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Fentanyl: What You Should Know

How To Identify a Potential Fentanyl Overdose and What to Do

Fentanyl is estimated to be about 100 times more potent than morphine and 50 times more potent than heroin as a pain reliever. It is an effective medication for managing severe pain when properly prescribed and monitored by a clinician. However, the rise of illegally manufactured fentanyl has created a devastating public health crisis.

Overdose deaths have increased dramatically in recent years due to this powerful drug.

Types of Fentanyl

Fentanyl is a synthetic opioid. There are two types.

  • Pharmaceutical fentanyl is FDA-approved and used as an anesthetic during surgeries as well as to treat severe pain, especially following surgery and for cancer pain. It is a Schedule II controlled substance according to the United States Drug Enforcement Administration (DEA). Patients prescribed fentanyl for severe pain are typically also being treated with other narcotic medications and monitored by their clinician for potential drug misuse. It may cause serious breathing problems or death.
  • Illegally made fentanyl often takes the form of a fine-grain powder pressed into counterfeit pills to make them look pharmaceutical. It is often mixed with other illicit drugs, such as heroin or cocaine, to increase their potency. The people who use those drugs may or may not be aware they contain fentanyl, which can lead to a much higher risk of overdose.

"In health care, we dose fentanyl in micrograms," explains Amanda N. Donald, MD, an addiction medicine physician at Northwestern Medicine. "There is no way to know what doses are going around on the street. To patients with a substance use disorder, fentanyl is what has dramatically increased the risk of not just overdose, but also the risk of severe and prolonged withdrawal."

"In health care, we dose fentanyl in micrograms," explains Amanda N. Donald, MD, an addiction medicine physician at Northwestern Medicine. "There is no way to know what doses are going around on the street. To patients with a substance use disorder, fentanyl is what has dramatically increased the risk of not just overdose, but also the risk of severe and prolonged withdrawal."

Lethal Dose of Fentanyl

Depending on a person’s size, tolerance and history of drug use, 2 milligrams of fentanyl can be deadly. The DEA has found counterfeit pills with fentanyl content up to 5.1 milligrams per tablet: more than double the lethal dose.

The rate of drug overdose deaths involving synthetic opioids in 2021 was nearly 22 times the rate in 2013, according to the U.S. Centers for Disease Control and Prevention (CDC). Of the 110,000 deaths in the U.S. from a drug overdose in 2022, nearly 70% were caused by fentanyl, leading to a public health crisis.

How to Tell If Someone Has Overdosed on Fentanyl

Key signs of an opioid overdose include coma, pinpoint pupils, and slow or difficult breathing. Other signs include:

  • Falling asleep or loss of consciousness
  • Choking or gurgling sounds
  • Limp body`
  • Bluish-purple skin (in people with light skin), gray or ashen skin (in people with dark skin), or cold skin

What to Do If You Think Someone Has Overdosed

Naloxone is a life-saving medication that can reverse an overdose from opioids. Naloxone comes as a nasal spray (called NARCAN®) or injection. You can buy naloxone over the counter from a local pharmacy, and you do not need training or authorization to use it.

If you suspect someone is experiencing an overdose, the CDC recommends following the steps below. If you are not sure, follow these steps anyway. It could save a life.

  1. Call 911.
  2. Administer naloxone, if you have it.
  3. Try to keep the person awake and breathing.
  4. Lay the person on their side to prevent choking.
  5. If you used naloxone, wait three minutes for the person to respond. If they don’t respond within this time and if emergency services haven’t arrived, open a second package if you have it to give the person another dose.
  6. Stay with the person until emergency services arrive.

The person should receive immediate medical attention for supportive care and to ensure the emergency has ended. Naloxone can also sometimes trigger withdrawal symptoms.

Testing Substances for Fentanyl

In addition to receiving treatment for a substance use disorder, people who use illegal drugs can help prevent overdoses by using fentanyl test strips. These are low-cost paper strips that can detect fentanyl in all kinds and forms of substances.

"Fentanyl is in the supply of many drugs on the street," explains Dr. Donald. "It took time to create this opioid epidemic, and it is taking time as we learn how to best combat it. There is hope, and there is treatment that works, is safe and is effective."

If you or someone you know has an opioid use disorder — a medical condition involving problematic opioid use — visit the Illinois Helpline, a government-funded resource for finding medication-assisted recovery support. Call 833.234.6343 or text “HELP” to 833234. Outside of Illinois, call the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800.662.HELP.