Fentanyl is a highly potent synthetic opioid, estimated to be 30-50 times more powerful than heroin and 50-10 times more powerful than morphine.1
Since fentanyl is so powerful, it is fairly easy to overdose. CNN reports that a quarter of a milligram, or 0.25 milligrams, can be fatal.1
Fentanyl was approved in 1968 as an anesthetic and is used for severe pain and as an adjunct to general anesthesia. It may also be prescribed for those with cancer who experience breakthrough pain – pain so intense that it “breaks through” the standard painkiller dose, requiring further treatment.2,3
It can be prescribed in the form of slow-release patches, nasal sprays, injectable formulations, tablets, and lozenges. 3
Addiction and Overdose
As an opioid, fentanyl has a high potential for both dependency and abuse.2
Although it’s a prescription medication, it has similar effects to heroin, such as euphoria, drowsiness, nausea, confusion, constipation, and sedation. In recent years, fentanyl has become a popular substance to add to heroin and cocaine before they’re sold on the streets. This, unfortunately, greatly increases the risk of overdose.4
An overdose can occur because fentanyl binds to opioid receptors in the brain and body. These receptors are found in areas of the brain that control breathing. Because it’s so potent, fentanyl can cause breathing to stop completely, which can lead to death.4
Due the these dangers, anyone taking fentanyl for any reason should be aware of the overdose symptoms. These can include:5
- Cold or clammy skin.
- Slow or irregular heartbeat or breathing.
- Pinpoint pupils.
- Bluish coloration of the skin.
Forms of Fentanyl and Their Related Overdose Risk
Fentanyl can be manufactured in many forms. When it’s prescribed, it can be administered through injection, transdermal patches, or in lozenges. On the street, it’s found as prescription pills, a white powder, on blotter paper, or mixed with heroin.4
Some of the forms of fentanyl that put users at risk of overdose include:
- White powder: One of the leading causes of overdose death in the last few years has been mixing fentanyl with heroin. Too often, a person buys a mixed powder, thinking it is a different substance, and may experience an overdose. Dealers may mix cocaine with fentanyl as well.7
- Fake prescription pills: It is unlikely that a person will receive fentanyl instead of a prescription opioid if their prescription is filled at a legitimate pharmacy. However, a form of fentanyl pressed into a pill, which mimics medications such as oxycodone and other prescription opioids, has been found in the U.S. and other countries.8 Like the white powder version of fentanyl, a person buying pills illegally may be told the drugs are oxycodone or hydrocodone, but instead, they are a much more potent drug. Fentanyl has also been found on the black market as illicit benzodiazepines, like Xanax.9
- Liquid: An intravenous form of fentanyl has been discovered during police raids and can be absorbed through the skin, putting emergency workers such as police officers and EMTs at risk.10
Emergency workers may come into contact with fentanyl through inhalation, mucous membrane contact, ingestion, and needlesticks. These exposures can potentially be fatal. However, brief skin contact with fentanyl is usually not fatal if the person removes the drug from their skin immediately.6
While some people intentionally purchase fentanyl, most people who come into contact with the drug do so accidentally. Among people who purchase illegal narcotics, like heroin, the introduction of fentanyl often leads to overdose. Fentanyl was involved in almost half of the over 72,000 drug overdoses in 2017.7
Drugs That Interact Negatively with Fentanyl
Fentanyl interacts with many different drugs. It can cause harm when combined with other prescription, over-the-counter, and illegal drugs.
Prescription and OTC drug interactions include:11
- MAO inhibitors (antidepressants) such as Marplan, Nardil, and Parnate.
- Other antidepressants such as SSRIs, SNRIs, and tricyclics.
- Other opioids such as oxycodone, hydrocodone, codeine, and heroin.
- Buprenorphine and other partial opioid agonists.
- Benzodiazepines (Klonopin, Xanax, Ativan, etc.)
- Muscle relaxers.
- Anticholinergic Drugs.
Combining fentanyl with alcohol and other opioids increases the risk of overdose by decreasing breathing and heart rate. It can also increase the risk of accidents and injuries.12
Other risks of fentanyl include skin infections, cardiovascular infections, and viral infections like HIV or hepatitis from injection. Snorting it can irritate the nasal mucosa and lead to perforation of the nasal septum.13
Recovering from an opioid addiction can be very difficult, especially if attempted alone. However, there are many addiction treatment centers available across the U.S. and beyond. Treatment can make the process much easier and safer with medically supervised detox and professional counseling.
. Kounang, N. (2018). What you need to know about fentanyl. CNN.
. National Institutes of Health: LiverTox. (2018). FENTANYL AND ANALOGUES.
. Drug Enforcement Administration. (2018). Fentanyl.
. National Institute on Drug Abuse. (2016). Fentanyl.
. Drug Enforcement Administration. (2017). Drugs of Abuse.
. Centers for Disease Control and Prevention. (2017). Fentanyl: Preventing Occupational Exposure to Emergency Responders.
. Pew Trusts. (2018). How Fentanyl Changes the Opioid Equation.
. Drug Enforcement Administration. (2016). DEA Report: Counterfeit Pills Fueling U.S. Fentanyl And Opioid Crisis.
. Zalkind, S. (2016). ‘Death pill’: fentanyl disguised as other drugs linked to spike in US overdoses. The Guardian.
. Casey, L. (2016). Liquid fentanyl capable of being absorbed through skin found in Ontario. CTV News Kitchener.
. Food and Drug Administration. (2016). ACTIQ® (fentanyl citrate) oral transmucosal lozenge, CII.
. Australian Government Department of Health. (2014). Polydrug Use: What You Need to Know About Mixing Drugs.
. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC.