Fentanyl Risks: What the Evidence Actually Says

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 speak to a doctor" below apply to you.

What it is

The dangers of illegally made fentanyl, a powerful synthetic opioid now found in many street drugs and fake pills. It sits within Substance Use. Here are the numbers, taken from the guidance cited at the end.

The numbers, in one place

What helps

These are worth doing. None of them needs to happen all at once.

• 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

Things that seem reasonable and are not.

• 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.

Treatment and support options

Treatment for opioid use disorder

Medications for opioid use disorder, including methadone, buprenorphine and naltrexone, are effective for people using fentanyl. Starting buprenorphine after regular fentanyl use can be more complicated, because fentanyl may linger in the body, so clinicians may use special approaches. Ask your doctor, an emergency room or a treatment program to help you start.

Harm reduction

If you use drugs, harm reduction steps can lower your risk: carry naloxone, test drugs with fentanyl test strips, start with a small amount, and never use alone. Some areas have programs that offer supplies, testing and links to care. These steps keep people alive so they have the chance to recover.

Talking with young people

Teens and young adults may be offered pills that look like real medicines through social media or friends. Talk honestly about fake pills and fentanyl, explain that a single pill can be deadly, and make sure they know how to recognize an overdose and to call 911. Keep the conversation open rather than relying on one talk.

Prevention

• Take only medicines prescribed for you and filled at a pharmacy
• Keep naloxone at home and in your bag or car
• Test drugs with fentanyl test strips if you use
• Never use alone and avoid mixing substances
• Lock up prescription medicines so they cannot be taken or sold

Day to day

For families, fentanyl has made talking about drugs more urgent. Even young people who would never use heroin may try a pill they think is a prescription medicine. Make naloxone a normal part of your household, the way you would keep a fire extinguisher. Talk about what to do in an emergency without assuming anyone is using.

For people who use drugs or are in recovery, staying alive is the first goal. Use the tools that lower risk, keep in touch with people who care about you, and know where treatment is available when you are ready. Relapse can happen; if it does, it is a reason to reconnect with care, not to give up.

For specific groups

Teens and young adults

Young people may buy pills through social media believing they are real prescription medicines. They often have no opioid tolerance, which raises overdose risk. Talk openly, share facts about fake pills, and make sure they know they can call you or 911 without fear.

People who use stimulants

Cocaine and methamphetamine can be contaminated with fentanyl. People who do not use opioids have no tolerance and can overdose quickly. Carrying naloxone and testing drugs is important even if you only use stimulants.

First responders and families

Touching fentanyl on the skin is very unlikely to cause an overdose. Do not hesitate to help someone because of fear of exposure. Wear gloves if available, wash hands with soap and water afterwards, and give naloxone and call 911.

Questions to ask your doctor

• Can you prescribe naloxone and show me how to use it?
• Are there treatment options for opioid use disorder that you can start today?
• How can I safely store and dispose of medicines in my home?
• What should I tell my teen about fake pills and fentanyl?
• Are there harm reduction programs or support services in my area?
• Can you help with pain or anxiety so I do not feel I need to buy pills?

More questions, answered

Can I overdose by touching fentanyl?

Brief skin contact with fentanyl is very unlikely to cause an overdose. Fentanyl is not easily absorbed through the skin. If you touch a substance you think contains fentanyl, wash your hands with soap and water, not alcohol-based sanitizer. Do not delay helping someone who has overdosed.

Is prescription fentanyl dangerous?

Prescription fentanyl, used as directed under medical supervision, is a strong pain medicine with known risks, like other opioids. The overdose crisis is driven mainly by illegally made fentanyl. If you are prescribed fentanyl, follow instructions carefully, store it safely, and dispose of used patches as directed.

Do fentanyl test strips mean my drugs are safe?

No. A positive result means fentanyl was found in the sample you tested. A negative result does not guarantee the drugs are safe, because fentanyl can be unevenly spread or another dangerous substance may be present. Still use less, never use alone, and carry naloxone.

Why do fake pills look so real?

Illegal producers use pill presses to make counterfeit pills that copy the color, shape and markings of real medicines. Even experts cannot reliably tell them apart by sight. The only way to know a medicine is genuine is to get it with a prescription from a licensed pharmacy.

What is rainbow fentanyl?

Fentanyl has been found in brightly colored pills and powders. Color does not change how dangerous it is. Any pill or powder that does not come from a pharmacy may contain fentanyl, whatever it looks like. Talk with children and teens about not taking pills from anyone other than a trusted adult or doctor.

Can treatment help if I use fentanyl every day?

Yes. Medications for opioid use disorder and counseling work for people who use fentanyl. Starting may take extra planning, but clinicians are increasingly experienced with it. Call your doctor, the SAMHSA National Helpline or a treatment program to discuss your options.

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

• Fentanyl Risks for Beginners: Where to Start
• A Q and A on Fentanyl Risks
• Fentanyl Risks — the reference entry
• Substance Use: The Complete Guide
• The Evidence on Alcohol Use Disorder, Without the Hype
• The Evidence on Cannabis Use, Without the Hype

When to speak to a doctor

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.