Fentanyl Risks
The dangers of illegally made fentanyl, a powerful synthetic opioid now found in many street drugs and fake pills.
Last revised
Key takeaways
- Strength: about 50 times stronger than heroin and 100 times stronger than morphine
- Where it is found: mixed into heroin, cocaine, methamphetamine and counterfeit pills that look like real prescription medicines
- Most useful single change: Only take pills prescribed for you and dispensed by a licensed pharmacy.
- Commonest mistake: Taking pills from friends or social media sellers, even if they look real.
- See a doctor if any of the signs under "When to get help" below apply to you.
Why it matters
Fentanyl is the main driver of overdose deaths in the US, and many people who take it do not know their drugs contain it.
The numbers, in one place
| Measure | Figure |
|---|---|
| Strength | about 50 times stronger than heroin and 100 times stronger than morphine |
| Where it is found | mixed into heroin, cocaine, methamphetamine and counterfeit pills that look like real prescription medicines |
| Detection | you cannot see, smell or taste fentanyl |
| Test strips | fentanyl test strips can detect fentanyl in drugs |
| Naloxone | reverses fentanyl overdose, though more than one dose may be needed |
What helps
- Only take pills prescribed for you and dispensed by a licensed pharmacy
- Carry naloxone and make sure people around you know where it is
- Talk to teens about counterfeit pills sold online and through social media
- Call the SAMHSA National Helpline at 1-800-662-4357 for treatment options
What to avoid
- Taking pills from friends or social media sellers, even if they look real
- Using drugs alone
- Mixing drugs, or combining them with alcohol or sedatives
In depth
Fentanyl is a synthetic opioid. A prescription form is used in hospitals and for severe pain, but most fentanyl involved in overdoses is made illegally. Because it is so strong, a very small amount can stop someone's breathing. Illegal producers mix it into other drugs, often unevenly, so one pill or bag may have little and the next may contain a deadly amount. This uneven mixing is sometimes described as the "chocolate chip cookie" problem.
Many people exposed to fentanyl do not mean to take it. Counterfeit pills made to look like prescription painkillers, anxiety medicines or stimulants often contain fentanyl, and fentanyl has also been found in powders sold as cocaine or methamphetamine. People who do not use opioids regularly have no tolerance, so their risk of overdose is especially high.
Fentanyl has also changed the risk of combinations. It is often found with other substances, such as xylazine, and many overdoses involve more than one drug. This makes naloxone, testing and not using alone more important. Treatment for opioid use disorder works for people using fentanyl, and getting help early lowers the risk of death.
Signs and symptoms
- Pills that look like real prescription medicines but come from a friend, dealer or online seller
- Pills with unusual colors, crumbly texture or uneven markings
- Someone becoming very drowsy, confused or limp soon after taking a pill or powder
- Slow or stopped breathing and pinpoint pupils
- Blue or gray lips or fingertips
Causes and risk factors
- Buying pills or powders outside a licensed pharmacy
- Low or no opioid tolerance
- Using alone, so no one can give naloxone or call 911
- Combining drugs or mixing drugs with alcohol
- Changes in the drug supply in your area
- Smoking, snorting or injecting, which all carry overdose risk
How it is checked
You cannot tell whether a pill or powder contains fentanyl by looking at it, smelling it or tasting it. Fentanyl test strips can detect it in a sample of drugs, though they do not show how much is present, and a negative test does not guarantee safety because fentanyl can be unevenly spread. Strip legality and availability vary by state, and many health departments and harm reduction programs give them out free.
In a hospital, standard urine drug screens may not detect fentanyl unless a specific test is used. If you are being treated for an overdose or seeking treatment, telling clinicians what you think you took helps them care for you safely. They are there to help, not to judge.
Related topics
- Buying Medicines Online: Sorting the Evidence From the Noise (Medicines Safety)
- Opioids for Long-Term Pain: What Published Guidance Supports (Chronic Pain)
- Traveling with Medicines: What Published Guidance Supports (Travel Health)
- Acetaminophen Safety: What the Evidence Actually Says (Liver Health)
Where to go next
- What People Get Wrong About Fentanyl Risks
- Fentanyl Risks for Beginners: Where to Start
- Substance Use: The Complete Guide
- The Evidence on Alcohol Use Disorder, Without the Hype
- The Evidence on Cannabis Use, Without the Hype
When to get help
Call 911 right away and give naloxone if someone has slow or stopped breathing, pinpoint pupils or will not wake up. Stay with them until help arrives.
Where this comes from
- CDC — Fentanyl Facts
- National Institute on Drug Abuse — Fentanyl DrugFacts
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.