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Is Heroin and Fentanyl a Safe Mixing Combination (& How?)

Heroin and fentanyl are not a safe combination. Mixing the two is very dangerous and can result in death.

young female drug addict

What to Know About Heroin

Heroin is a semi-synthetic opioid that is made from morphine, which is derived from seeds of the poppy plant. It is typically produced in southeastern and southwestern Asia, Mexico, and Colombia, and then distributed around the world.

Heroin is not a prescription drug, though it is closely related to prescription opioids. Many prescription opioids produce highs that are similar to heroin, though often less intense.

According to the National Institute on Drug Abuse (NIDA), almost 80 percent of Americans who use heroin started by abusing prescription opioids.

When people abuse heroin, they can inject, sniff, snort, or smoke it. It is typically used on its own, though some people like to mix heroin with other drugs, such as cocaine or fentanyl, in search of an even more intense high.

Heroin works by binding to opioid receptors in the brain. It then interferes with the transmission of signals of pain and pleasure. Pain is typically relieved while an intense, euphoric sense of pleasure is experienced.

The danger of interfering with opioid receptors, however, is that receptors responsible for monitoring heart rate, sleeping, and breathing are also impacted. Too much heroin in your system can cause heart rate and breathing to stop entirely, leading to a fatal overdose.

drug exchange

Fentanyl Drug Use

Fentanyl, like heroin, is an opioid drug. It is completely synthetic, however, meaning it is 100 percent made in labs.

Unlike heroin, fentanyl was originally developed for medical reasons, though it has also become a widely misused drug. Medically, fentanyl is used for the treatment of severe pain, such as pain following surgery or a terrible injury. It is also used to manage advanced cancer pain.

Fentanyl is the strongest prescription opioid available, though illicit fentanyl analogs have been created that are significantly more potent and more dangerous. Fentanyl itself is 50 to 100 times stronger than morphine and has become an increasingly popular substance for illicit drug manufacturers to produce.

Fentanyl is commonly sold on the streets to people looking for an even stronger heroin-like high. According to the Centers for Disease Control and Prevention (CDC), fentanyl is often mixed with other drugs as well, to increase the euphoric effects the user experiences.

This is a very dangerous practice, as many people don’t know they have bought a product laced with fentanyl and experience drug overdoses. Many of these overdoses are fatal. Heroin, cocaine, and counterfeit prescription pills are frequently laced with fentanyl.

Can You Mix Heroin and Fentanyl?

It is possible to mix heroin and fentanyl, though it is very dangerous to do so. Heroin and fentanyl are both potent opioids. Combining them significantly increases their impact on the body and the risk of overdose.

Over the past few years, the majority of the U.S. heroin supply has been laced with illicit fentanyl. The result has been a steep spike in fatal overdoses due to heroin use.

The spike in fatal overdoses led the U.S. Department of Health and Human Services (HHS) to declare the opioid overdose epidemic a public health emergency in 2017. The following statistics on the ongoing opioid crisis in the U.S. are from 2017:

  • Over 130 people die every day due to opioid-related overdoses.
  • About 886,000 people used heroin .
  • More than 15,000 deaths were related to a heroin overdose.
  • More than 47,000 people died from an opioid overdose.
  • More than 28,000 people died from a synthetic opioid overdose.

As drug testing kits are updated to detect current drug trends, the majority of opioid-related overdoses test positive for fentanyl.

Fentanyl is responsible for causing the steep rise in overdose deaths involving synthetic opioids since 2013. The market of illicitly manufactured fentanyl continues to change. It is more and more frequently found in dangerous combination with heroin, counterfeit pills, and cocaine.

drug effects

Short-Term and Long-Term Effects of Heroin and Fentanyl Use

Since heroin and fentanyl are potent opioids, they both have significant effects on the body.

Short-term effects of each drug can be felt relatively quickly after ingestion, especially if the drugs are being injected.

  • Sense of euphoria
  • Rush of good feelings
  • Warm flushing of skin
  • Heavy feeling in the arms and legs
  • Transitioning in and out of wakefulness or going “on the nod”
  • Impaired cognition
  • Decreased breathing rate

The above symptoms are likely to dissipate as the effects of heroin and fentanyl wear off. Long-term effects of using these drugs, however, are much more damaging to your health.

  • Collapsed veins
  • Chronic constipation
  • Stomach cramps
  • Pneumonia
  • Kidney disease
  • Heart infections
  • Liver disease
  • Lung infections and complications
  • Skin sores and infections
  • Increased risk of contracting hepatitis B and C or HIV

Choosing to inject heroin or fentanyl greatly increases your risk of contracting blood-borne diseases like HIV. Sharing needles and using unsterilized needles is one of the leading causes of infection and diseases that intravenous drug users encounter.

Consuming your drugs through other routes, such as orally or snorting, is one way to reduce your chances of causing some long-term harmful effects to your body. Changing your consumption route simply means you will experience different long-term harms. For example, snorting the drugs can result in serious damage to the nasal passages, a lost sense of smell, and a deviated septum.

Is Overdose Possible?

Overdose is a very real risk associated with fentanyl and heroin use, especially when they are combined with one another. Because of how opioids interact with receptors in the brain, they can cause respiratory depression and death, in the case of an overdose.

According to the World Health Organization (WHO), the three main signs of an opioid overdose, the opioid overdose triad, are:

  • Pinpoint pupils.
  • Unconsciousness
  • Respiratory depression.

Opioids are responsible for a significant percentage of fatal drug overdoses around the world due to how quickly they can cause someone to stop breathing. In 2016, approximately 27 million people around the world struggled with opioid use disorder, of which 118,000 people suffered fatal overdoses due to opioid use.

According to WHO, people at risk for an opioid-related overdose include:

  • People with an opioid dependence.
  • People who inject opioids.
  • People prescribed opioids, especially in high doses.
  • People who combine opioids with other sedatives.
  • People who use opioids and have pre-existing medical conditions like HIV, liver disease, or lung disease.
  • People who live with others who possess prescription or non-prescription opioids.

drug addiction

Is There Any Safe Amount That Can be Mixed?

No. There is really no safe amount of heroin and fentanyl that can mixed.

The difference between a fatal and non-fatal dose of fentanyl can be as little as a couple milligrams, which is difficult to measure. Especially when substances are bought illegally off the street, there is no way to guarantee the quantity or purity of the products you are purchasing.

Additionally, everyone responds to drugs, prescription or recreational, differently. A safe dose for one person could send the next person to the hospital.

If you suspect you may have purchased a product that has heroin and fentanyl mixed together, it’s best not to use it. You can test the contents of the substance via a fentanyl test kit. If fentanyl has been mixed into your heroin, the safest thing is to not use it at all.

If you use it anyway, start by using very small doses to see how your body reacts to the combination, have a friend present who can assist in an emergency, and keep a dose of naloxone on hand, in the event of an overdose.

Heroin and fentanyl is not a safe combination. Take extra precautions to avoid an unnecessary fatal overdose. 


10 Facts About Heroin. (March 2018). Drug Policy Alliance.

Opioid Overdose: Fentanyl. (December 2018). Centers for Disease Control and Prevention.

Information Sheet on Opioid Overdose. (August 2018). World Health Organization.

The Health Effects of Heroin. (June 2018). Verywell Mind.

What Is Heroin? (June 2018). National Institute on Drug Abuse.

What Is the U.S. Opioid Epidemic? (January 2019). U.S. Department of Health and Human Services.

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