Fentanyl Use in Combination With Street Drugs Leading to Death in Some Cases

NIDA Director Nora Volkow

June 2006

A deadly drug combination has been eliciting a great deal of media attention lately. Dozens of individuals in the Philadelphia, Chicago, St. Louis, and Detroit areas have overdosed on a combination of heroin (or cocaine) and fentanyl, a narcotic analgesic that is 50 to 100 times more potent than morphine - and some have died. A powerful opiate pain reliever typically used after surgery or to treat patients with severe pain, fentanyl, like many prescription medications, can be deadly when abused.

Why would anyone risk death for the high of this powerful drug? For some addicts, it is an unwitting mistake, as they often do not know the composition of what they buy on the street. Incredibly, other addicts intentionally make this choice as part of a desperate search for an increasingly better high. The reason for this behavior is addiction, or one of its fundamental features: the ability to alter peoples' brains such that they can no longer exercise proper judgment or experience normal pleasures. Along with displacing natural "reinforcers" such as food, family, and friends, drugs of abuse also eventually lose their ability to reward, placing the addict on a compulsive quest for more drug and for greater drug potency as their reward circuitry becomes increasingly blunted and desensitized.

Fentanyl's superior potency makes it a good medication for pain and a good target for abuse. And while it may not be as familiar as other prescription opiates or street drugs like heroin, it is causing a wave of overdoses and deaths, not from its diversion for non-medical purposes, but likely a result of illicit drug manufacturing. Combined with heroin and used in powder form, fentanyl represents an intersection of prescription drug with street drug and reminds us of the potential dangers associated with the abuse of both - particularly as the abuse of prescription painkillers continues to grow in young adults and youth. We must therefore be vigilant in educating ourselves and those around us on the dangers associated with all drug abuse.

For more information on fentanyl, go to For more information on prescription drug abuse go to


Nora D. Volkow, M.D.

Messages from the Director

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