Estimated reading time: 27 minute(s)
Fentanyl is a popular medication that belongs to the category of opioid painkillers. With up to 50 times more potency than that heroin, this condensed opioid drug can provide immediate and effective pain relief to make users comfortable. The use of fentanyl has become a lot more common in recent years because it is easy to manufacture, and even a small dose of this drug can go a long way in pain management.
In addition to being used as a prescription medication, many individuals across the United States continue to use it without their knowledge, as they do not realize that the product they are using has fentanyl in it. At the same time, many keep abusing it on purpose because of its potency, making it one of the most common opioids responsible for the ongoing overdose crisis in the U.S.
Beginning in 2012, America has seen a sharp spike in the cases of overdose deaths related to the use of manmade opioids. These deaths, particularly associated with fentanyl overdose have also increased four-fold in recent years, making it extremely risky to use. These alarming statistics make it vital to educate yourself about fentanyl overdose, its symptoms, and how to manage it.
Fentanyl Fast Facts
- As a synthetic opioid, Fentanyl has been in use in various clinical settings for years because it is 50 times more potent than heroin and up to 100 times stronger than morphine.
- Combined with a lack of resources and criminalization of people using drugs, fentanyl is partially responsible for contributing to the current overdose crisis in the United States.
- In the illegal drug market, fentanyl is available as a white, tan, or gray powder that users can snort, smoke, or inject in their veins. It also comes mixed with other drugs, such as cocaine, meth, and heroin.
- Contrary to the widespread belief, fentanyl and all of its analogs can never be resistant to naloxone. Regardless of the variety a person is using, these drugs will respond to naloxone during an overdose case.
- The Centers for Disease Control and Prevention reported that fentanyl overdose led to 71238 deaths in 2021. Most of these deaths were triggered by non-pharmaceutical fentanyl
What Happens When You Overdose on Fentanyl?
Fentanyl is an opioid drug that acts as a depressant of the central nervous system. When someone consumes this drug in high doses, it may lead to physical side effects. Some of these most common fentanyl overdose symptoms include the following:
- Slow or abnormal heartbeat
- Constricted pupils
- Slow breathing (less than 1 breath every 5 seconds)
- Cold, clammy skin
- Foaming from mouth
- Bluish hue in lips, skin, or fingernails
- Stiffening of the body
- Loss of consciousness
Remember, those fentanyl overdose symptoms are likely to differ from one person to another. Not everyone who overdoses on this drug will develop all of these symptoms in a specific pattern.
Fentanyl Overdose Causes & Risk Factors
A fentanyl overdose, also known as opioid toxicity, can lead to severe adverse impacts on the body and potentially fatal symptoms arising after taking this medication in very high doses. There can be multiple reasons why a person experiences an overdose of this drug. For instance, many people continue consuming fentanyl without knowing it, such as when it is secretly mixed with other substances they might be using. Other risk factors for experiencing a fentanyl overdose include the following:
- Mixing fentanyl with other illicit substances, such as benzodiazepines, alcohol, cocaine, and methamphetamine
- A positive history of a fentanyl overdose in the past
- Consuming fentanyl after a short period of abstinence
- Giving a low or no tolerance to opioid use
- Not taking fentanyl as prescribed, such as taking it in higher doses or using it more frequently than needed.
- Combining fentanyl use with a certain prescribed drug, including prescription opioids
- Purchasing and using illicitly manufactured fentanyl
- Using a substance that may have fentanyl alone
Fentanyl Poisoning: How to Respond to an Overdose
If you suspect that someone around you has overdosed on fentanyl, keep the following points in mind to help them remain safe until professional help arrives:
- Assess for signs of overdose: Check if the person is breathing or showing any signs of response. Try talking to them to check if they can speak.
- If the person is unconscious or confused: Try to wake them up by calling their name. You may also consider using phrases like, “I am going to give you some naloxone” or “I am calling 911.” If these phrases do not get them to respond, try to stimulate them by using your knuckles to rub on their sternum.
- If the person is not responding: Get in touch with 911 at once and let them know that the person has stopped breathing or is breathing abnormally slow. Do not forget to provide them with your exact location so that help can arrive as soon as possible.
- Administer naloxone: If you are sure that the person with you has used fentanyl or something contaminated with fentanyl, you may consider giving them some naloxone. The medication may take up to 3 minutes to exert its effects and may prove life-saving.
- If breathing stops or becomes abnormally slow: If you notice that the person is breathing very slowly or has stopped breathing completely, place them at their back and tilt the head backward with their chin up. This position will help them maintain their airway without any blockage from the tongue. Next, give two slow breaths into their lungs and ensure that their chest rises with each breath you give. Continue providing one breath after every 5 seconds.
- Repeat Naloxone: Keep in mind that a single dose of Naloxone may produce effects for up to 90 minutes, whereas the effects of fentanyl may persist for hours. So even after giving naloxone, the victim may start showing signs of an overdose after an hour or so. Hence, make sure you have 911 on the way and more naloxone in hand to repeat as needed.
Preventing Fentanyl Overdose: What to Keep in Mind
If you have been using fentanyl medically or non-medically, it is crucial to be mindful of preventing overdosing.  For this purpose, keep the following tips in mind:
- Always use fentanyl strips before using any drug to check if it has any traces of fentanyl in it.
- Decrease the amount of drug you consume at one time, especially if you have had an overdose incident in the past or have not used any drug for a long time
- Most fatal overdoses occur because of using more than one drug at a time. So make sure you use fentanyl alone and do not combine it with other substances, including alcohol.
- Try not to use fentanyl alone. Always have someone with you who you can trust and who is familiar with what to do in an emergency. If you have no option but to use fentanyl alone, be extra cautious.
- Injecting fentanyl is much more likely to trigger an overdose, so try to shift your consumption method to smoking or snorting the powder. However, keep in mind that even these methods can lead to an overdose, so you have to be careful either way.
- Always listen to your body and take care of it by eating well, hydrating yourself, and resting as much as possible. A healthy body is at a lower risk of overdosing on any drug.
- Fentanyl has a rapid mechanism of action and may produce different effects for different people depending on their drug tolerance and the dose they consume. Be wary of this fact and use fentanyl very carefully.
Practicing Extra Caution With Fentanyl Patches: Avoiding An Overdose
If you are using a fentanyl patch as prescribed, take the following precautions to minimize the risk of an overdose:
Avoid exposing yourself to heat.
Keep in mind that heat can increase the rate at which fentanyl from your patch enters your bloodstream, increasing the risk of an overdose. Hence, do not use a patch using a heating pad, a tanning lamp, a heated bed, or a sauna. Long hot showers and sunbathing are also not safe for similar reasons.
Don’t handle the patch from its sticky side.
Fentanyl can quickly absorb through the tissues of the mouth and eyes, so make sure to handle the patch correctly. If you touch the sticky side, you may carry the product on your fingers from where it can transfer to your mouth or eyes. If you come in contact with the sticky part of the patch, let a nurse know and wash the affected area with plenty of water.
Be aware of personal contact with others.
Your fentanyl patch can become dangerous for anyone who comes in contact with it while hugging or while helping you replace it and add a new one. If someone else does touch it, they must wash the affected area with a generous amount of water.
What do you mean by fentanyl analogs?
Fentanyl analogs refer to illicit drugs with structures similar to fentanyl but not identical to it. These include furanyl fentanyl, U-47700, carfentanil, and acetyl fentanyl. These fentanyl analogs are not easily identified, requiring special toxicology detection tests. Some of these analogs are weaker than Fentanyl, while others are much more potent. Carfentanil is the most robust analog, with up to 10,000 times higher potency than that morphine.
What makes fentanyl so dangerous?
Because of its very high potency, even a tiny amount of Fentanyl can quickly become dangerous, even deadly. Experts believe that even two milligrams of it can lead to overdose or even death. Additionally, because the drug has no smell or taste, it is nearly impossible to know if a drug you are using has been laced with fentanyl or not.
What does fentanyl look like?
Fentanyl typically comes in two forms: liquid and powder. In liquid form, fentanyl serves as a replacement for heroin. It is also a part of some eye drops and nasal sprays in addition to being added to small candies and paper. Powdered fentanyl, on the other hand, is often available as pressed pills that may look exactly like prescription medications, such as Xanax and Percocet.
How much fentanyl does it take to overdose?
The amount of fentanyl a person needs to experience fentanyl toxicity and overdose is not fixed. It varies depending on different factors, such as the user’s body weight, tolerance, past history of fentanyl use, etc. Given its high potency, even a tiny about of fentanyl may lead to an overdose in most people.
1 NIDA. 2021, June 1. Fentanyl DrugFacts. Retrieved from https://nida.nih.gov/publications/drugfacts/fentanyl on 2023, January 16
2 Walter K. Fentanyl Overdose. JAMA. 2023;329(2):184. doi:10.1001/jama.2022.22462