What are some street opioids and their associated risks?

October 8, 2025 •

4 min read

In 2023, nearly 80,000 opioid-involved overdose deaths occurred in the United States, a figure nearly ten times higher than in 1999 [1.5.3]. This article addresses the crucial question: what are some street opioids?

Quick Summary

An overview of common street opioids like heroin and illicitly manufactured fentanyl. It details their street names, extreme potency, and the risk of lethal overdose due to contamination.

Key Points

Heroin and Fentanyl are Primary Street Opioids: Heroin is a semi-synthetic drug, while fentanyl is a much more potent synthetic opioid often mixed into other drugs [1.3.1, 1.4.4].
Fentanyl Drives Overdose Deaths: Illicitly manufactured fentanyl (IMF) is 50-100 times stronger than morphine and is the main driver of the current opioid overdose crisis [1.4.4, 1.5.1].
Contamination is a Lethal Risk: Many users are unaware that drugs like cocaine, heroin, or counterfeit pills are laced with deadly doses of fentanyl [1.4.5].
Naloxone Reverses Overdoses: Naloxone (Narcan) is a life-saving medication that can rapidly reverse the effects of an opioid overdose and restore breathing [1.6.1].
Treatment for OUD is Effective: Opioid Use Disorder is a treatable medical condition. Medications like buprenorphine, methadone, and naltrexone, combined with therapy, are effective treatments [1.7.3, 1.7.6].

Understanding the Landscape of Illicit Opioids

The term "opioid" refers to a class of drugs that includes the illegal drug heroin, synthetic opioids such as fentanyl, and pain relievers available legally by prescription, such as oxycodone, hydrocodone, and morphine [1.2.8, 1.3.1]. Street opioids are those obtained and used outside of medical guidance. They represent a significant public health crisis due to their high potential for abuse, dependence, and fatal overdose [1.3.1]. In 2023, about 76% of the approximately 105,000 drug overdose deaths in the U.S. involved an opioid [1.5.3]. The crisis has evolved, with the third wave, beginning in 2013, being driven by a rapid increase in deaths from synthetic opioids like illicitly manufactured fentanyl (IMF) [1.5.1].

Heroin: The Prototypical Street Opioid

Heroin is an illegal, highly addictive opioid drug processed from morphine, a natural substance taken from the seed pod of the poppy plant [1.3.1]. It can be a white or brownish powder, or a black sticky substance known as "black tar heroin" [1.3.1].

Street Names: Common names include H, Horse, Smack, Junk, Brown Sugar, and Black Tar [1.2.7, 1.3.1].
Methods of Use: Heroin is typically injected, sniffed, snorted, or smoked [1.3.1].
Risks: Beyond the inherent risks of addiction and overdose, chronic use can lead to collapsed veins, infections of the heart lining and valves, and liver and kidney disease. The sharing of injection equipment also increases the risk of contracting infectious diseases like HIV and hepatitis [1.4.8]. While once a primary driver of the opioid epidemic, overdose deaths involving heroin have decreased significantly, though a high proportion of these deaths now also involve fentanyl [1.5.4].

Illicitly Manufactured Fentanyl: A Deadly Adulterant

Fentanyl is a powerful synthetic opioid that is 50 to 100 times more potent than morphine [1.4.4]. While it has legitimate medical uses for treating severe pain, the substance sold on the street is illicitly manufactured fentanyl (IMF) [1.3.2, 1.4.6]. IMF is the primary driver of the current overdose epidemic [1.5.1, 1.5.2].

Street Names: Apache, China Girl, China White, Dance Fever, Goodfella, Murder 8, and TNT [1.2.7].
The Danger of Contamination: Drug traffickers often mix fentanyl with other drugs—including heroin, cocaine, and methamphetamine—because of its high potency and low cost [1.4.5, 1.4.8]. They also press it into counterfeit pills made to look like legitimate prescription opioids such as OxyContin®, Vicodin®, or Xanax® [1.3.4, 1.4.5]. Many users may be unaware that their drugs are laced with fentanyl, and as little as two milligrams can be a lethal dose [1.4.4, 1.4.5]. The DEA reports that 42% of pills tested for fentanyl contained at least a potentially lethal dose [1.4.5].
Fentanyl Analogs: The danger is compounded by the existence of fentanyl analogs, which are chemical compounds with a similar structure. Some, like carfentanil, are even more potent than fentanyl and are used as large animal tranquilizers [1.4.2].

Comparison of Common Street Opioids


Feature	Heroin	Illicitly Manufactured Fentanyl (IMF)
Origin	Semi-synthetic, derived from morphine [1.3.1]	Entirely synthetic, made in a lab [1.3.1]
Potency	High	50-100 times more potent than morphine [1.4.4]
Common Forms	White/brown powder, black tar [1.3.1]	Powder, liquid, counterfeit pills [1.4.5, 1.4.6]
Street Names	H, Smack, Junk, Brown Sugar [1.2.7]	Apache, China White, Murder 8, TNT [1.2.7]
Primary Risk	High addiction potential, overdose	Extreme overdose risk due to potency and hidden contamination [1.4.5]

The Overdose Crisis and Harm Reduction

The presence of triad symptoms—coma, pinpoint pupils, and respiratory depression—strongly suggests an opioid overdose [1.3.2]. Fentanyl and its analogs can cause a rapid onset of overdose, reducing the time available to administer life-saving treatment [1.4.2].

Naloxone (Narcan) is a critical harm reduction tool. It is a medication that can rapidly reverse an opioid overdose by blocking the effects of opioids on the brain and restoring breathing within 2 to 3 minutes [1.6.1, 1.6.3]. It can be administered as a nasal spray or an injection [1.6.6]. Naloxone is safe and has no effect on someone who does not have opioids in their system [1.6.6]. Due to the potency of fentanyl, multiple doses of naloxone may be required to reverse an overdose [1.6.3]. Anyone at risk or who knows someone at risk of an opioid overdose is encouraged to carry naloxone [1.6.4].

Seeking Help for Opioid Use Disorder (OUD)

Opioid use disorder (OUD) is a chronic and treatable brain disease [1.7.5]. Effective treatment approaches combine medications with counseling and behavioral therapies [1.7.6].

Medications for Opioid Use Disorder (MOUD):

Buprenorphine: A partial opioid agonist that reduces cravings and withdrawal symptoms without producing a high. It can be prescribed in a physician's office [1.7.1, 1.7.4].
Methadone: A full opioid agonist that blocks the effects of other opioids and controls withdrawal. It is dispensed through federally certified opioid treatment programs (OTPs) [1.7.2, 1.7.5].
Naltrexone: An opioid antagonist that blocks the euphoric effects of opioids, helping to prevent relapse. It is available as a long-acting injection and can be prescribed by any clinician [1.7.1, 1.7.5].

Counseling, such as Cognitive-Behavioral Therapy (CBT) and support from mutual-help groups like Narcotics Anonymous, helps individuals develop healthy coping skills and change behaviors related to drug use [1.7.1, 1.7.5].

Conclusion

Street opioids, particularly illicitly manufactured fentanyl and its analogs, pose a grave and unpredictable danger to public health. Their extreme potency and common use as a hidden adulterant in other illicit drugs have fueled an unprecedented overdose crisis. Understanding the specific substances, their street names, and the signs of overdose is critical. Life-saving measures like naloxone and evidence-based treatments such as MOUD and behavioral therapy offer hope and a path to recovery for those with opioid use disorder.

For more information and to find treatment options, you can visit the Substance Abuse and Mental Health Services Administration (SAMHSA) website.

Frequently Asked Questions

The most common and dangerous street opioids are heroin and, increasingly, illicitly manufactured fentanyl and its analogs [1.3.1, 1.5.1].

Fentanyl is 50 to 100 times more potent than morphine. As little as two milligrams can be fatal. It is often secretly mixed into other drugs, so users may not know they are taking it [1.4.4, 1.4.5].

Common street names for fentanyl include Apache, China Girl, China White, Dance Fever, Goodfella, Jackpot, Murder 8, and TNT [1.2.7].

Naloxone (often sold as Narcan) is a medication that rapidly reverses an opioid overdose. It is effective against fentanyl, but due to fentanyl's high potency, multiple doses may be necessary [1.6.1, 1.6.3].

Yes. Criminal drug networks mass-produce fake pills made to look like oxycodone (OxyContin), hydrocodone (Vicodin), and others, but these pills often contain lethal doses of fentanyl or methamphetamine [1.3.4, 1.4.5].

Key signs include unresponsiveness or coma, constricted (pinpoint) pupils, and slowed or stopped breathing. Other signs are cold and clammy skin and blue discoloration of the skin (cyanosis) [1.3.2, 1.4.5].

The most effective treatments for Opioid Use Disorder (OUD) are FDA-approved medications (MOUD) such as buprenorphine, methadone, and naltrexone, often used in combination with counseling and behavioral therapies [1.7.3, 1.7.5].