One of the many dangers associated with purchasing and using illegal street drugs is that it is difficult to know for certain what is in them. Many drugs have unintentional impurities acquired during the manufacturing process, which can lead to a variety of risky and even potentially lethal side effects. Some drugs are intentionally mixed with certain quantities of other drugs to produce a stronger effect. Even when these drug combinations are created on purpose, purchasers are not always aware that they are getting anything other than their usual fare. When drugs are combined to make them more potent, the users are at a much higher risk of accidental overdose. A prime example of such a \u201ccocktail drug\u201d is heroin laced with the prescription narcotic fentanyl. This combination has been blamed for a number of deaths across the country in recent years. Fentanyl, which is sold under various brand names including Actiq, Duragesic and Sublimaze, is 10 to 100 times stronger than morphine and 50 to 100 times stronger than heroin itself. In medical settings, it is most commonly used during surgery and to treat chronic pain in cancer patients. Fentanyl Suspected in Numerous Heroin Deaths A number of states across the country, particularly those in the Northeast, are investigating the role of fentanyl in heroin-related drug poisoning deaths. The Delaware Medical Examiner\u2019s office has blamed fentanyl-laced heroin for 11 deaths so far in 2014. Maryland, Michigan and Pennsylvania suspect fentanyl-laced heroin in 50 recent drug-poisoning deaths among them. Thirteen deaths in Rhode Island have been positively linked to heroin laced with fentanyl or a similar synthetic narcotic. Deaths have also been reported in New Jersey, where narcotics investigators believe at least some of the fentanyl-laced heroin is being manufactured and shipped to other states. Investigators in these states believe the true number of deaths from fentanyl-laced heroin is more than those that have been identified. Fentanyl-laced heroin caused a rash of deaths in the late 1980s, early 1990s and in 2006, and investigators are extremely concerned that it has turned up on the streets again. Fentanyl Relatively Easy to Manufacture According to Dr. Karl Williams, chief medical examiner for Pennsylvania\u2019s Allegheny County, fentanyl is fairly easy to manufacture. The molecule is relatively simple to create, and instructions for doing so can be found on the Internet. While prescription narcotics are usually expensive to purchase illegally, fentanyl\u2019s ease of manufacture makes it much more feasible for drug dealers to include it in their heroin order to produce a stronger high and create a more addictive product. A Dangerously Strong Product The number of heroin-related deaths involving fentanyl suggests that those who purchase the product do not know that the fentanyl is present. People who inject the same quantity of heroin as usual without realizing that it is laced with fentanyl will receive a much more potent dose than they are accustomed to receiving. This puts them at a much greater risk of arrested breathing shortly after shooting up. Others may intentionally purchase fentanyl-laced heroin\u2014sold on the streets under names like \u201cTheraflu,\u201d \u201cBud Ice\u201d and \u201cIncome Tax.\u201d The prospect of a cheaper, stronger drug is attractive to some people with a drug abuse habit despite the risks it presents. However, they may not realize just how strong the fentanyl-laced drug can be, or may not know just how much fentanyl is present in the heroin. This makes it much more likely that they will inject too much and suffer respiratory arrest. In the state of Vermont, and possibly elsewhere, investigators believe that pure fentanyl is being sold as extra-potent heroin. But fentanyl is so much stronger than pure heroin that even users who deliberately purchase a potent product are unlikely to realize its true danger.