According to a recent survey of those who’ve used drugs, the drug that people least regret trying is also one of the most deadly: fentanyl. Part of a class of dangerous synthetic opioids, fentanyl is up to 100 times more potent than morphine and 50 times more powerful than heroin. As little as a 0.25 milligrams of the drug — about the size of the head of the pin — can kill.

If fentanyl is so destructive, why did only two of the survey’s 502 respondents say they regret using it? On one hand, it’s likely that many of them have never consumed fentanyl. On the other, these results could be a testament to the drug’s lethal nature. Those who have consumed fentanyl — knowingly or unknowingly — may not be alive today to actively regret their decision.

A Concealed Killer

Most people who take fentanyl don’t ingest it intentionally. While legal varieties approved by the Food and Drug Administration (FDA) are used in clinical settings to address severe, ongoing pain, most of the illicit fentanyl consumed in the United States is imported from China. There, labs churn out a cheap, crystallized version of the drug and send it to countries across the globe, where it’s mixed with other illicit substances to boost their potency. This mixing isn’t just done with conventional street opioids like heroin. Trace amounts of fentanyl have also been found in illicit drugs like ecstasy, MDMA and cocaine across the country.

Some dealers are aware of and upfront about the presence of fentanyl in their drugs, but others may not be as knowledgeable or transparent with their customers. Because of this, some people consume fentanyl without ever realizing it before ingesting a lethal amount or overdosing. In many areas, mixing fentanyl with other drugs, particularly heroin, has become so common that many drug users know about the substance’s deadly potential and try to avoid it. But when the choice is between staving off withdrawal or risking the chance of overdosing on fentanyl, many take the risk. “Most of us know that that’s what we’re getting,” said Sean, a Massachusetts man who uses heroin in an interview with NPR earlier this year. “And if you don’t believe it, you’re living in a fairy tale world.”

In other cases, fentanyl is illegally pressed into pill form and passed off as a prescription opioid, like OxyContin. Because prescription drugs are usually manufactured by professionals and regulated by the FDA, many people feel a false sense of security when purchasing so-called prescription pills from dealers over traditionally riskier opioids, like heroin. But prescription pills sold on the street are often counterfeit, and increasingly common varieties that contain fentanyl carry an enormous risk of overdose and death. Law enforcement officials compare buying black market pills to playing Russian Roulette. “These pills on the street, nobody knows what’s in them and nobody knows how strong they are,” Barbara Carreno of the DEA told the Guardian in a recent interview.

The passing of Prince, one of America’s most prolific singers and songwriters, is one of the most tragic and well-known examples of this phenomenon. After his death, investigators found medication labeled as prescription hydrocodone — the generic form of Vicodin and Lortab — in his home. After conducting lab tests, authorities discovered that the pills were actually made of fentanyl. This finding suggests that, like many others, Prince most likely purchased what he thought were regulated prescription pills on the black market without fully realizing their contents. As the circulation of fentanyl in its many forms becomes more common, thousands of others have met the same fate as the singer.

Rising Death Tolls

According to a new CDC study, the death rate from synthetic opioids in the United States increased by about 72 percent between 2014 and 2015, with fentanyl largely to blame. This increase occurred  in states across the country. Take Pennsylvania for example: In 2014, there were 349 fentanyl-related deaths. Just one year later, that number jumped to 913. Seventy-five percent of Massachusetts’s unintentional overdose deaths in 2016 involved fentanyl, up from 57 percent in 2015. In North Carolina, fentanyl deaths jumped from 165 in 2014 to 226 in 2015. Fentanyl-related casualties rose nearly 70 percent from 2014 to 2015 in Florida.

The extremely high potency of fentanyl means that only a few stray crystals of the substance injected, inhaled or even absorbed through the skin can be lethal. Once ingested, the drug quickly takes effect, spiralling many of its victim into overdose in a matter of seconds. This is significantly faster than a heroin overdose, which usually begins several minutes after ingestion. Megan Hynes, a manager at the AAC Needle Exchange in Cambridge, Massachusetts described the experience of watching someone overdose on fentanyl in an April interview with NPR:

“Recently we had a guy leave the bathroom and all the color just drained from his face, like immediately, and he just turned blue,” Hynes said. “I’ve never seen anyone turn blue that fast. He was completely blue and he just fell down and was out — not breathing.”

Fentanyl overdoses are usually accompanied by health complications that make it difficult to revive victims. Many experience “wooden chest,” a side effect where the chest seizes up and becomes temporarily paralyzed, stalling breathing and causing asphyxiation. This paralysis can spread throughout the body, locking the jaw and making it difficult for emergency professionals to perform rescue breathing or CPR. Worse, naloxone, a prescription medication used to block the effects of opioids and reverse overdose, often proves ineffective in the case of fentanyl overdose. While a single dose can reverse heroin overdose, several are required to bring someone back from the brink of fentanyl overdose.

As casualties from fentanyl continue to climb, more and more people are personally affected by the opioid crisis sweeping the nation. Every day, this drug and others jeopardize the lives of millions of men and women across the country. But the end of this tragedy starts on a person-to-person level. With the right mindset and treatment plan, you or a loved one can overcome opioid addiction. It all starts with a call.

The Recovery Village offers a comprehensive, patient-centered approach to treatment that addresses substance use disorders and co-occurring conditions to get to the root of addiction. At our state-of-the-art centers, clients learn about themselves and their struggles while outlining goals that will put them on the path to lifelong sobriety. With locations in Ohio, Florida, Colorado and Washington, The Recovery Village offers something for everything. Reach out today to take the first step toward a better life.

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