Fentanyl, a synthetic opioid up to 100 times more potent than morphine, is a major driver of the opioid overdose crisis. Its widespread availability in illicit drug markets heightens the risk, especially when combined with other substances—a practice known as polysubstance use.
This guide explores the dangers of fentanyl-related drug combinations and offers practical harm reduction strategies to help minimize associated risks.
What is polysubstance use?
Polysubstance use refers to the intentional or unintentional consumption of multiple substances within a short time frame. This behavior may stem from a desire to enhance the drug’s effects, alleviate withdrawal symptoms, or occur in less-than-ideal circumstances, such as unknowingly consuming a contaminated drug.
When fentanyl is involved in polysubstance use, the risk becomes especially severe. Even a minimal amount of fentanyl can trigger a fatal overdose.
Why is fentanyl especially dangerous when mixed?
Fentanyl poses extreme dangers due to its unparalleled potency, rapid onset, and ability to significantly suppress breathing. These factors make it particularly hazardous, even in small amounts.
The risks escalate when fentanyl is mixed with other substances, as the interactions often produce unpredictable and fatal results. This danger is further intensified by fentanyl’s increasing presence in other drugs like heroin, cocaine, and counterfeit pills, where users may be unaware of its inclusion.
Common Fentanyl Combinations and Associated Risks
Mixing fentanyl with other substances significantly increases the risk of severe health complications and fatal overdoses. Below are some of the most common combinations and their associated dangers:
1. Fentanyl and Benzodiazepines
- Commonly Mixed Drugs: Xanax, Valium, Klonopin
- Effects: Profound sedation and severe respiratory depression
- Risks: The combination’s compounded depressant effects greatly increase the risk of fatal respiratory failure. Naloxone (Narcan) is less effective in reversing overdoses involving benzodiazepines, as it does not counteract their effects.
2. Fentanyl and Alcohol
- Commonly Abused Substances: Beer, wine, spirits
- Effects: Extreme sedation, impaired motor coordination, and slowed breathing
- Risks: Even small amounts of alcohol amplify fentanyl’s respiratory depression, dramatically increasing the likelihood of overdose and death.
3. Fentanyl and Stimulants
- Commonly Mixed Drugs: Cocaine, methamphetamine, MDMA
- Effects: A “push-pull” effect, where stimulants raise heart rate and energy levels while fentanyl suppresses breathing and induces sedation
- Risks: This combination creates severe cardiovascular strain, increasing the chances of heart attack, arrhythmias, and overdose. Many users are unaware that their stimulant drugs are laced with fentanyl, further heightening the risk.
4. Fentanyl and Other Opioids
- Commonly Mixed Drugs: Heroin, oxycodone, morphine
- Effects: Intensified euphoria and sedation
- Risks: Combining opioids, even prescribed ones like oxycodone, leads to compounded respiratory depression, drastically increasing the likelihood of overdose.
What are the risks of polysubstance use involving fentanyl?
Polysubstance use involving fentanyl poses severe and often unpredictable risks. Below are the key dangers associated with this practice:
Heightened Overdose Potential
Fentanyl’s extreme potency makes even the smallest dose potentially lethal. When combined with other substances, the unpredictability of individual reactions dramatically increases the risk of overdose. As experts note, “People who use polysubstances tend to miscalculate and are more likely to inadvertently overdose, with serious mortality consequences.
Delayed or Ineffective Naloxone Response
While naloxone is a lifesaving drug used to reverse opioid overdoses, its effectiveness is often reduced in cases involving polysubstances. Multiple or higher doses may be required, particularly when non-opioid depressants or stimulants are also involved.
Unpredictable Drug Interactions
The effects of fentanyl, when mixed with other substances, depend on various factors, including the user’s tolerance, the type of substances involved, and dosage levels. These interactions are highly unpredictable and frequently deadly.
Increased Risk of Long-Term Health Complications
Chronic polysubstance use involving fentanyl can lead to serious long-term health issues, including liver and kidney damage, cardiovascular problems, cognitive impairments, and an elevated risk of mental health disorders such as depression and anxiety.
Harm Reduction Strategies for Polysubstance Users
While quitting substance use entirely is the safest approach, harm reduction offers practical strategies to minimize the risks associated with continued use. Below are key harm reduction measures tailored for polysubstance users:
Testing Drugs for Fentanyl Contamination
Fentanyl test strips are an essential tool for detecting the presence of fentanyl in drug samples.
- How to Use: Mix a small portion of the drug with water and dip the test strip. A positive result confirms the presence of fentanyl.
- Where to Access: Available through harm reduction organizations and some public health departments.
Always Carry Naloxone
Naloxone is a life-saving medication that can reverse opioid overdoses.
- Best Practices:
- Learn how to use naloxone and train others around you.
- Carry multiple doses, as polysubstance overdoses may require additional administration.
Avoid Using Alone
Using drugs in isolation greatly increases the risk of a fatal overdose.
- Safer Alternatives:
- Use with a trusted friend who can assist in case of an emergency.
- Visit supervised consumption sites where medical professionals can provide immediate help.
Initiate with Small Dosages
The strength and potential contamination of drugs are often unknown. Begin with a small dose to gauge effects before consuming more.
Access Safe Supply Programs
Some regions, such as Canada, offer pharmaceutical-grade alternatives to illicit drugs, reducing the risk of fentanyl contamination.
- Availability: Safe supply programs are accessible in progressive areas that endorse harm reduction policies.
Get Integrated Addiction Treatment
Comprehensive treatment programs are essential for addressing polysubstance addiction.
- Treatment Options:
- MAT (Medication-Assisted Treatment): Medications like methadone or buprenorphine can help manage opioid dependency.
- Therapy and Counseling: Focus on addressing underlying issues contributing to substance use.
- Peer Support Groups: Programs like Narcotics Anonymous provide community-based support for long-term recovery.
Polysubstance Use Statistics in Canada
Polysubstance use is a significant public health concern in Canada, with increasing prevalence and severe consequences:
- Prevalence: Approximately 12.2% of Canadians (about 3.8 million people) reported using multiple substances, with higher rates among youth, men, and individuals who vape.
- Opioid-Related Deaths: Between 2020 and 2021, opioid-related deaths remained critically high, with 6,214 lives lost in 2020 and projections suggesting continued severe impacts into 2021.
Checklist: Safer Polysubstance Use Practices
- Test for Fentanyl: Use fentanyl test strips to detect contamination before consuming any substance.
- Carry Naloxone: Always have multiple doses of naloxone available and ensure you and those around you are trained to use it.
- Avoid Using Alone: Minimize overdose risks by using substances with a trusted person or at supervised consumption sites if available.
- Start with a Small Dose: Begin with a low dose to assess potency and reduce the likelihood of overdose.
- Understand Drug Interactions: Familiarize yourself with the risks of mixing specific substances to avoid dangerous or unpredictable effects.
- Access Safe Supply: Whenever possible, obtain regulated drugs through safe supply programs to reduce the risk of contamination.
- Seek Addiction Support: Explore addiction treatment options, such as therapy, peer support, or medication-assisted treatment, to address polysubstance use.
Conclusion
Combining fentanyl with other substances significantly increases the risks of overdose and severe health complications. Harm reduction strategies, such as fentanyl testing, carrying naloxone, and avoiding solitary use, can help minimize these dangers.
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