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Fentanyl Poisoning

8 Minutes

Edited & medically reviewed by THE BALANCE Team

Fact checked

CONTENTS

Fentanyl poisoning is a rapidly emerging crisis due to the drug’s potency—up to 100 times the strength of morphine. Even just two milligrams can be fatal, and that’s just the size of a few grains of salt, especially if it’s unknowingly consumed in counterfeit pills or other items. Synthetic opioids like fentanyl accounted for more than 70,000 overdose deaths in the U.S. alone in 2022. This indicates an alarming situation that needs prompt action before the problem escalates.

Fentanyl poisoning happens when a person snorts or breathes in too much fentanyl, and can be extremely dangerous for a person’s health. Fentanyl is an opioid that was originally synthesized in the 1960s as a powerful analgesic (pain killer) and at approximately 50 to 100 times the strength of morphine [1].

It is used widely in medical situations where a patient experiences severe pain after a procedure or in patients with chronic debilitating pain as in cancer patients who are now tolerant to other opioids. Fentanyl works by targeting opioid receptors in the brain that are part of the body’s pain-controlling system. This mechanism alleviates pain and also creates a euphoric or pleasurable sensation. Due to the high potency of fentanyl, it has a huge potential to reap deadly consequences even with the smallest adjustments in dosage: way above and beyond what would be considered safe consumption.

A high dose of pharmaceutical fentanyl, a controlled and medically prescribed drug, is deadly in its own right; illicitly manufactured fentanyl is an even larger concern. Most often this illegal form is mixed with heroin, cocaine, or bogus pills, without the user’s knowledge, which greatly increases the potential for poisoning and fatal overdoses. Synthetic opioids, like fentanyl, are now the leading cause of overdose deaths in the U.S., according to the U.S. Centers for Disease Control and Prevention, which reported 70,891 preventable deaths from overdose in 2022; 5% up from 67,325 the year prior [2].

Accidental or intentional ingestion of fentanyl can result in poisoning. Fentanyl is usually taken accidentally because a person unknowingly consumes fentanyl-dosed substances. In cases when it is intentionally ingested the person knows that fentanyl is incredibly powerful and they are still hunting for this potency. In either case, the outcome can be fatal, with the person becoming unconscious until their respiration stops and they pass away if the incident is not remedied quickly enough.

The symptoms of fentanyl poisoning depend on the dose and how individual body systems and metabolic machinery respond to a certain dose of fentanyl. In the early stages, these signs can resemble signs of other opioid overdoses and are challenging for nonmedical persons to determine what type of drug caused them.

The following are key symptoms that indicate potential fentanyl poisoning:

Early Symptoms

Early signs include tiredness, feeling dizzy, being confused, and feeling sick. Initially, many affected individuals may show behaviors including slurred speech; uncoordinated movement; or chronic and non-specific fatigue [1]. These symptoms develop rapidly, and because fentanyl is so potent, even a few minutes can make a real difference to a person’s health.

Physical Symptoms

Fentanyl poisoning is usually accompanied by physical symptoms of constricted pupils, slowed breathing (respiratory depression), and pale or clammy skin. How your symptoms differ depends on things like how long you’ve been on opioids, if you have other drugs in your system, and the dose of fentanyl [3].

One of the most dangerous signs is respiratory distress; when oxygen levels in the bloodstream start to drop quickly, it can lead to brain damage if it isn’t treated swiftly.

Behavioral Symptoms

Sometimes, friends or bystanders will notice behavioral signs such as lethargy, sudden confusion, or an inability to respond to verbal cues. In the most severe cases, affected people will fall unconscious, or slow to a state seemingly resembling a deep sleep, during which they are unresponsive to noise or touch.

It’s important to recognize the signs of fentanyl poisoning at the first chance because fentanyl is so potent that it can cause life-threatening symptoms in a short period. Knowing these indicators is important for bystanders, friends, family members, or any others who may be in a position to help — the difference between life and death.

How Should One Identify Critical Signs In Emergencies

The most urgent symptoms of fentanyl poisoning include slowed or labored breathing, extremely small pupils, and extreme sedation. People who have consumed or inhaled fentanyl can appear to be in a deep unresponsive sleep and will not wake up even after being shouted at or shaken.

Also, other telltale signs include blue-tinged lips and fingernails—evidence of severe lack of oxygen due to failed breathing [3]. Intervention is required if somebody cannot breathe or has become unconscious straight away.

Case Example: Symptoms Recognition In Real Scenarios

Imagine a young adult who unknowingly took a fentanyl-laced pill. Within minutes, they appear extremely drowsy, then unresponsive and start breathing in a noticeable drowsy manner. Friends quickly called emergency services recognizing abnormal signs, that fit with opioid toxicity, and likely saved his life. For non-medical people, such cases can be a literal lifesaver.

Knowing how fentanyl poisoning progresses differently compared to other opioids and narcotics may help you not only in recognizing it but also in dealing with it as soon as possible. At any time when you believe you are suffering from fentanyl poisoning, it is important to act quickly and contact emergency services.

Severe and sometimes irreversible health risks are associated with fentanyl poisoning. The effects are highly acute and sometimes dangerous in the short term, and in some cases can continue long term, particularly if you had prolonged oxygen deprivation.

Short-Term Health Impacts

Respiratory depression is the primary risk of fentanyl poisoning at first hand. Respiratory failure occurs when breathing stops, or slows to such a slow rate, that there isn’t enough oxygen taken into the body, therefore the brain and the other vital organs are in danger. A lack of oxygen for too long can cause brain damage even in minutes [3]. Fentanyl overdose symptoms also often result in cardiac arrhythmias; disturbing the normal rhythm of the heart and in some cases, total heart failure from lack of oxygen in the blood reaching the heart.

Long-Term Health Impacts

People who survive severe fentanyl poisoning may experience long-term effects, including cognitive impairment that occurs because of brain hypoxia (low oxygen to the brain) during the overdose. Some can also develop chronic respiratory issues and other kidney or liver complications the body develops as a result of trying to metabolize and get rid of fentanyl [1]. Damage to the brain from intense hypoxia over an extended period can result in memory problems, decreased motor functions, and the inability to make decisions, solve problems, and think clearly.

Specific Organ Systems and Neurological Effects

What makes fentanyl poisoning particularly severe is how difficult it is to live from it; by poisoning organ systems such as the nervous system, excretory system, and digestive system, it can cause permanent damage in prolonged cases. Many people who have had fentanyl toxicity symptoms continue to have mental processing and focus problems.

In some patients, episodic fatigue, weakness, or neuropathy (nerve pain) may last as long as several weeks or months. As these effects become more widely known, however, additional research and support of people who live with health effects that persist are necessary.

Fentanyl poisoning is an emergency as the high potency and quick onset mean a fatal outcome is possible before the drug can be treated. The most vital thing is to note symptoms of poisoning early as well as start emergency action protocols promptly.

Emergency Response Protocols

If you suspect fentanyl poisoning, call emergency services first. To keep your airway clear, place the affected person in the recovery position (lying on their side) whilst waiting for responders. CPR can be lifesaving if the individual has stopped breathing because when this happens the person’s heart has to be stimulated and rescue breaths have to be given until medical help arrives.

Because the arrest can be respiratory with a potential for rapid reversal, CPR can also prevent adverse effects like brain damage till the time Naloxone is available to reverse the effects of opioid poisoning.

Naloxone And Its Limitations: The Vital Role of Naloxone In Fentanyl Cases

The good news is naloxone (Narcan) is a drug made just for reversing opioids and can be incredibly effective in the event of fentanyl poisoning. When administered, naloxone binds to the opioid receptors in the brain and holds it from binding with fentanyl and other similar opioids. It is generally given as a nasal spray or injection, and in many areas is accessible for medical service personnel and bystanders to use.

But with fentanyl, it’s so potent that sometimes standard doses of naloxone won’t save a life, requiring multiple doses in many cases to fully reverse the overdose. Naloxone does not reverse symptoms in all cases, including in some cases when extremely high doses of fentanyl or fentanyl analogs (even stronger derivatives) are involved. Once naloxone is administered, medical follow-up is still necessary, because the body can continue to exhibit the effects of fentanyl for a longer period than the effects of naloxone.

Naloxone is a powerful defense against opioid overdose. With fentanyl poisoning spreading through communities, raising public awareness about Naloxone’s availability and how to use it could help dampen the blow.

Several elements increase the risk of fentanyl poisoning among different populations: exposure, less familiarity, and health vulnerabilities.

Groups At Higher Risk

Teens and Young Adults: Fentanyl poisoning is a particular danger for teenagers and young adults when they tend to accidentally ingest the drug. People don’t know they’re taking fentanyl, because the counterfeit pills being sold and marketed as prescription drugs (OxyContin, for instance, or Xanax) contain fatal doses of fentanyl. Accidental poisoning in this group is enhanced through exposure to social pressures and experimentation.

Recreational Drug Users: Recreational drug use is a huge risk of fentanyl poisoning. Fentanyl is often combined with other drugs by drug dealers to make the mix more potent but possibly with a fatal risk.

Medical Patients: People who take opioids for pain control may also be at risk for fentanyl, especially if they accidentally get counterfeit or contaminated medication. People with conditions that lower their tolerance to opioids, or those with unknown dependencies are at greater risk.

The Factors Affecting Our Vulnerability

Fentanyl poisoning vulnerability is due to a variety of social, environmental, and psychological factors. Published studies have documented a sudden new accessibility in illicit fentanyl, making it much easier to come across accidentally. Counterfeit drugs are widely available and the lack of education about the risks of opioids has led many to face the dangers associated with fentanyl exposure. Other factors that can increase risk include prior underlying allergies and co-occurring substance dependencies that render some groups at heightened risk for fatal fentanyl poisoning.

Implemented together, these strategies can help prevent fentanyl poisoning and reduce its harmful effect but further research and development is the need of the hour to curb the devastating effects of addiction and fentanyl poisoning.

1. National Library Of Medicine. Fentanyl. https://www.ncbi.nlm.nih.gov/books/NBK459275/

2. National Safety Council. Drug Overdoses. https://injuryfacts.nsc.org/home-and-community/safety-topics/drugoverdoses/data-details

3. National Institute On Drug Abuse. Fentanyl Drug Facts. https://nida.nih.gov/publications/drugfacts/fentanyl

FAQs

How Long Does It Take To Die From Fentanyl Poisoning?

The time it takes for fentanyl poisoning to be fatal will vary, and in severe poisoning, death may happen within minutes as this leads to rapid respiratory depression. Because fentanyl is so potent it quickly affects the opioid receptors of the brain to cause respiratory arrest or stop breathing. If no immediate intervention—frequently during the first several minutes, or even an hour—is taken, then fatal outcomes are probable therefore immediate emergency response is crucial.

What’s The Difference Between Fentanyl Poisoning And Opioid Overdose?

Fentanyl poisoning is different than a typical opioid overdose in that fentanyl is very potent and quickly impacts the body. Opioids other than fentanyl may cause progressive symptom evolution, but fentanyl may lead to respiratory arrest and unconsciousness within minutes. That’s why fentanyl poisoning calls for faster intervention, and sometimes repeated naloxone dosing because it takes longer for it to wear off the body.

Why Is Fentanyl Mixed With Other Stuff By Illicit Drug Manufacturers?

It’s cheaper to manufacture and produces a stronger effect in smaller doses, and as such, illicit producers often lace other substances with fentanyl. By this process, they can make higher profits with the same strength as their product. Sadly, even small variations in dosing in these materials can lead to user death from fentanyl poisoning, unrecognized by the user.

Are There Particular Geographic Regions With Higher Fentanyl Poisoning Rates?

The levels of fentanyl poisoning do change with the region because, in North America, the fentanyl poisoning rates are much higher, especially in the USA and Canada. The result of this distribution has led to major increases in illicit fentanyl in these regions trafficked through organized network traffic. In the U.S., the Northeast, and the Midwest have recorded some of the biggest spikes, in part because local drug supply chains are increasingly contaminated with fentanyl.

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