The Truth About Drugs Booklets / The Truth About Fentanyl
The Truth About Fentanyl
What is Fentanyl?
Fentanyl is an extremely powerful drug that has been used for decades as a painkiller.1 Because of its high potential to cause addiction, it has primarily been used to relieve severe pain, such as from advanced cancer or after serious surgery.
Fentanyl is in the same class of drugs as painkillers like morphine or oxycodone and the illegal drug heroin.2 Those drugs, called opioids, are primarily products of the opium poppy. Some, like heroin and morphine, are directly derived from opium. Others, like oxycodone, are semisynthetic, meaning created in a laboratory from a natural substance. Fentanyl is 100 percent created in a lab and fully synthetic.
No plant products are needed to make fentanyl, which means it can be created anywhere that lab chemicals can be obtained. This has made it easy for drug-trafficking organizations to manufacture it in illicit labs for distribution as a street drug. In 2013, distribution of fentanyl began skyrocketing in the United States, with resultant overdose deaths increasing from that point forward.3
How is Fentanyl Used?
As a pharmaceutical drug, fentanyl can be applied to the skin in a patch,4 administered as a very low-dosage pill or given in a lozenge, or “lollipop,” that slowly dissolves.3 There are also sprays used under the tongue or in the nose. Liquid fentanyl may be injected.
Any of these forms of fentanyl can be misused. Patches can be cut up and placed under the tongue or the contents squeezed out and swallowed.
Illicit forms of fentanyl are often found in fake prescription pills, any one of which may be fatal.5 Powdered fentanyl can be dissolved for injection or for smoking in a glass pipe. Nonpharmaceutical fentanyl can also be added to eyedrops, nasal spray or small squares of blotter paper that users place in their mouths.
Because fentanyl can be combined with methamphetamine* or cocaine, it may be snorted, smoked or injected, with users unaware they are taking fentanyl.1
An increasing number of illegal vape products and marijuana are also being laced† with fentanyl, which can be lethal.6
* Methamphetamine: a dangerous drug that disrupts the nervous system, often known as meth or crystal meth.
† Lace: to add a small amount of a substance to.
Why is Fentanyl So Dangerous?
Two factors make fentanyl dangerous and deadly. One is its incredible potency. It is as much as 50 times stronger than heroin and 100 times stronger than morphine. As little as two milligrams of pure fentanyl, which is only a few grains, can be a fatal dose.7
The other factor is that people may not even know they are taking fentanyl. It is often mixed with illegal drugs such as heroin, cocaine or methamphetamine. An unknowing user can unexpectedly overdose on fentanyl.3
Powdered fentanyl is often pressed into fake pills that look like real prescription drugs. In 2023, law enforcement personnel in the United States seized more than 80 million counterfeit pills containing fentanyl from the black market.8
Street Names
Apache
China Girl
China Town
China White
Dance Fever
Drop Dead
Fetty
Friend
Goodfellas
Great Bear
He-Man
Jackpot
King Ivory
Lethal Injection
Murder 8
Poison
Tango & Cash
TNT
Fake Pills: One Pill Can Kill
Criminal drug networks mass-produce counterfeit pills, lacing them with fentanyl and marketing them as brand-name prescription drugs.
Fake pills gotten from a friend or bought online or through social media may contain fentanyl and can be deadly.
These pills are made to look like prescription drugs such as oxycodone (OxyContin and Percocet), hydrocodone (Vicodin) and psychotropic medications or stimulants (Xanax and Adderall).
Of the fentanyl-laced fake pills analyzed by the DEA,* 7 out of 10 contained a potentially lethal dose of fentanyl.
* DEA: US Drug Enforcement Administration.
“I went down to her room and opened up the door and I found her. She was standing upright, but she was bent over, down with her head on the couch arm and a pile of vomit. When I picked her up, her eyes were open, and I knew she was dead.”
How Does Fentanyl Kill?
A person who overdoses on fentanyl becomes groggy and sleepy and may quickly lose consciousness. The drug affects the part of the brain that controls breathing, so the person’s breathing will slow down and become difficult. They may begin to snore and make gurgling sounds, until they stop breathing altogether.9
Fentanyl can also freeze the muscles of the chest, which also stops breathing. This physical response can happen immediately after ingestion of the drug.3
“I was literally flatlined, dead in my mother’s living room at my mom’s feet in front of my sister. And I never wanted to be in that situation.”
Symptoms of Fentanyl Overdoes
Since even small doses of fentanyl can be fatal, recognizing the signs of an overdose can save a life.1
Here are some symptoms of a fentanyl-related overdose:
Deep sedation
Slow, shallow breathing
Respiratory arrest
Blue nails and lips
Gasping, gurgling or snoring
Unresponsive or unconscious
Cold and clammy skin
The Harmful Effects of Fentanyl
The danger for a person who consumes fentanyl, either intentionally or unintentionally, is that they can too easily suffer a fatal overdose—even after a single use.1
Short-Term Effects of Fentanyl
Death
Sedation
Confusion
Poor physical coordination
Drowsiness
Nausea
Vomiting
Tiny pupils
Constipation
Headache
Respiratory depression
Long-Term Effects of Fentanyl
The most obvious long-term effect of fentanyl is addiction. Because the drug is so powerful, addiction can occur quickly. This is one of the reasons some drug dealers add fentanyl to methamphetamine or cocaine—to get their customers hooked on their drugs fast.10
Dealers also mix fentanyl with other drugs because only small quantities are needed to get a user high. Adding fentanyl makes other drugs more powerful and cheaper, but also more deadly.
Addiction
Permanent damage to respiratory system
Mental fog
Damage to liver and kidneys
Depression, anxiety and mood swings
Suppressed immune system
Death
A Short History of Fentanyl
Fentanyl was developed as a medical drug in 1959 and approved for medical use in 1968. It was first used in hospitals as an injection for severe pain or in anesthetic formulas for surgery. Because of fentanyl’s addictive potential, it is primarily prescribed only for severe pain in end-of-life care, such as with terminal cancer patients.1
In the 1990s, the fentanyl patch was approved and, in 1998, fentanyl began being distributed in lozenge form. Following those releases, minor quantities of these forms were diverted from medical facilities and illegally sold on the street, resulting in a small number of overdose deaths each year.
Overdoes Deaths
In 2006, a dramatic increase in fentanyl-related overdose deaths began to be recorded in the United States. They were traced to an illicit lab in Toluca, Mexico. When this lab was closed down, the number of deaths dropped back to low levels.11
Then, in 2013, deaths started increasing again as labs in Asia manufactured fentanyl in large quantities.16 Established drug-trafficking organizations began importing fentanyl from these labs, often adding fentanyl to heroin, methamphetamine, cocaine and counterfeit prescription drugs. As trafficking patterns expanded, overdose deaths steadily increased again.
The Centers for Disease Control and Prevention estimates yearly fentanyl-related deaths at more than 70,000. Over one year, it is estimated that 84 percent of opioid deaths involved a drug from the fentanyl family.
Stronger Than Fentanyl
There are dozens of drugs related to fentanyl, some of them even stronger. For example, carfentanil is 100 times more powerful than fentanyl and is used to treat elephants. However, dealers have added it to drugs intended for people, causing thousands of deaths.
Fentanyl Deaths: A Catastrophic Epidemic
The impact of fentanyl has been the most tragic in the United States where, in one year, two out of every three drug overdose deaths were caused by fentanyl.
In April 2021, the total number of overdose deaths over a 12-month period reached 100,000 for the first time, with fentanyl as the main cause.12
In Canada during the first half of 2024, 79 percent of opioid-related overdose deaths involved fentanyl or a fentanyl-like substance. Total opioid deaths nearly doubled in just a few years.13
In Europe, 13 countries reported fentanyl-related deaths, including Germany, Sweden, United Kingdom and Finland.14
The graph below shows U.S. Fentanyl overdoes deaths compared to other opioids.15
Photo credit: Angels Across America, photographs used with permission from the families of the victims.
Who We Lost to Fentanyl
Prince: The music icon died from an accidental overdose of self-administered fentanyl.
Mac Miller: At the age of 26, the rapper and producer died from a combination of cocaine, alcohol and fentanyl.
Tom Petty: The singer-songwriter overdosed on a fatal mix of fentanyl, oxycodone, Xanax and other substances.
Lexii Alijai: The 21-year-old rapper-singer-songwriter died from a fentanyl and alcohol overdose.
Tyler Sanders: The young actor had a history of illicit drug abuse before he overdosed on fentanyl at 18.
Angus Cloud: Famous as “Fez” on Euphoria, the actor died at 25 from a cocktail of illicit drugs including fentanyl.
Jordan Cashmyer: The reality TV personality was 26 when she died of an overdose of fentanyl and cocaine.
Jimmy Hayes: The 31-year-old National Hockey League star’s death was caused by fentanyl and cocaine toxicity.
Jaylon Ferguson: His NFL career was cut short at 26 when he overdosed on fentanyl and cocaine.
Tyler Skaggs: Baseball player
Coolio: Hip-hop legend
Shock G: US rapper
Luke Bell: Country music singer
Logan Williams: Actor
Daniel Mickelson: Actor
Michael K. Williams: Actor
Frank Vallelonga Jr.: Actor
What Dealers Will Tell You
When teens were surveyed to find out why they started using drugs in the first place, 55 percent replied that it was due to pressure from their friends. They wanted to be cool and popular. Dealers know this.
They will approach you as a friend and offer to “help you out” with “something to help you relax and feel good.”
Drug dealers, motivated by the money they make, will say anything to get you to buy their drugs.
They will tell you they have a quality product, even though they may have no idea what’s in it or how strong it is. They may even assure you that their pills or heroin don’t contain any fentanyl when, in fact, they may contain lethal doses.
One drug dealer arrested for selling fentanyl and methamphetamine was heard to say, “If they can survive the high, I will always have a paycheck.”16
Get the facts about drugs. Make your own decisions.
“I could literally take the smallest grain that you could see with your eye and that would be a dose. I started taking that around and giving it to people and it just blew up my reputation.”
The Truth About Drugs
The real answer is to get the facts and to not take drugs in the first place.
Drugs are essentially poisons. The amount taken determines the effect.
A small amount acts as a stimulant (speeds you up). A greater amount acts as a sedative (slows you down). An even larger amount poisons and can kill.
This is true of any drug. Only the amount needed to achieve the effect differs.
But many drugs have another liability: they directly affect the mind. They can distort the user’s perception of what is happening around him or her. As a result, the person’s actions may be odd, irrational, inappropriate and even destructive.
Drugs block off all sensations, the desirable ones along with the undesirable. So, while providing short‑term help in the relief of pain, they also wipe out ability and alertness and muddy one’s thinking.
Medicines are drugs that are intended to speed up or slow down or change something about the way your body is working to try to make it work better. Sometimes they are necessary. But they are still drugs: they act as stimulants or sedatives, and too much can kill you. So if you do not use medicines as they are supposed to be used, they can be as dangerous as illegal drugs.
Why Do People Take Drugs?
People take drugs because they want to change something in their lives.
Here are some of the reasons young people have given for taking drugs:
To fit in
To escape or relax
To relieve boredom
To seem grown-up
To rebel
To experiment
They think drugs are a solution. But eventually, drugs become the problem.
Difficult as it may be to face one’s problems, the consequences of drug use are always worse than the problem one is trying to solve with them. The real answer is to get the facts and to not take drugs in the first place.
References
Fentanyl Factsheet, United States Drug Enforcement Administration
Fentanyl Drug Profile, European Union Drugs Agency
United States Sentencing Commission, Fentanyl and Fentanyl Analogues: Federal Trends and Trafficking Patterns report, published January 25, 2021. Authors: Kristin M. Tennyson, Ph.D., Deputy Director, Office of Research and Data; Charles S. Ray, J.D., Assistant General Counsel; and Kevin T. Maass, M.A., Research Associate
DEA Laboratory Testing Reveals That 6 out of 10 Fentanyl-Laced Fake Prescription Pills Now Contain a Potentially Lethal Dose of Fentanyl, United States Drug Enforcement Administration, Public Safety Alert
The Alarming Surge of Fentanyl-Laced Vapes: A Lethal Combination, PharmChek, June 26, 2023
Fentanyl Facts, Overdose Signs to Look For and How You Can Help Save a Life, UC Davis Health, January 11, 2023
Long-Term Effects of Fentanyl, Rising Phoenix Center, June 8, 2023
Nonpharmaceutical Fentanyl-Related Deaths, Multiple States, April 2005–March 2007, Centers for Disease Control, Reviewed July 23, 2008
Drug Overdose Deaths: Facts and Figures, National Institute on Drug Abuse
Opioid- and Stimulant-Related Harms in Canada, Updated December 23, 2024, Government of Canada Website
Report on Drug-Related Deaths and Mortality in Europe, Update from the EMCDDA Expert Network, May 2021, European Monitoring Center for Drugs and Drug Addiction.
Drug Overdose Deaths in the United States, 2002–2022, Centers for Disease Control and Prevention
Drug Dealer Sentenced to 25 Years for Selling Drugs, Causing Overdoses and Disposing of a Body, United States Attorney’s Office, Middle District of Florida, Press Release, August 23, 2022
