Fentanyl is a synthetic opioid in the same class of drugs as very powerful painkillers like heroin, methadone, morphine, OxyContin, Vicodin, Lortab, Dilaudid, etc.1,2 Fentanyl is extremely potent and considered to be nearly 100 times more potent than morphine and 50 times more potent than heroin.2
Injections of fentanyl are typically administered to patients in hospitals and other medical environments to manage chronic pain in those with cancer or other debilitating diseases as well as moderate to severe pain during and after surgery.3,4 Fentanyl may also be prescribed to patients for self-administration as “lollipops” (Actiq), effervescent tablets (Fentora), tablets that dissolve beneath the tongue (Abstral), sublingual spray (Subsys), nasal spray (Lazanda) and transdermal patches (Duragesic).4
Dangers of Fentanyl Use
Fentanyl should be used under the active supervision of a physician and according to its prescribed purposes. Even when used as directed by a doctor, there are risks with using this potent medication, including life-threatening allergic reaction and respiratory depression.5
Mixing fentanyl with other medications that depress the central nervous system can also be life-threatening.5 Physicians should be made aware of all the medications a patient currently takes prior to prescribing fentanyl.
Dangers Associated with Fentanyl Misuse
Misuse of a drug occurs when a person uses a drug in a manner that is inconsistent with its prescribed instructions. Misuse can occur in both individuals who have a prescription for the drug or those who do not have a prescription. Addiction is characterized by chronic substance misuse that results in significant problems for the person, including problems with physical or mental health, in everyday functioning, and those that cause significant distress and/or impairment.6
One of the major risks associated with the misuse or abuse of fentanyl is the potential to overdose on the drug.7 Fentanyl is an extremely potent drug and individuals can overdose on relatively small amounts of the drug.
In 2016, 19,413 Americans died from drug poisoning deaths involving synthetic opioids (mainly fentanyl)—an increase of 110% from 2015. Overdose deaths involving fentanyl increased nearly 47% from 2016 to 2017.7,8
These overdose deaths are rising alongside fentanyl’s increasing prevalence. In their 2018 drug threat assessment, the Drug Enforcement Administration points out that fentanyl’s availability is widespread and increasing, while also becoming more geographically diverse.9 They also report that fentanyl-related substances (synthetic opioids that are similar in chemical structure to fentanyl) are also becoming available—and the potency of these new substances as well as what constitutes a lethal dosage are frequently unknown.9
This, as well as the increasing prevalence of fentanyl-laced heroin, creates a dangerous situation when people are injecting fentanyl and they think it is some other drug, such as heroin, or they are injecting heroin that is laced with fentanyl.9
The signs and symptoms that occur as a result of acute intoxication and overdose on fentanyl and/or other opioids include:10,11
- Marked problems with walking, balance, and significant issues with coordinating one’s movements.
- Slurred speech, irrational behaviors, and potential violence and aggressiveness.
- Pinpoint eye pupils.
- A bluish or purplish color to the lips, hands, fingernails, toenails, or feet.
- Extreme lethargy, drowsiness, and sedation.
- Slow, shallow breathing.
- An extreme increase in heart rate and blood pressure.
- A loss of consciousness.
The fatal effects of an overdose on fentanyl result from the opioid’s ability to shut down areas of the brain that control automatic functions, such as breathing.1 Fentanyl overdose is treated with the drug Narcan (naloxone), which reverses the effect of opioids, however multiple doses may need to be administered given fentanyl’s potency relative to other opioids.10
If a person is suspected of overdosing on fentanyl or any opioid, it’s important to immediately call 9-1-1 and request emergency medical personnel.12 If naloxone is available, it should be administered as soon as possible.12 If the person is not unconscious, try to keep them awake and breathing.12 It is advisable to lay the person on their side to prevent choking and stay with him or her until professional help arrives.12
- National Institute on Drug Abuse. (2019). DrugFacts: Fentanyl.
- Drug Enforcement Administration. (2017). Drugs of Abuse: Fentanyl.
- National Institute on Drug Abuse. (2016). Fentanyl.
- Diversion Control Division. Drug Enforcement Administration. (2018). Fentanyl.
- Food and Drug Administration. (2019). Drug Label: Duragesic.
- American Society of Addiction Medicine. (2015). The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
- DEA Intelligence Brief. (2018). Fentanyl Remains the Most Significant Synthetic Opioid Threat and Poses the Greatest Threat to the Opioid User Market in the United States.
- Centers for Disease Control and Prevention. (2019). Opioid Basics: Fentanyl.
- Drug Enforcement Administration. (2018). 2018 National Drug Threat Assessment
- Centers for Disease Control and Prevention. (2019). Opioid Overdose: Fentanyl.
- Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
- Centers for Disease Control and Prevention. (n.d.). Preventing an Opioid Overdose.