Fentanyl Overdose: Symptoms, Risk Factors, & Treatments

What Is Fentanyl?

Fentanyl is an FDA-approved prescription drug used to treat severe pain and can be administered as a skin patch, IV medication, or lozenge. Fentanyl is closely regulated as a schedule II narcotic, which means it carries a high risk for abuse and dependence. It is usually only given to people struggling with severe pain related to advanced stages of cancer or during or after surgical procedures.^1,2

As a synthetic opioid, fentanyl isn’t made using the poppy plant (the main ingredient in opium, heroin, and drugs like morphine). Instead, it is synthetically made in a lab and mimics the effects of traditional opiates on the body and brain. All opioids bind to certain receptors in the brain to trigger the release of neurochemicals involved in mood and pain management. This response is what makes fentanyl so effective in reducing pain and also is what causes the “high” users experience after taking it.^1,4

Fentanyl is extremely potent, making it highly addictive and much more deadly than traditional opiates. Unfortunately, drug cartels and other organized crime groups are now manufacturing Fentanyl illegally because it is easier and cheaper to make than poppy-derived opiate drugs. In many cases, Fentanyl is sold to unsuspecting buyers who believe they’re buying another drug or to buyers who buy a drug laced with Fentanyl. This has led to a worsening of the existing opioid epidemic and a drastic rise in the number of overdose deaths.^2,3

Why Is Fentanyl So Lethal?

Fentanyl is deadly because it is 50-100 times stronger than morphine. The lethal dose of Fentanyl is just 2-3 mg, compared to a lethal dose of heroin, which is about 30mg. When someone ingests too much fentanyl, they can lose consciousness and die from respiratory depression in about 1-3 hours.

While it’s not possible to know for sure, it’s likely that most fatal overdoses are accidental in nature. Because of the high potency of fentanyl, it’s very easy for a person to accidentally overdose on the drug, especially if they’re buying it on the street. While prescription fentanyl is manufactured in tightly regulated environments to ensure accurate dosages, illegally made versions vary widely in purity from dose to dose. Getting a more potent batch of Fentanyl or a bad batch contaminated or laced with other drugs greatly increases the risk of an accidental overdose.^2,3

Signs of Fentanyl Overdose

When the signs of a fentanyl overdose are identified quickly enough, it’s often possible to save a person’s life by administering the drug naloxone. This medication is carried by most emergency medical responders, hospitals, and healthcare clinics, and most states also allow people to obtain it without a prescription. Without the medication, people who have overdosed on fentanyl or another opioid will often go into respiratory depression, which can be fatal.^2,4

The signs and symptoms of a fentanyl overdose include:⁴

• Slurred speech or inability to talk
• Slow, erratic, or shallow breathing
• No visible signs of breathing
• Bluish fingers, lips, or pale skin
• Very small ‘pinpoint’ pupils
• Extreme drowsiness or lethargy
• Inability to respond or wake up
• Loss of consciousness
• Limp arms or legs
• Vomiting, choking, or gurgling sounds
• Skin that feels cold or clammy to the touch

The symptoms above indicate respiratory depression, which means a person is not getting enough oxygen. Noticing these signs usually means emergency medical help is needed to save a person’s life. The increased sale and use of fentanyl in the U.S. has greatly increased the risk of fatal overdose for opioid users, especially those buying drugs illegally.^2,4

In most cases, there’s a 1-3 hour window between an opioid overdose and the time of death, and naloxone usually begins working in 2-3 minutes. Calling 911 is the best course of action for an opioid overdose, even if naloxone is administered, as the person may need additional medical intervention and monitoring during the recovery period.^2,5

Risk Factors & Causes of Fentanyl Overdose

Because of how widespread the sale and use of fentanyl has become in the U.S., buying illegal drugs is riskier now than ever. There have been numerous reports of DEA officials finding fentanyl in supplies of various substances being sold illegally in the US. Fentanyl has been found in supplies of drugs being sold as heroin, and cocaine, and even in fake prescription pills that look identical to the real product.³

While there are fentanyl test strips that can detect fentanyl-laced substances, most people don’t have access to them and aren’t testing illicit drugs before they take them.⁶ This greatly increases the risk of accidental overdose or fentanyl poisoning.

Factors increasing the risk of a fentanyl overdose, include:^1,2,5,7

• Abusing prescription fentanyl or opioids by taking higher doses than recommended or taking more often than recommended
• Taking fentanyl in combination with alcohol or other drugs with sedative or depressant properties (aka other ‘downers’)
• Taking fentanyl in combination with stimulants like cocaine, ADHD medication, or amphetamine drugs
• Taking fentanyl in combination with a prescription medication, which increases the risk of negative drug interactions
• Switching to a new dealer or type of drug, which can affect the amount of fentanyl in each dose
• Using fentanyl or opioids after a period of sobriety, which can change how sensitive the body is to a drug to specific doses and amounts
• Taking fentanyl when you are alone or not in the presence of another person who is monitoring for the signs and symptoms of an overdose
• Not being honest with family, friends, and medical providers about your drug use, including what, how much, and how often you’re using drugs
• Having a history of serious drug use or addiction, especially a history of past overdoses
• Having liver complications or cirrhosis, which can lower the body’s ability to metabolize opioids, leading to toxicity and overdose

How to Help Someone Having a Fentanyl Overdose

If you notice the signs of a fentanyl overdose, it’s important to get medical help immediately. In most parts of the US, the fastest way to get emergency medical help is to call 911 and ask for EMS to be dispatched to the person’s location. Make sure to speak clearly and provide detailed information about the person’s location and condition, including whether they’re conscious, breathing, and able to respond or not. Follow any recommendations the 911 dispatcher gives and remain with the person until help arrives.^2,4,5

After calling 911, other steps to help someone who has overdosed on fentanyl include:^2,5

• If you have the nasal spray version of the drug naloxone, administer it to the person by twisting the cap off, inserting it into one nostril and dispensing half of the medication, then repeating it in the other nostril with the remaining amount
• If you have the injectable version of Naloxone and are trained to administer it, do so by poking the needle into the vial, pulling back the plunger to get all of the medication into the syringe, and injecting it into the muscle of the upper arm
• Monitor the person’s breathing after administering the naloxone, and administer a second dose if the person’s breathing has not returned to normal after 3-5 minutes (if you have a second dose)
• Whether you administer naloxone or not, it’s important to remain by the person’s side to closely monitor their breathing and watch them closely until help arrives
• If the person is unconscious on their back, you may need to reposition them onto their side to help them breathe and to prevent choking
• If the person is unconscious and not breathing (or if instructed by 911), begin doing CPR and administer rescue breaths until they are breathing on their own or until help arrives
• If the person is conscious, provide reassurance in a calm tone and let them know that help is on the way, and try to keep them talking and awake
• If the person is able to communicate, ask questions to find out more information about what substances they took, how they took it (i.e. injected vs snorting), and when they took it, and share this information with EMS or medical professionals when they arrive
• Try to keep the person warm until help arrives, covering them with a blanket if needed

There are also some things you should NOT do if you suspect or know that someone has ingested or overdosed on fentanyl or other drugs.

If you believe someone has overdosed on fentanyl or other drugs:^2,5

• Do NOT try to force the person to vomit
• Do NOT put the person in a bath or shower
• Do NOT administer any other medication or drug besides naloxone
• Do NOT attempt to slap a person to wake them up
• Do NOT attempt to transport them yourself if there’s another option
• Do NOT try to confront the person about their drug use when they’re intoxicated
• Do NOT encourage them to eat or drink anything
• Do NOT allow them to get in the car and drive
• Do NOT ignore signs of an overdose and leave them alone
• Do NOT encourage them to go to sleep or take a nap

What Does Fentanyl Overdose Treatment Look Like?

A fentanyl overdose is a medical emergency that requires urgent and fast intervention. In almost all cases, the immediate treatment given is the prescription medication naloxone, which can be administered as a nasal spray or an injection. When EMS arrives after an opioid overdose, naloxone is usually given immediately before deciding whether or not to transport the person to the hospital. The severity of the person’s condition and whether or not they respond to the naloxone usually determines whether or not they’ll be taken to the hospital.^4,5,7

If someone is admitted to the hospital for a fentanyl overdose, the hospital staff may run tests or monitor their condition before discharging them. Standard tests include bloodwork and toxicology labs, an ECG to test heart function, and X-rays or CT scans if there are other health concerns or complications.^5,7 After these tests are run, the person is usually discharged from the hospital and advised to follow up with inpatient or outpatient rehab or other addiction treatment.

Treatment for Fentanyl Addiction

Naloxone and medical attention can treat the acute stages of an opioid overdose, but this does not count as a treatment for the underlying fentanyl addiction. Addiction treatment can be provided in specialized inpatient or outpatient treatment settings, depending on the severity of the addiction. Each treatment center for addiction may have a slightly different approach to treating an opioid addiction, but most treatments include one or more of the following:^5,7,8,9

• Inpatient rehab: Inpatient rehab for an opioid addiction provides a secure, 24-hour facility where people can detox and establish their sobriety. Most inpatient rehab facilities offer a blend of individual and group therapy, skills groups, medication management, and therapeutic and leisure activities throughout the day and evening.
• Medication-assisted treatment (MAT): MAT involves prescribing medications that prevent or reduce painful fentanyl withdrawals without getting the person high. Suboxone and methadone are the most commonly prescribed medications for fentanyl addiction and are proven to improve the likelihood of sobriety and prevent relapse.⁹
• Intensive Outpatient Programs (IOP): Intensive outpatient programs (IOP’s) offer a blend of individual therapy, case management, and groups that teach coping and recovery skills to people trying to get clean and sober. Most of these programs also offer psychiatric medication and urine drug screens to people enrolled.
• Outpatient addiction treatment: Outpatient treatment for opioid addiction can involve meeting with a therapist for weekly group, individual, and/or family psychotherapy sessions. In these sessions, an addiction therapist will help the person in recovery set goals, identify supports, and learn skills to support a healthy and sober lifestyle.
• 12-step or other peer support recovery groups: Many people in recovery benefit from attending peer-run recovery meetings like those offered by Narcotics Anonymous or SMART recovery, where they can join a community of people supporting one another in their recovery from substance use disorders

Unless there is a mandate from a judge or child protective services, it’s usually not possible to force someone with an addiction to get treatment, even if they recently overdosed. Many people who struggle with addictions to fentanyl or other drugs refuse or drop out of treatment, which can be very difficult for loved ones to cope with.

Final Thoughts

Because it is so much more powerful than heroin, morphine, or other traditional opioids, fentanyl is an extremely dangerous drug. The illegal manufacturing and sale of fentanyl in the U.S. has worsened the opioid crisis in recent years, causing a significant rise in the number of overdose deaths.^1,3 If you suspect a fentanyl overdose and notice signs like shallow breathing, blue lips or fingers, or extreme lethargy, call 911 immediately.^2,4 Most of the time, the medication naloxone can reverse a fentanyl overdose and save a person’s life, but they will still need ongoing treatment for the underlying fentanyl addiction.^5,7,8,9