Fentanyl 101: How to Spot the Danger and Treat Overdoses

Fentanyl has become a major thorn in the country’s side in recent years.

Cited as the leading culprit behind fatal overdoses in the U.S., the synthetic opioid has wreaked significant damage in Wisconsin. It is the number one killer of residents aged 25 – 54 in the state. This was reported in a 2023 study by Forward Analytics.

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What is Fentanyl?

Fentanyl is a highly addictive synthetic opioid. Compared to heroin, a potentially lethal opioid, it is at least 50 times stronger. It is also 100 times stronger than morphine.

Legally prescribed to treat severe pain after surgery, it’s also used for chronic pain in patients with a tolerance for other opioids. In prescription form, fentanyl is distributed under brand names such as Actiq, Duragesic, and Sublimaze.

Because it’s addictive and causes heroin-like effects, it has become popular illegally. Fentanyl is so potent that it only takes a very small portion to induce strong highs.

Drug dealers are thus using it to reduce production costs. Some are mixing it with other stimulants, such as cocaine and methamphetamine. Others are pressing it into pills that look like Percocet and Adderall. One drug dealer, Marianna Zimmer, was caught trafficking 8,400 fake Percocet pills containing fentanyl. The Wisconsin resident was sentenced to eight years of imprisonment in August 2023.

How do people use Fentanyl?

As a prescription drug, fentanyl is legally administered in the following forms:

  • Oral lozenges (Actiq)
  • Fizzy tablets (Fentora)
  • Sub-lingual (under-the-tongue) tablets (Abstral)
  • Sub-lingual sprays (Subsys)
  • Nasal sprays (Lazanda)
  • Adhesive patches (Duragesic)
  • Injections.

Illegally, it is sold as a powder, spiked onto blotter paper, put inside nasal sprays, and mixed into fake pills.

How dangerous is Fentanyl?

It is potentially fatal. A very tiny amount—as little as two grains of salt—is enough to cause death.

Fentanyl is so potent that it’s easy to overdose on the substance. A fentanyl overdose can lead to slow breathing. In some cases, the affected person can stop breathing altogether.

The worst part? Many people ingesting the substance may not even be aware they’re taking it. It’s hard to detect. You can’t see, smell, or taste it.

Because it’s quite potent in tiny amounts, it’s also a cheaper alternative to other stimulants like heroin, cocaine, and methamphetamine. Thus, drug dealers are mixing fentanyl with these stimulants to cut costs and make them more addictive.

Many people buying these laced drugs won’t know they’re taking stronger opioids than their bodies are used to. This explains why there have been thousands of fentanyl-related overdoses in the country.

The war against fentanyl is still raging. In 2022, the DEA reportedly seized millions of fentanyl-laced pills and 10,000 pounds of fentanyl powder nationwide. According to Forward Analytics, those seizures amounted to over 379 million potentially deadly doses of fentanyl.

That number becomes more alarming when you consider that the U.S. population was estimated at just under 340 million in 2023.

How do you know someone has taken fentanyl?

Fentanyl binds to areas of the brain that control pain and emotions. Prolonged use of the opioid makes the brain adapt to the drug. It then becomes hard to feel pleasure from anything besides the drug.

Symptoms of fentanyl use/abuse

  • Extreme happiness
  • Extreme drowsiness
  • Persistent nausea
  • Confusion
  • Mood swings
  • Poor coordination
  • Constricted pupils resembling pinpoints
  • Impaired judgment
  • Having problems breathing
  • Hallucinations
  • Rapid heartbeats

Symptoms of fentanyl overdose

  • Constricted pinpoint pupils
  • Cold and clammy skin
  • Falling unconscious
  • Choking
  • Slow, weak, or non-breathing
  • Falling into coma
  • Discolored skin (takes on a bluish hue)
  • Limp body

How to treat a fentanyl overdose

If you suspect a fentanyl overdose, look for these signs in the affected person: slow or stopped breathing, blue lips or nails, and unresponsiveness. Call 911 immediately if you can spot these signs.

Naloxone, which blocks the effects of opioid use, will be administered by medical personnel if there is a suspected overdose. The drug can be taken via injection or nasal spray.

Because it’s safe and effective, people close to opioid addicts are encouraged to keep naloxone around to use when needed.

If there’s no naloxone and you’re with someone experiencing a fentanyl overdose, here are a few things you can do before medical help arrives:

  • Stay with the person. Keep talking to them to maintain consciousness.
  • If they’re not breathing, perform rescue breaths every five seconds.

Please note: Many opioids, including fentanyl, work for longer in the body than naloxone does—30 to 90 minutes. So there’s a risk that the opioid will remain active even after naloxone has been used.

While you can administer naloxone to an affected person, you still have to call 911 and monitor them until emergency care arrives. You should keep watch for 2 hours after the last dose of naloxone, checking for signs of slowed or stopped breathing.

How addictive is Fentanyl?

Fentanyl is highly addictive. Its usage, even as prescribed by a doctor, can lead to dependence. People who become dependent can experience withdrawal symptoms when they stop using it.

It’s possible to become dependent without being addicted, but dependence is also a gateway to addiction.

Just like with other forms of substance abuse, fentanyl addiction can have drastic lifestyle consequences. A user’s daily life might revolve around obtaining and using the drug, leading to strained relationships, job loss, and financial struggles.

People who are addicted to fentanyl may do the following:

  • Get scared at the prospect of not having fentanyl
  • Try to buy fentanyl illegally from people with lawful prescriptions, such as doctors, nurses, and pharmacists.
  • Continue to use fentanyl even if they’re aware it is damaging their quality of life.
  • Use fentanyl in dangerously inappropriate situations, such as driving.
  • Chew on a fentanyl patch.
  • Consume higher doses after developing a tolerance to the drug.

How to treat fentanyl addiction?

A fentanyl addict is not a lost cause. A combination of behavioral therapy with medications such as naltrexone and methadone has been found to treat fentanyl addiction effectively.

Withdrawal symptoms of Fentanyl

A fentanyl addict can start having withdrawal symptoms just a few hours after they last used the drug.

Symptoms often include:

  • Vomiting
  • Muscle and bone pain
  • Insomnia
  • Cold flashes and goosebumps
  • Uncontrollable leg movements
  • Intense cravings

How to treat withdrawals

Fentanyl withdrawals are extremely uncomfortable, making it hard for addicts to stop the abuse.

Medications such as Lofexidine can help combat difficult withdrawals. Lofexidine is a non-opioid approved by the Food and Drug Administration to help reduce opioid withdrawal symptoms.

The FDA also cleared a mobile app called the reSET-O app to help people undergoing fentanyl addiction treatment. The app is used in combination with contingency management and an opioid-dependence drug called buprenorphine.