What is Fentanyl?

Fentanyl, one of the world’s first synthetic opioids, was approved by the FDA in the 1960s for pain management.^1-3 More than 50 years later, a different sort of fentanyl is making headlines.¹ Illicitly manufactured fentanyl (or illicit fentanyl), is believed to be the driving force behind the surge of drug overdose deaths across the US in recent years.⁴

There’s a Fine Line Between Feeling It and Fatal

Compared to other opioids, fentanyl is more potent — up to 50 times stronger than heroin.¹ Depending on a person’s body size, tolerance and past opioid use, just 2 mg of fentanyl (the amount shown below) can be deadly.⁴ More than 60% of all overdose deaths in the US are attributed to fentanyl, fentanyl derivatives and/or other synthetic opioids.⁵

Although some dealers sell straight fentanyl, others interlace it into other things, like cocaine or methamphetamines.^4,6 Fentanyl’s potency makes this risky, as dealers sometimes miscalculate how much fentanyl they can safely add.⁶ Because you can’t see, smell or taste fentanyl, most won’t know if they’re getting too much.¹

Counterfeit Pills = A Roll of the Dice

Some dealers use simple binding agents and small amounts of illicit fentanyl to make counterfeit pills that look just like real prescription medications (oxycodone, Xanax® and Adderall®, for example).^4,6 These are pervasive—the US DEA seized more than 20.4 million fake prescription pills in 2021 alone.⁷ Meanwhile, most dealers aren’t professional chemists, and they aren’t doing quality control tests.⁶ As a result, the DEA Laboratory found that an average 6 out of 10 fentanyl-laced fake prescription pills contained a potentially lethal dose of fentanyl in 2022 compared with an estimated 4 out of 10 in 2021.⁸

How to Identify and Respond to a Suspected Fentanyl Overdose

One of the most dangerous things about a fentanyl overdose is how quickly it can happen.¹¹ Here’s what one witness to a fentanyl overdose had to say about it:

Just 4 minutes without breathing can cause permanent brain damage.¹⁰ That’s why it’s so important to be ready to respond with an opioid overdose reversal medication.¹⁰ In an overdose emergency, acting quickly might just save someone’s life.¹⁰

What to Look For

So how can you tell if someone is experiencing a fentanyl overdose? The symptoms of fentanyl overdose include:^11,12

• No response to your voice or touch
• Slow breathing (less than 1 breath every 5 seconds)
• Small, “pinpoint” pupils
• Slow heartbeat
• Bluish lips, skin or fingernails
• Cold, clammy skin
• Stiffening of the body
• Seizure
• Confusion
• Slurred speech

Keep in mind that fentanyl overdose symptoms may vary, and not everyone who has a fentanyl overdose will develop all of the symptoms above.^11,12

What to Do

If you suspect fentanyl overdose, take action right away:¹¹

1. Give the person medicine to reverse the overdose (such as an opioid antagonist), if available.
2. Call 911.
3. Stay with the person and keep them comfortable until emergency medical help arrives.

Treatment as Prevention

The best way to prevent fatal opioid overdose may be by treating opioid use disorder (OUD).¹³ 5.6 million Americans live with OUD, and while medication-assisted treatment (MAT) has been shown to be an effective way to reduce the risk of overdose death, just 22% of them receive it.¹³ MAT, which combines counseling and medications, can help people with OUD to manage withdrawal symptoms, reduce cravings and maintain their recovery.¹⁴ While some of these medications are opioids, they have been specifically approved by the FDA to treat addiction.¹⁴

Some criticize the use of MAT, viewing it as “substituting one substance for another.”¹⁴ The science does not support this opinion, however.¹⁴ In fact, withholding MAT medications greatly increases the risk of relapse and death from opioid overdose.¹³ Studies clearly demonstrate that MAT leads to better treatment outcomes compared to behavioral therapy alone, and decades of research show that the benefits of MAT greatly outweigh the risks.¹⁴

Reach Out

If you are suffering with OUD, know that you are not alone. Resources that can help are just a few clicks away:

• The National Harm Reduction Coalition is a nationwide advocate and ally for people who use drugs.
• FindTreatment.gov is a confidential and anonymous resource for persons seeking treatment for mental and substance use disorders in the United States and its territories.

If you are in crisis or distress and need help right now, the services below are available to you 24 hours a day, seven days a week:

• 988 Suicide & Crisis Lifeline provides free and confidential support for people in distress—call or text 988.
• Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline provides treatment referral and information—call 1-800-662-HELP (4357)
• SAMHSA Disaster Distress Helpline provides immediate crisis counseling related to disasters—call 1-800-985-5990.

References

1. Fentanyl Facts. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/stopoverdose/fentanyl/index.html. Accessed June 13, 2023.
2. Stanley TH. The Fentanyl Story. J Pain. 2014;15(12):1215-1226.
3. Fentanyl DrugFacts. National Institute on Drug Abuse website. Available at: https://nida.nih.gov/publications/drugfacts/fentanyl. Accessed June 13, 2023.
4. Facts about Fentanyl. US Drug Enforcement Administration website. Available at: https://www.dea.gov/resources/facts-about-fentanyl. Accessed June 13, 2023.
5. Drug Overdose Death Rates. National Institute on Drug Abuse website. Available at: https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates. Accessed June 13, 2023.
6. If fentanyl is so deadly, why do drug dealers use it to lace illicit drugs? ABC News website. Available at: https://abcnews.go.com/Health/fentanyl-deadly-drug-dealers-lace-illicit-drugs/story?id=96827602. Accessed June 13, 2023.
7. DEA Laboratory Testing Reveals that 6 out of 10 Fentanyl-Laced Fake Prescription Pills Now Contain a Potentially Lethal Dose of Fentanyl. US DEA website. Available at: https://www.dea.gov/alert/dea-laboratory-testing-reveals-6-out-10-fentanyl-laced-fake-prescription-pills-now-contain. Accessed June 20, 2023.
8. One Pill Can Kill. US Drug Enforcement Administration website. Available at: https://www.dea.gov/onepill. June 13, 2023.
9. Somerville NJ et al. Characteristics of Fentanyl Overdose—Massachusetts, 2014-2016. MMWR. 2017;66(14):382-386.
10. Non-Fatal Opioid Overdose and Associated Health Outcomes: Final Summary Report. ASPE website. Available at: https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//190846/Nonfatal.pdf. Accessed June 18, 2023.
11. Fentanyl Overdose. Addiction Info for Rehab and Recovery website. Available at: https://addictioninfo.org/fentanyl-overdose/. Accessed June 13, 2023.
12. Detoxification and Substance Abuse Treatment. National Library of Medicine website. Available at: https://www.ncbi.nlm.nih.gov/books/NBK64116/#A85631. Accessed June 18, 2023.
13. Key Substance Use and Mental Health Indicators in the United States: Results from the 2021 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration website. Available at: https://www.samhsa.gov/data/sites/default/files/reports/rpt39443/2021NSDUHFFRRev010323.pdf. Accessed July 17, 2023.
14. US Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016. Available at: https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf. Accessed July 17, 2023.

XANAX® is a registered trademark of Pharmacia & Upjohn Company LLC.

Adderall® is a registered trademark of Teva Pharmaceuticals USA, Inc.

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