Gray death

Gray death is a slang term used for a potent mixture of synthetic opioids. Samples have been found to contain the designer drug U-47700, heroin, fentanyl, and carfentanil.[1] It is taken by injection, smoking, snorting, or oral ingestion.[2] It was first discovered in the United States and was thought to be a unique chemical compound before being identified as a mixture of drugs.[3]

In addition to containing powerful opioids, what makes gray death an extremely dangerous drug is the fact that the constituent drugs' identities, their overall ratios in the product, and their uneven distribution within the product are completely unknown to the user.[2] This means that the user cannot predict what dose to safely take; even two identical doses by mass may contain more or less of an unknown substance due to uneven physical distribution, as seen with heroin and fentanyl mixes. Opioid addicts tend to be more susceptible to the drug. They may think they are buying heroin, unaware that it is actually gray death.[4]

Reversing a gray death overdose frequently requires multiple doses of naloxone, whereas a typical overdose of heroin (which is much less potent) typically needs only one dose.[2] This is consistent with the difficulty of overdose reversal seen with high-affinity opioids in the fentanyl chemical family or with buprenorphine. The greater affinity of these substances for the μ-opioid receptor causes less naloxone to bind to receptors, increasing the dosage necessary to counteract the resulting respiratory depression. The difficulty in reversing an overdose of gray death is likely due to the presence of a fentanyl analogue, which reporting seems to corroborate as of December 2018.