Fentanyl

Fentanyl is an opioid drug. Opioids are a class of drugs that include both prescription medicines such as morphine and illegal drugs like heroin.  

Fentanyl is synthetic, which means it is made entirely in laboratories and has no natural ingredients. It was developed as a prescription medicine for treating severe pain, such as pain after surgery. When used as prescribed, it is also very effective in treating cancer pain or other types of severe chronic pain that don’t respond to other pain medicines.^1,2,3 Read more about opioids on the NIDA website.

Fentanyl is also made and used illegally, because it is very powerful and relatively easy to produce. Illegally made fentanyl is now a main driver of the overdose and addiction crisis in the United States.⁴  

Like other opioids, fentanyl can ease pain and make a person feel happy and relaxed. These effects can lead to other changes in mood and thinking, such as wanting to take more of the drug and having a hard time concentrating or making decisions.⁵ F entanyl is much more powerful than morphine or heroin, and its effects can start more quickly.⁶  

Fentanyl can have negative health effects, even when taken as prescribed. These effects may include confusion, drowsiness, nausea, visual disturbances, constipation, muscle stiffness, and many others.  

Fentanyl can also cause serious health problems and even death from overdose.⁷ Like other opioids, fentanyl affects the parts of the brain that control breathing. When a person takes a higher fentanyl dose than their body can handle (an overdose), their breathing can slow to a life-threatening level.⁸ See “What is an overdose?”

Even a small dose of fentanyl can cause a fatal overdose.  Fentanyl is much more potent than other opioids like morphine or heroin. As little as 2 mg of fentanyl—the amount of a few grains of salt—can be fatal.⁹

Some counterfeit pills contain fentanyl. Pills made to look like prescription pain medicines or medicines to treat anxiety or attention deficit/hyperactivity disorder (ADHD) are often sold through social media or internet sites.^10,11 These fake pills may look exactly like the real thing but can also contain fentanyl, often in deadly doses.¹² People taking these pills often do not know they are taking fentanyl.¹³  

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Fentanyl may be a hidden ingredient in other illegal drugs. It is often mixed with heroin, cocaine, methamphetamine, or the veterinary tranquilizer xylazine (“tranq”). In many cases, people do not know that their drugs are tainted with fentanyl.¹⁴ Unless drugs are tested, it is impossible to tell if they have been mixed with fentanyl.¹⁵  

Drug combinations are particularly dangerous. Some people may combine opioids like heroin with other drugs such as methamphetamine on purpose, and these drugs can be adulterated with fentanyl.¹⁶ Taking more than one drug—whether it’s on purpose or unknowingly—increases the risk of serious health effects or even death.^17,18 This is more likely to happen to people who don’t normally take fentanyl, because their bodies are not used to powerful opioids like fentanyl.¹⁹  

You cannot tell if another drug or pill contains fentanyl by looking, tasting, or smelling it. The only way to check if a drug or pill contains fentanyl is by using fentanyl test strips.²⁰  

Fentanyl test strips are small strips of paper, similar to what’s in a pregnancy test. They can check for fentanyl in different kinds of drugs and pills. This is done by:²¹

• Mixing a small amount of the drug or pill with water (pills should be crushed first).
• Dipping one end of the test strip into it.
• If fentanyl is present, a clear line will appear on the test strip within a couple of minutes.  

However, the test strips may not always work:

• Even if a drug contains fentanyl, the small sample you are testing may not have fentanyl in it. So, even if the test strip says there is no fentanyl, it’s possible that the drug may still contain fentanyl.
• The test strips may not be able to detect other similar drugs that could have been mixed in. Some of these fentanyl-like drugs, like carfentanil, are even stronger and more likely to cause an overdose.²²

Fentanyl test strips are legal to carry in most states. They may be available through state and local health departments, syringe services programs, or drug stores and online retailers.

Fentanyl and other illegally produced synthetic opioids have played a major role in the overdose crisis in the United States since 2013.²³ Since about 2017, overdose deaths often involve use of multiple drugs. In many cases, fentanyl is one of these drugs.^24,25 When fentanyl is mixed with other drugs, either on purpose or unknowingly, the combination can have more serious health effects.

Overdose deaths involving fentanyl among adolescents have risen in recent years, even though teens don’t report taking more illegal drugs. This rise may be linked to their use of counterfeit medicines for anxiety and ADHD that had fentanyl mixed in. Teens may not know the medicines could contain fentanyl and might not realize the pills are dangerous.²⁶  

Certain signs may mean that a person is having an overdose and needs immediate medical attention. If you think someone is overdosing:

• Call 911.
• Use naloxone (e.g., Narcan^®, Kloxxado^®, Zimhi^®, RiVive^®) or nalmefene (Opvee^®) if it is available. These overdose reversal medicines are life-saving tools that can be given to anyone who could be having an opioid overdose. Naloxone and nalmefene are available as nasal sprays and can be carried and administered by anyone. Naloxone is available over the counter, without a prescription.
• Try to keep the person awake and breathing.

Although fentanyl is more powerful than other opioid drugs, standard-strength naloxone (e.g., Narcan®, RiVive®) still works to reverse the drug’s effects in most people who overdose from fentanyl. However, some research has suggested that in certain cases, people who overdose from fentanyl or a related drug may need a second standard-strength dose or a dose of high-strength naloxone (Kloxxado^®).²⁷

For more information, see, “What to Do if You Think Someone is Overdosing” on the U.S. Centers for Disease Control and Prevention (CDC) website.   

Fentanyl, like other opioids, is addictive, especially when not used as prescribed by a health professional. Because fentanyl is so powerful, people can quickly lose control over their fentanyl use. Fentanyl causes changes in brain activity that can eventually motivate people to continue using it even when they experience harmful effects.²⁸  

Repeated fentanyl use can lead to dependence, which means that the person’s body gets used to the presence of the drug. They are only able to feel normal when they take the drug.

Dependence can cause extremely unpleasant withdrawal symptoms if the person stops using it.  

It can also lead to tolerance, which means that the person’s body responds less and less to the drug. They may need to take a larger dose or take it more often to achieve the same effects.^29,30    

A person who uses fentanyl may be diagnosed with opioid use disorder if they have two of the diagnostic criteria for opioid use disorder listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. For example, they may use fentanyl more or for longer than intended, experience a strong desire to use fentanyl (craving), and continue to use it even when knowing that it causes problems.³¹ To learn more, see “Are opioids addictive?”  

Like other opioid use disorders, fentanyl addiction is a treatable chronic medical condition. Treatment options include medications for opioid use disorder and behavioral therapy.  

Medications are the standard treatment for fentanyl addiction.^32,33 Several medications have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of opioid use disorder. They include methadone, buprenorphine, and naltrexone. Another medication, lofexidine, has been approved for treatment of withdrawal symptoms.³⁴  See “Medications for Opioid Use Disorder” for more information.

Some people have concerns about becoming addicted to medications for opioid use disorder. When taken as prescribed by a person with an opioid use disorder, methadone and buprenorphine do not cause the same “high” or intense pleasurable effects as illegal opioids, and this makes these medications less addictive.³⁵ Naltrexone is not addictive.³⁶ See “Are medications for opioid use disorder addictive?” 

As with other opioids, fentanyl use during pregnancy can harm the health of both the mother and her baby.³⁷  

Research has found that pregnant women with untreated addiction may be less likely to get regular prenatal care. This can raise their risk of serious or even deadly pregnancy complications.  

Babies exposed to fentanyl before birth have a higher risk of various health problems and may experience withdrawal symptoms after birth, such as irritability, crying, tremors, or poor feeding.³⁸  

Medications for treating fentanyl addiction are safe and effective for pregnant women. These medicines can lead to better pregnancy outcomes for both the mother and their baby.³⁹  It is also safe to take them while breastfeeding, since only very small amounts of the medicines pass through to breast milk.^40,41 For more information, see “Opioid use during pregnancy.”