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Why is Fentanyl So Dangerous to Mix

Medically Reviewed by: Charley Allen

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Man taking medications

Why is Fentanyl So Dangerous to Mix

Fentanyl is a substance that is legally prescribed to treat severe and chronic pain.

shutterstock 597219416 Design for RecoveryIt is a synthetic opioid, meaning an opioid that is manufactured by scientists in a lab rather than found naturally in nature. Fentanyl is a high potency opioid that is 50-100 times more intense than morphine and significantly more potent than heroin.

When fentanyl is used legally as prescribed, it is usually administered via a patch that is applied to the skin, though it can sometimes be prescribed in pill form as well as the fentanyl patch. However, fentanyl tends to have a high rate of abuse.

Fentanyl purchased illegally or prescription fentanyl that is misused can be injected, smoked, or snorted. Abusing fentanyl in this way significantly increases the side effects and the risk of overdose. Further increasing the danger is a tendency by drug abusers to mix fentanyl with other substances. This further compounds the risks and can be life threatening.

One of the more recent and well-known cases of a fentanyl overdose happened to the rapper Mac Miller when he was found dead in September 2018. The celebrity’s tragic death is officially attributed to fentanyl overdose, but the coroner actually determined the cause to be “mixed drug toxicity.” While fentanyl overdose was indeed what killed Miller, it was the combination of alcohol, cocaine, and fentanyl that created the conditions for the overdose to occur.

Mixing fentanyl with other substances poses unique risks that fentanyl alone does not have. Some substances interact with fentanyl to create new effects, while others merely intensify the damage that fentanyl is already capable of doing.

Fentanyl Mixed with Heroin

Combining fentanyl with heroin is one of the most common ways fentanyl is mixed. Both substances are opioids and thus have similar effects. In the United States, the Drug Enforcement Administration classifies heroin as an illegal drug under the Schedule I designation, whereas fentanyl on the other hand does have recognized uses. Surprisingly, fentanyl is about 50 times more potent than heroin.

When combined, the effects are compounded and create a more powerful surge of euphoria than each one alone. Addicts who have developed a tolerance to one drug might find that combining them produces the high they crave. This is the primary reason heroin is used along with fentanyl by those suffering from fentanyl addiction.

Unfortunately, this increased potency comes along with more intense side effects, such as drowsiness, nausea, and confusion. Combining the two substances also increases the risk of overdose and severity of withdrawal symptoms.

Fentanyl Mixed with Cocaine

In 2018, the Drug Enforcement Administration noted that the amount of drug samples containing a fentanyl/heroin combination has decreased, but the amount of drug samples containing a combination of fentanyl and cocaine has more than doubled. The practice of consuming the stimulant cocaine along with the depressant fentanyl is known as “speedballing.” The sedating effects of the opioid work to take the edge off of cocaine, and both substances provide a feeling of euphoria and confidence.

This combination can have a deadly effect on the heart, since fentanyl tends to slow it and cocaine overworks it. It should be noted, however, that many of the drug samples containing a mix of the substances were labeled as cocaine samples, meaning that simply purchasing what is supposed to be cocaine can have disastrous implications.

Fentanyl Mixed with Alcohol

Is it safe to consume alcohol and fentanyl? Alcohol and opioids are two of the most widely abused drugs in the world. Combining the two poses particular risks. Both alcohol and fentanyl are central nervous system depressants. This means that people abusing both drugs at the same time put themselves at a huge risk of suffering from a potentially deadly respiratory problem.

Respiratory depression, which is a result of a malfunctioning central nervous system, results in slowed or even stopped breathing. While this is already a potential problem of alcohol and fentanyl on their own, the rates of respiratory depression skyrocket when they are combined.

Fentanyl Mixed with Other Drugs

Opioids should only be used under strict medical supervision. Fentanyl is a particularly potent opioid, which means that using fentanyl alone poses extreme risks. However, when fentanyl is combined with other substances, these risks intensify. Aside from heroin, cocaine, and alcohol, fentanyl is extremely dangerous when combined with:

  • Anti-seizure medications
  • Certain antibiotics
  • Certain antidepressants
  • Certain antifungals
  • Certain antiretroviral drugs used for HIV infection
  • Sleep medications, such as zolpidem (Ambien, Intermezzo, others)
  • Drugs used to treat psychiatric disorders
  • Muscle relaxers
  • Other opioid medications
  • Sedatives, such as diazepam (Valium)

If you are taking fentanyl under a health care professional’s orders and you are concerned that another prescribed drug may interact with fentanyl, simply talk with your physician. They can alter your prescription if need be. However, if you find yourself addicted to fentanyl or any other substance, it is often a good idea to seek additional help at a residential treatment center where you can taper off and obtain new tools to deal with the underlying issues.

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David moved to California from his hometown in North Carolina after multiple failed attempts to get sober. While living in an all-male sober living, David started to excel as a leader and mentor. These skills and tools ended up being the catalyst for his recovery and ultimately the foundation he has today. David has a passion for helping young men and sharing his experience. After working in the treatment industry he noticed a serious need for ethical sober living facilities. This prior work experience brought about David’s idea and drive to open Design For Recovery. He’s ambitious to promote growth and change within each individual client that enters the house. David has a strong presence in the house and continues to be part of mentoring young men on a daily basis.


Edited by: David Beasley

David Beasley - Design for Recovery

David Beasley is a certified RADT (Registered Alcohol/Drug Technician). David, moved to California from North Carolina after many failed attempts to get sober.

Medically Reviewed by: Charley Allen

Charley earned his Masters of Clinical Psychology from Antioch University, Los Angeles, and is a California Licensed Marriage and Family Therapist (LMFT).He teaches mindfulness to both adults and children in group setting such as schools, corporate workplaces, and medical treatment facilities.

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