Drug Interactions

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Fentanyl as a Drug of Choice

In conversations about fentanyl, we often hear it described only as a contaminant or a danger. While it’s true that fentanyl has dramatically increased the risk of overdose, it’s also important to acknowledge another reality that for some people, fentanyl is their drug of choice.

People may choose fentanyl for many reasons.

Acknowledging choice does not mean ignoring the risks. Fentanyl is far more potent than heroin or morphine, and that means the margin for error is small; you can always use more but you can never use less. But when we frame fentanyl use only as accidental or unwanted, we erase the experiences of people who use it intentionally, and we miss the opportunity to have real, nonjudgmental conversations about safety. The overdose crisis and unregulated drug market won’t be solved by blaming others. Instead, we must foster open, nonjudgemental conversations about safety. We keep each other safe.

If you or someone you know wants more information about fentanyl, reach out to us hello@nasen.org.

How Did Fentanyl Get Into My Coke?

It probably wasn’t on purpose, but it is happening.

Here's how it can happen:

• Dealers handle multiple drugs and use the same tools and surfaces without cleaning.
  • While fentanyl is oftentimes viewed as just an adulterant in other drugs, in reality for some people it is their drug of choice. Fentanyl adulteration isn’t always malicious, sometimes it’s simply the result of manufacturer error.
• Pills and powders can be misrepresented or mispackaged.
• Some pressed pills look like legit pharmaceuticals but contain fentanyl or other analogs.
• There's no quality control in an unregulated market. Criminalization of drugs and the people who manufacture and sell them means there is no mechanism to ensure quality and safety of drugs like there is for legal pharmaceuticals.

How to reduce your risk:

• Test your party drugs using fentanyl test strips (FTS).
• Don’t use alone. If possible, have a friend or sitter, and take turns!
• Start with a small amount. Start low, go slow. You can always use more, you can never use less!
• Know the signs of an opioid overdose (above) and keep Narcan on hand.

What is drug checking?

Drug checking refers to the process of using different methods to determine what substances are present in your drugs. You might already be familiar with various test strips that you can use to detect the presence of fentanyl and other substances in your drugs. Some harm reduction programs offer drug checking services using different methods like infrared spectroscopy to provide you a more detailed picture of everything that's in your sample.

There's no quality control in the unregulated drug market. Drug checking empowers you with knowledge about what substances are in the sample you're using so you can make informed decisions about when and how to use.

Interested in drug checking? Get in touch with your local harm reduction program! You can find a program near you at NASEN.org.

What Is an Opioid and What Isn’t?

Opioids are drugs that affect the brain’s opioid receptors. They reduce pain, slow breathing, and can cause euphoria or drowsiness. They also carry a risk of overdose, especially when mixed with alcohol or other depressants.

Common opioids include:

• Fentanyl (including illicit “street” fentanyl)
• Heroin
• Oxycodone (OxyContin, Percocet)
• Hydrocodone (Vicodin, Norco)
• Morphine
• Medications for opioid use disorder (Methadone, Buprenorphine/Suboxone/Subutex, Naltrexone)*
• Codeine
• Opium

Narcan (naloxone) works ONLY on opioids. If someone is overdosing from another type of drug (like GHB, benzos, or alcohol), Narcan won’t reverse it, but it also won’t hurt them, so it’s still okay to try if you’re unsure what the person took.

* These medications are used to treat opioid use disorder. They affect the opioid receptors and can help curb cravings and withdrawal symptoms. You might see people refer to them as medications for opioid use disorder (MOUD) or medication-assisted treatment (MAT). 

Not Opioids: 

Drugs that work differently in the brain and body other than the substances listed above.

They may cause overdose or health risks, but they do not respond to Narcan. These include…

Stimulants:

• Methamphetamine (meth, tina, crystal)
• Cocaine/crack
• Prescription ADHD meds (Adderall, Ritalin, Vyvanse)

Depressants (non-opioid downers):

• Alcohol
• Benzodiazepines (Xanax, Valium, Klonopin, Ativan)
• GHB/G (sometimes called "liquid ecstasy")

Psychedelics/Club Drugs:

• MDMA/Molly/Ecstasy
• LSD/Acid
• Psilocybin/Mushrooms
• Ketamine
• PCP
• Nitrous oxide/Whippets

Important note: These drugs can still be risky, especially when mixed with each other or with opioids. Some combinations (like opioids + benzos, or opioids + GHB) greatly increase the risk of overdose or death.