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China White: A Heroin Epidemic

Medically reviewed by

Dr. Alan Weiner, MD

February 25, 2019

China White is a street name given to a highly potent heroin substitute made from the prescription drug Fentanyl, a fast-acting and powerful pain medication. Dealers sometimes cut heroin with china white to increase potency, though failure to do this correctly can cause sudden death for the unsuspecting user.

Where heroin is one of the hardest drugs to quit, severe withdrawals and cravings make china white on par or more difficult to quit. Other street names for fentanyl include “dance fever,” “apache,” “good fella,” “murder eight,” and “tango.” The powder is snorted, or mixed with water and injected intravenously.

China White Addiction And The Brain

Our bodies have evolved a kind of pattern language as a way of more efficiently locating food sources, clean water, and other life-sustaining necessities. The nucleus accumbens, otherwise known as the reward or “pleasure center” of our brains plays a central role in the development of this pattern recognition. During our evolution, when primitive man discovered a food source high in fats, proteins, or carbohydrates, the positive influence of those foods triggered a release of dopamine from the nucleus accumbens. Dopamine is a neurotransmitter responsible for that satiated feeling you get when you finish a good meal, drink a tall glass of water after a long walk, or have sex. It’s the brain’s way of encouraging us to seek out life-sustaining activities.

At the same time that our primitive ancestor is locating this food source, his brain is also taking a mental snapshot of his surroundings; everything from sight, smells, sounds, and even those other humans in close proximity. It’s learning the patterns of the landscape associated with the food source to make relocating this or a similar food source more efficient in the future. The combination of pattern recognition and the potential for the pleasurable release of dopamine generate cravings for these types of life-sustaining activities, so we continue to seek them out.

It’s a truly impressive system, except for the Achilles heel. Substances like opioids, including heroin and china white, excite the reward centers of our brains to an unnatural degree, leaving us vulnerable to cravings for the substance over those necessary for our survival. And any patterns it now associates with the drug influences the severity of associated cravings.

Heroin acts on the reward centers of our brains, much like that nutritious meal, but the response is a thousandfold more than any dopamine response that would otherwise occur naturally. China white acts on the reward center of the brain, just like heroin, but where heroin produces a dopamine response a thousand times more powerful; fentanyl in powdered form is 50 times more powerful than heroin. And as such, china white is highly addictive, generating extreme cravings and severe withdrawals, among other major health concerns.

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Unfortunately, tampering with the dopamine reward system means the body begins relying on the drug to stimulate the dopamine release. This means someone that tries china white for the first time may discover heroin no longer has any effect on them, compelling continued abuse of the more potent and deadly alternative.

Adverse Health Effects Of China White

China white has an immediate impact on the body, and even in small doses can depress breathing to fatal levels. As a central nervous system depressant, it can also prove fatal if used in combination with any other CNS depressant, like alcohol or heroin.

Apart from respiratory depression, china white can also cause gastrointestinal upset, changes in heart rate, fatigue, fainting, and prolonged sedation. It increases a person’s risk of developing mood disorders including depression, anxiety, paranoia, confusion, and changes in personality. It can also cause hallucinations.

Adverse Health Effects from China White Include:

  • Respiratory depression
  • Gastrointestinal upset
  • Changes in heart rate
  • Fatigue
  • Fainting
  • Prolonged Sedation
  • Mood disorders
  • Hallucinations
  • Decreased immunity
  • Death

China White is also frequently lethal, with more than 1,000 deaths reported by the Centers for Disease Control between 2005 and 2007 in the United States alone. Some of these deaths were linked to heroin that had been unknowingly cut with fentanyl. A dose of pure china white any higher than 2 μg can prove to be fatal. And combining china white with other substances is equally, if not more, fatal.

China White Withdrawal

Withdrawals from china white are more severe than that of heroin and include severe cravings for the drug, flu-like chills and muscle aches, profuse sweating, changes in appetite, rapid breathing, confusion, extreme irritability, and other mood changes including anxiety and depression.

Due to the severity of symptoms and cravings, a medically-managed detox is highly recommended to safely help someone through the physical and mood changes, while also preventing relapse. This process may last anywhere from three to seven days. Pharmaceutical support in the form of other synthetic opioid drugs, nutritional support, addressing any co-occurring mental disorders, as well as ongoing emotional support are an important part of any comprehensive treatment plan for china white addiction.

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