as both drugs act on the pleasure center in the brain. The combination of the two may create a more powerful surge of euphoria than just one of these drugs alone.

Drowsiness, nausea, and confusion are potential side effects of the heroin-fentanyl combination. Heroin may be “cut” with fentanyl, and people may be able to buy these combination drugs in pills or in the form of counterfeit prescription medications online or on the street under such names as China White or China Girl.

As a synthetic opioid drug, fentanyl is often manufactured in illegal laboratories as a white powder, which is taken on its own, mixed with heroin, or passed off as “synthetic heroin.” Fentanyl is about 50 times more potent than heroin, CNN reports, and it produces a more rapid and powerful high that individuals suffering from addiction involving another opioid drug or drugs may desire.

Fentanyl-Laced Heroin

Fentanyl is so strong that it can be lethal at much lower doses than heroin, according to Forbes, so mixing these drugs is even more dangerous than taking one on its own. Overdose deaths involving the combination of heroin and fentanyl topped 1,000 between 2005 and 2007, NPR publishes.

Spotting Fentanyl Laced with Heroin and Its Abuse

On the East Coast, heroin is typically sold as a white powder, as is fentanyl, which may make it difficult to discern it from heroin. In other parts of the county, heroin may be found in an off-white powder, or black sticky substance called “black tar heroin,” which may be easier to recognize as heroin and not fentanyl.

Fentanyl and fentanyl-laced heroin may be especially common in regions of New England, as fentanyl is now responsible for more deaths than heroin, The New York Times publishes. Fentanyl, and its precursor products, is often manufactured in China and makes its way into the United States via Mexico or Canada where it may be used to “cut,” or be added to, heroin as a cheaper and easier-to-make alternative to the already powerful opioid drug, the Drug Enforcement Administration (DEA) postulates. Individuals who are looking for heroin may not even realize that they are getting heroin laced with fentanyl. It may also be made into pills that resemble prescription medications labeled as “Norco” (a combination of the opioid drug hydrocodone and the over-the-counter drug acetaminophen) or “Xanax” (a prescription benzodiazepine sedative), the National Institute on Drug Abuse (NIDA) warns.

The high from fentanyl-laced heroin may be more intense and the euphoric sensations start sooner than with heroin alone, as fentanyl quickly crosses the blood-brain barrier and binds to opioid receptors in the brain. When it does, pain sensations are dulled, and individuals may become drowsy, lethargic, mellow, and happy. Dopamine levels are increased, and the central nervous system is suppressed, lowering heart rate, body temperature, and blood pressure as well as slowing breathing and respiration rates.

The slowed breathing is what makes the combination of heroin and fentanyl so dangerous. With just a small amount, it can cause a person to forget to breathe, leading to an overdose. The DEA warns that fentanyl can be lethal in doses as small as 0.25 milligrams.

The slowed breathing is what makes the combination of heroin and fentanyl so dangerous

The combination of heroin and fentanyl is a serious health concern. CBS News reports that it overwhelms the body, leading to death in many cases. Difficulties breathing, cold skin, pinpoint pupils, confusion, and possible loss of consciousness are signs of a fentanyl-heroin overdose.

Detox and Treatment Options

Opioid drugs like both fentanyl and heroin are highly addictive and can easily lead to drug dependence. One of the side effects of drug dependence is the occurrence of withdrawal symptoms when the drugs wear off and stop being active in the body. In around 12 hours after the last dose, individuals may begin feeling irritable, anxious, restless, sweaty, and achy. They may have a runny nose, increased tearing, yawning, and trouble sleeping. Within about a day or so, withdrawal side effects may peak and include nausea, vomiting, diarrhea, stomach cramps, chills, depression, mental “fogginess,” and dilated pupils.

Opioid withdrawal may be more intense in individuals who have regularly abused a combination of drugs like fentanyl and heroin, and it is best managed with medical detox. Medications are often useful during medical detox to help the body naturally process out the toxins in a secure environment where vital signs and mental health can be monitored and managed.

Complete treatment for abuse and/or addiction involving fentanyl and heroin likely includes the following components:
  • Medical detox
  • Individual and group therapy and counseling sessions
  • Stress management and skills training sessions
  • Medications to sustain sobriety, curb cravings, and prevent relapse
  • Peer support groups and 12-Step programs
  • Educational programs
  • Holistic methods, including diet plans, fitness regimes, and adjunct and complementary tools and methods
  • Relapse prevention programs
  • Family involvement and programs
  • Medical and mental health evaluation and treatment of any co-occurring disorders
  • Aftercare programs