Fentanyl is a powerful synthetic opioid pain reliever, estimated to be approximately 100 times more potent than morphine and 50 times stronger than heroin. While pharmaceutical fentanyl plays a crucial role in managing severe pain under strict medical supervision, especially post-surgery and for cancer patients, the emergence of illegally manufactured fentanyl has triggered a severe public health crisis, marked by a dramatic surge in overdose deaths.
What is Fentanyl? Pharmaceutical vs. Illicit Fentanyl
There are two primary forms of fentanyl: pharmaceutical fentanyl and illegally made fentanyl.
Pharmaceutical fentanyl is an FDA-approved medication classified as a Schedule II controlled substance by the DEA. It is primarily used in clinical settings as an anesthetic and for managing intense pain, often in patients already on other strong pain medications and under close medical observation to prevent misuse. Despite its therapeutic applications, pharmaceutical fentanyl carries the risk of significant respiratory issues and even death if not carefully managed.
Illegally made fentanyl, conversely, is the major driver of the current overdose epidemic. This type of fentanyl is often produced as a fine powder and pressed into counterfeit pills that mimic legitimate prescription drugs. Alarmingly, it is frequently mixed with other illicit substances like heroin and cocaine to amplify their effects. Unsuspecting users may consume these fentanyl-laced drugs without knowing their presence, drastically increasing the risk of accidental overdose.
According to Amanda N. Donald, MD, an addiction medicine physician at Northwestern Medicine, “In health care, we dose fentanyl in micrograms. 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.” This stark difference in dosage control between medical and illicit fentanyl underscores the extreme danger posed by street drugs.
What Makes Fentanyl So Dangerous? Lethal Dose and Potency
The potency of fentanyl is a critical factor in its danger. A mere 2 milligrams of fentanyl, an amount that can fit on the tip of a pen, can be lethal for some individuals, depending on factors like body size, tolerance, and prior drug use. Disturbingly, the DEA has discovered counterfeit pills containing up to 5.1 milligrams of fentanyl, more than double a potentially lethal dose, highlighting the unpredictable and deadly nature of these illicit products.
Data from the CDC shows a staggering increase in overdose deaths involving synthetic opioids like fentanyl. In 2021, the rate was nearly 22 times higher than in 2013. In 2022, fentanyl was implicated in approximately 70% of the 110,000 drug overdose deaths in the U.S., underscoring its central role in the ongoing public health crisis.
What are the Signs of a Fentanyl Overdose? Recognizing the Symptoms
Recognizing the signs of a fentanyl overdose is crucial for timely intervention. Key indicators of an opioid overdose include:
- Coma: Unresponsiveness or inability to be awakened.
- Pinpoint Pupils: Constricted pupils, appearing very small.
- Slow or Difficult Breathing: Shallow, irregular, or stopped breathing.
Other overdose symptoms may include:
- Falling asleep or loss of consciousness.
- Choking or gurgling sounds, indicating blocked airways.
- Limp body, lacking muscle tone.
- Changes in skin color: Bluish-purple in fair-skinned individuals, or gray/ashen in those with darker skin tones, along with cold skin.
What to Do if You Suspect a Fentanyl Overdose? Actionable Steps
If you suspect someone is overdosing on fentanyl, immediate action is critical. The CDC recommends these life-saving steps:
- Call 911 immediately. Emergency medical services are essential.
- Administer naloxone if available. Naloxone (NARCAN®) is an overdose-reversing medication, available as a nasal spray or injection. It is obtainable over-the-counter at pharmacies without needing a prescription or prior training.
- Attempt to keep the person awake and breathing.
- Position the person on their side to prevent choking if they vomit.
- If naloxone was administered, wait three minutes. If there’s no response and emergency services haven’t arrived, administer a second dose if available.
- Stay with the person until emergency responders arrive.
Even after naloxone is administered, immediate medical attention is necessary for supportive care and to ensure the overdose is fully resolved. Naloxone may also induce withdrawal symptoms in some individuals.
What About Fentanyl Testing? Prevention and Harm Reduction
For individuals struggling with substance use, particularly those using illicit drugs, fentanyl test strips are a valuable harm reduction tool. These inexpensive paper strips can detect the presence of fentanyl in various substances, enabling users to make informed decisions and potentially prevent accidental overdoses.
Dr. Donald emphasizes, “Fentanyl is in the supply of many drugs on the street. 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.”
For those seeking help with opioid use disorder, resources are available. The Illinois Helpline (for Illinois residents) at 833.234.6343 or text “HELP” to 833234, and the SAMHSA National Helpline at 800.662.HELP (nationwide) offer support and guidance for medication-assisted recovery and treatment options.
