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“Playing with death,” says Dr. Steven Aks of the Cook County Health and Hospitals System to NBC Nightly News with regard to opioid addicts using the powerful analgesic fentanyl. As if the American opioid epidemic wasn’t tragic enough, across the country law enforcement and health officials are seeing greater use of a drug that is 100 times more potent than morphine. Dealers have been mixing fentanyl with heroin for a number of years, in an attempt to make their product stronger. Users who are unaware of the presence of fentanyl are at great risk of overdose and potentially death.

Commonly, opioid addicts will do their heroin as they normally would, but when fentanyl is present they are in for much stronger side effects, such as severe respiratory depression. Fentanyl was designed to be used in a hospital setting; patients given the drug are under the close eye of both physicians and skilled nurses who constantly monitor the patients’ drug reaction. If a problem arises, doctors can act quickly to reverse the drug’s effect.

With ever greater demand for heroin in the wake of prescription opioid prescribing crackdowns, heroin manufacturers and distributors have turned to fentanyl as a way to not only strengthen their product but to increase the amount they have – profiting on the most deadly of admixtures. What’s more, much of the fentanyl used illicitly does not come from hospitals or pharmacies. The drug can be manufactured by chemists in clandestine laboratories with relative ease.

While heroin laced with fentanyl overdose deaths have occurred all over the United States, the Midwest has seen a dramatic rise in fentanyl related cases, and some people are just abusing fentanyl by itself, NBC Nightly News reports. The news agency reports that the drug is:

The Centers for Disease Control and Prevention (CDC) has called Ohio, “ground zero for fentanyl overdoses.” Overdose deaths in Cincinnati now surpass both vehicular deaths and murders combined. Please take a moment to watch a short video below:

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