Purple heroin, also known as “purple,” or “purp,” is an exceptionally dangerous illicit drug concoction that is common in Canada and is making its way into the United States. Purple heroin is generally a mixture of heroin with fentanyl or carfentanil. OxyContin is occasionally included, but OxyContin is difficult to obtain and can be very expensive.

During the opioid epidemic, as opioid prescriptions increased, so did opioid-associated deaths. Between 1999 and 2008, prescription opioid-associated deaths tripled in the United States. In an attempt to get the opioid epidemic under control, federal and state laws and regulations were enacted to limit the availability of prescription opioids. A devastating unforeseen consequence of the crackdown was that people struggling with prescription opioid use disorders turned to heroin. An estimated 79.5% of people who use heroin, first misused prescription opioids.

With the increased demand for heroin, many drug dealers wanted to profit on that demand. To compete, many would cut their heroin with stronger substances to produce a stronger high or boost the addictive nature of their heroin. The result of these production blends were different types of heroin. One such creation was purple heroin.

What is Purple Heroin?

Purple heroin is a mixture of heroin with fentanyl or carfentanil. Purple heroin is vastly more dangerous than heroin. Because fentanyl is 40 to 50 times more potent than heroin, and carfentanil is 5,000 times more potent than heroin, there is no room for error when these drugs are measured and mixed. With that being said, estimating lethal doses of opioids can be challenging. Factors that affect the lethal dose include purity of the drug, route of administration, the weight of the person who will be using the drug and whether the person has used opioids before.

For someone who has never used opioids, 30 mg of pure heroin could be fatal. For a heavy user, a lethal dose of pure heroin could exceed 100 mg (in reality, regular heroin users consume an average of 300 to 500 mg per day of “street” heroin, which has been cut with relatively innocuous agents like quinine or caffeine so that the final purity averages around 25%). Fentanyl is often considered to have a lethal dose of 2 mg. Less than 0.02 mg (20 micrograms, about the size of a grain of sand) of carfentanil is considered a fatal dose. Extrapolating from these numbers, we can determine that heroin with 2% fentanyl or 0.02% carfentanil is lethal.

What Makes Purple Heroin Different

Aside from the fact that purple heroin is indeed purple, a great deal remains to be learned about the pharmacology and pharmacokinetics of purple heroin. For example, it is possible that the components of purple heroin act synergistically, meaning that the net effect of the drugs together is greater than would be expected based on the effects of either drug alone.

One unique feature of purple heroin is the potential for “hot spots.” No matter how much mixing and grinding you do, purple heroin will never be a homogenous mixture. This means that one dose of purple heroin may have substantially less (or more) fentanyl or carfentanil than the next. Consequently, the lethality of purple heroin may vary, even within the same batch.

Overdose Prevention

The only way to truly prevent overdose is to not use purple heroin. Other strategies to minimize the risk of overdose include:

  • Start with a fraction of your normal dose with every new batch.
  • Only use purple heroin if you have a sober friend nearby.
  • Do not mix other drugs or alcohol with purple heroin.
  • Only use drugs that come from a trusted source.
  • If you feel uncomfortable mentally or physically at any time, call emergency medical services immediately.
  • Have extra doses of naloxone on hand. Fentanyl and carfentanil often require at least double doses.
  • If you see blue lips or fingernails, respiratory depression, unconsciousness or seizures in someone taking heroin, call emergency medical services immediately.

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