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Fentanyl Overdose

12 Minutes

Edited & medically reviewed by THE BALANCE Team

Fact checked

CONTENTS

The notorious synthetic opioid, fentanyl, is commonly misused and abused. It is estimated to be 50 to 100 times more potent than morphine. Two milligrams is a lethal dose that is too small to be seen with the naked eye [1].

Fentanyl, tragically, is often unknowingly mixed into other drugs which makes it especially deadly to users, and a leading cause of surging overdose deaths around the world.

The world has not been able to wipe the grim stain left by the opioid crisis which has resulted in the loss of millions of lives and ruined countless families by addiction, and deaths due to overdoses. At the center of this crisis is fentanyl, a synthetic opioid that has risen rapidly to become one of the deadliest drugs on the street. First time developed for medical purposes as a pain reducer, fentanyl has turned into a driving force behind the unfathomable expansion in opioid overdose cases, essentially found in North America.

But fentanyl is different from, say, heroin or morphine, because it is far more potent. It was once used, in carefully monitored contexts, to treat extreme pain, especially in cancer patients, but illicitly manufactured fentanyl has become a major player in the illicit drug market.

Because the drug can be cheaply produced and is also extremely potent, drug traffickers are drawn to it; often, they mix it with something else, such as heroin or cocaine, but the unsuspecting user doesn’t know. One reason fentanyl is becoming increasingly implicated in overdose deaths is that its false form of purity allows for continued injection, according to the practice.

The overdose rates though have soared as fentanyl has infiltrated illegal drug supplies. Synthetic opioids such as fentanyl made up at least 70 percent of all opioid overdose deaths in 2022, making up a higher share than in earlier years, according to the Centers for Disease Control and Prevention (CDC) [2].

Because of the drug’s potency and the fact that fentanyl is unpredictably present in illicit drugs, fentanyl overdose can be an alarming public health threat, and people must understand the dangers and symptoms.

It is the chemical potency of fentanyl that distinguishes it from other opioids. Fentanyl is thought to be from 50 to 100 times more potent than morphine (and around 50 times stronger than heroin) [3]. That heightened potency also means that just tiny amounts can be deadly. In fact, according to the DEA, it only takes just two milligrams of fentanyl—an amount small enough to fit on the tip of a pencil—to kill most people [1].

Fentanyl does attach to the opioid receptors in the brain, which are the ones that determine pain and feelings. If the drug attaches itself to these receptors, in addition to easing the pain it creates feelings of euphoria. But it is the rapid effect fentanyl has on the body, specifically the respiratory system, which makes it so dangerous. Drug-induced respiratory depression, where a person’s breathing slows to the point where it stops, can also occur after taking only a small amount of the drug much faster than other opioids, without much time at all to get to emergency help.

Fentanyl is manufactured and utilized illegally, making the danger far more serious. In contrast to prescription fentanyl which has carefully measured doses, illicit fentanyl is produced – often in clandestine labs – with no quality control [2]. This lack of knowledge means that users have no idea how much fentanyl is in the drugs they are taking and are increasing the risk of accidental overdose. Many people who die from fentanyl overdoses don’t realize it — fentanyl is often mixed in with other substances.

If fentanyl is overdosed, it happens quickly and is primarily down to the way that it affects the central nervous system (CNS). Like other opioids, fentanyl slows down the CNS, the part of the body in charge of breathing, heart rate, and consciousness. Fentanyl, when it enters the body in high enough amounts, overwhelms the CNS and ultimately leads to respiratory depression, which is one of the major causes of death in overdose of fentanyl.

Symptoms from a fentanyl overdose can progress quickly. First, users might feel drowsy, confused, and dizzy, but these effects could worsen to bring more serious side effects. When fentanyl toxicity rises, individuals may become unconscious, breathe slower or stop, and lips and skin turn blue — indicative of oxygen levels in blood dangerously low. If naloxone is not given fairly quickly, death can happen in minutes.

And it’s the speed at which fentanyl causes respiratory depression that makes it so deadly. Since other opioids may take longer to induce an overdose, there is little time needed to react to an act of fentanyl overdose.

Perhaps the most shocking thing about fentanyl is that it only takes a little bit for a lethal overdose. For most people, roughly two milligrams of fentanyl is the lethal dose. That is such a small amount as that would be barely visible to the naked eye, and far less than what is commonly taken in would be a dose of heroin or other opioids. That is why fentanyl is such a source of so many more deaths from opioid overdose when compared to other powerful opioids.

The danger of fentanyl becomes even clearer when it’s compared to other opioids. If even trace amounts of fentanyl are mixed in, the ratio of that lethal heroin may vary but a dose the normal user would get away with without suffering fatal immediate consequences would become lethal.

The problem with fentanyl, furthermore, is that the difference between a euphoric dose and an overdose is so small, that there is almost no margin for error.

While the severity of fentanyl overdose is influenced by multiple things, none of them cancel out the fatal dose of this incredibly toxic drug. Opioid tolerance is one of the key factors. Because the body is used to the effects of the drug and long-term opioid users have a higher tolerance, their bodies may now need higher doses of the drug to sustain the same influence. But even for the most tolerant, fentanyl’s potency may be more than the body can handle [4].

Body mass is also involved as smaller body mass and underlying health conditions put one at a higher risk of overdose. As with all drugs, mixing fentanyl with other substances — especially depressants such as alcohol or benzodiazepines — greatly enhances your risk of a fatal overdose.

The change feels terrifying and disorienting to individuals who have overdosed on fentanyl. The early signs of a fentanyl overdose include being very sleepy, confused, or having trouble staying awake.

Users may also experience dizziness and even lightheadedness, which can follow swiftly into a more dire state as the overdose goes to work.

As the overdose progresses, the body eventually cannot even breathe. Respiratory depression occurs when a person feels the chest is overly heavy, shallow, and labored breathing or the feeling of struggling to breathe at all. Often, the body cannot take in enough oxygen and suffers a sense of panic or confusion.

However, some overdose victims will lose consciousness without warning and will not be able to seek help for themselves. For some, alertness will slowly wane, becoming slurred in their speech and impaired in their motor functions.

Near the end of a fentanyl overdose, the person may not respond, or may even stop breathing altogether. If the lack of oxygen is bad enough, the skin and lips may start to take on a bluish tint at this point called cyanosis. However, if it isn’t given in time and medical intervention (such as giving naloxone) isn’t given, the outcome can be fatal [4]. Those who do survive relive the physical sensations and near-death experiences of fentanyl overdose and can experience lifelong trauma.

These symptoms tend to come on much more quickly than with other opioids, and, because of the potency of fentanyl, those overdosing on fentanyl have fentanyl overdose symptoms that advance more rapidly, too. Because of this, recognizing the early warning signs and getting out life-saving treatment as fast as possible gains importance.

Fentanyl overdose death rates have spiked in recent years and now constitute staggering numbers in certain areas around the world, among them in the United States, Canada, and parts of Europe. More than 106,000 people died from drug overdoses in the U.S. in 2021, and fentanyl and other synthetic opioids were involved in a little more than 70% of those deaths, data from the CDC show [2]. This is an enormous uptick compared to a decade ago when fentanyl was not as large a part of the illicit drug market.

Not everyone dying from a fentanyl overdose is a seasoned opioid user. In reality, more and more first-time or occasional users are catching fentanyl in drugs. Often these people think they are taking heroin or cocaine or even prescription pills, and they don’t know that the drugs have been cut with fentanyl. The product is an increasingly deadly drug supply in which even casual use can be fatal.

Fentanyl overdose deaths have been especially concentrated in regions with high use rates of opioids. For example, some of the states with some of the highest overdose death rates in the country are states like Ohio, West Virginia, and Pennsylvania, where fentanyl is having such a profound impact in terms of having infested more and more of the drug supplies there. In addition, people with substance use disorder or barriers to accessing healthcare and marginalized groups are more at risk for a fentanyl overdose.

Public health authorities in many countries have reacted to fentanyl-related deaths by declaring the opioid crisis a national emergency, necessitating the need to raise awareness, provide wider access to treatments, and distribute life‐saving interventions such as Naloxone. But fentanyl overdose victims today are a diverse slice of the population — from experimenting young adults to chronic opioid users.

Fast, effective intervention is key to saving someone from a fentanyl overdose, and naloxone can and must be used to reverse the overdose. Naloxone, also known by the brand name Narcan, is an opioid antagonist, which means that it blocks the same opioid receptors in the brain that fentanyl does from attaching to them which reverses the effects of the drug [2]. This is a lifesaving tool that can quickly return normal breathing and consciousness to people suffering from an opioid overdose.

Time is critical after someone overdoses on fentanyl. Fentanyl is so potent and the symptoms come on so fast that people can lose consciousness and stop breathing in minutes. If you suspect a fentanyl overdose, the first thing to do is to call emergency services straight away. Waiting for help and administering naloxone as soon as possible can make up the difference between life and death. Naloxone is becoming more common with fewer restrictions such as prescription, while overdoses rise across the nation — and naloxone can be given through a nasal spray or injection.

Sometimes, just one dose of naloxone doesn’t work, because the effects of fentanyl last longer than the effects of naloxone. That also indicates that only after naloxone administration, the individual may require many doses to turn the overdose. In certain cases, particularly after large amounts of fentanyl or after a prolonged exposure, the effects of the drug can be prolonged and the person falls back into overdose when the effects of the first naloxone dose wear off. This is why it’s so important to stay under medical supervision until the drug has cleared from their system.

Emergency services are also known to provide other critical care, apart from naloxone, during a fentanyl overdose. This can mean offering oxygen, using ventilators if someone can’t breathe on his own, giving IV fluids in emergencies to stabilize the person’s condition, check heart rate and oxygen levels. In very extreme circumstances, the body may require intubation, or the insertion of a breathing tube, to make sure it gets enough oxygen until the drug is out of circulation.

Naloxone is lifesaving, but it doesn’t cure the problem and timing is important. A fentanyl overdose can be fatal, or a person can be at risk for severe brain damage from lack of oxygen depending on the amount and duration of an uncontested overdose. Unfortunate, however, is that most treatments and overdoses occur while the patient is alone or in instances where help arrives too slowly.

It’s particularly hard for those who survive a fentanyl overdose to recover – physically and mentally. Fentanyl can have long-lasting effects based on the type of fentanyl so how long oxygen deprivation could affect a fentanyl user? Both overdoses of this product can result in hypoxia (lack of oxygen to the brain) and lead to brain damage including permanent brain damage, damage to memory, motor skills, cognitive function, etc. For some, it can even lead to chronic pain, other health complications, or serious long-term respiratory complications. Surviving a fentanyl overdose is quite psychologically traumatic. Many people suffer afterward with a sense of shame, guilt, and even fear of dying as a result of the overdose, understandably this was not likely done deliberately. But this physical toll of the overdose and these emotions can also lead to anxiety, depression, and even post-traumatic stress disorder (PTSD). In some cases, survivors may fall into opioid dependence and develop long-standing cravings and withdrawal symptoms or have a fear of taking opioids again.

Fentanyl overdose recovery is most often a lifelong support from medical professionals, therapy, as well as rehabilitation. Healthcare programs for people who have opioid use disorder must combine medical care with counseling and behavioral therapies. Medication for opioid dependence and the reduction in risk of future overdose are generally methadone and buprenorphine medications, which stabilize brain chemistry, reduce cravings, and revert withdrawal symptoms so that the person can dedicate recovered time to get back to things and also assign the right importance to remedial exercises for whatever is to be redeemed of psychological variables associated with mania.

For example, many people use cognitive behavioral therapy (CBT) to recognize, and change, any drug-use thoughts and behaviors that aren’t helpful. Long-term recovery is up to the community and that recovery group has an incredible amount of wisdom, for example in Narcotics Anonymous, and support and help you get from family and friends in recovering. They are the ones who most often have to rely on loved ones for encouragement and understanding of recovery. They will also seek educational programs and counseling for the families to educate them on how to support their beloved without helping make matters worse in their lives.

Recovery is tough but possible with a good cocktail of medical treatment, psychological help, and a solid network of friends and family behind you. People need access to the resources and support to prevent future overdoses, and on some levels, it does require continued care and attention, which is why I’m so signaling supportive of decriminalization because it gets us to an area where we can do much better at than what we are doing today.

Opioid use and fentanyl overdose prevention is a priority and harm reduction strategies are an important means of reducing the risk of opioid use. Harm reduction approaches seek to diminish the negative health results of drug use, but doing so by providing individuals with safety tools and by providing education.

For folks to prevent fentanyl overdoses, testing strips for fentanyl is one of the more effective harm reduction tools available to them. These strips allow users to test their drugs for fentanyl to find a few bad decisions away from death by the synthetic opioid. Testing strips are already being distributed widely in the country’s hotspots of opioid crisis, and they are easy to use. As a result, users are better informed about whether or not fentanyl is present in a substance and are thereby better able to make better-informed decisions about whether or not to use a drug, or about how much of a drug to use if they decide to do so.

The government sees an opportunity to save lives — buoyed by public health campaigns with a steady stream of news reminding people of the dangers of fentanyl and knowing how to respond to an overdose. More and more communities have begun programs that arm at-risk patients and their families and even bystanders with naloxone. But they also teach them how to administer naloxone and recognize the signs of an overdose — more people prepared to be lifesavers in an emergency.

Healthcare providers prevent fentanyl overdoses. Both of them are doctors and pharmacists right on the front lines of the opioid crisis, and they know how to help educate patients when it comes to fentanyl or tell someone where to go, and here to talk to someone if they want to use a safer drug. By changing policy that provides financing for harm reduction services, increasing access to addiction treatment, and regulating the prescription of opioids, they also can control the surge of fentanyl-related deaths. Any solution to the fentanyl overdose crisis will have to be a two-pronged approach to preventing overdoses and treating addicts. What all of us can do is expand access to fentanyl test strips and naloxone, educate the public about what fentanyl is and how dangerous it is, and give people what they need to recover from addiction.

1. United States Drug Reinforcement Administration. Facts About Fentanyl. https://www.dea.gov/resources/facts-about-fentanyl

2. Centers For Disease Control And Prevention. Fentanyl. https://www.cdc.gov/overdose-prevention/about/fentanyl.html

3. Yale Medicine. Why Is Fentanyl Driving Overdose Deaths? https://www.yalemedicine.org/news/fentanyl-driving-overdoses

4. World Health Organization. Opioid overdose. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose

FAQs

Can Fentanyl Be Absorbed From The Skin Or Inhaled Accidentally?

Fentanyl is absorbed through the skin or accidentally inhaled and is therefore a danger to drug users and first responders, particularly when in powdered form. Unlike skin absorption, which more often relies on long-term exposure to large amounts, powdered fentanyl is airborne, so accidental inhalation is a possibility. When fentanyl comes into contact with your skin or it is accidentally swallowed — or if you are a first responder or someone handling fentanyl, wearing protective gloves and masks will help prevent intentional fentanyl exposure.

How Long Does Fentanyl Stay In Your System After Taking It?

How long fentanyl stays in your body depends on how often you take it and your dosage and also how quickly your body metabolizes fentanyl. Blood tends to retain fentanyl for up to 12 hours and urine for up to 1 to 3 days following use. However, the detection window of such a drug can stretch when it is used long-term or in high doses.
Fentanyl is also known to build up in fatty tissues which slows its excretion from the body. The onset and duration of their effects are rapid and short respectively, and does not necessarily reflect the length of time they remain detectable in bodily fluids.

Is There A Difference Between Prescription And Illicit Fentanyl?

Prescription fentanyl is produced in controlled pharmaceutical settings, so its potency and dosage are monitored for medical use (pain relief for cancer patients, etc.) in prescribed situations. The problem with illicit fentanyl, however, is that it’s manufactured in unregulated, clandestine labs.
It’s much more dangerous, however as the dosing is inconsistent, and it’s often mixed with other drugs increasing the chance of overdose. Fentanyl that is illicit is also more likely to be sold in counterfeit pills or mixed with street drugs without the customer’s knowledge.

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Fentanyl Overdose

FAQs

Can Fentanyl Be Absorbed From The Skin Or Inhaled Accidentally?

How Long Does Fentanyl Stay In Your System After Taking It?

Is There A Difference Between Prescription And Illicit Fentanyl?

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Fentanyl Overdose