Overdose signs and risk factors
Fentanyl is an extremely potent opioid. Just the smallest amount of fentanyl — an amount equal to three grains of salt, according to the Centers for Disease Control and Prevention (CDC) — can be hazardous. Sometimes referred to by dealers as Apache, Friend, or Goodfella, illicit fentanyl can be inhaled as a nasal spray, eaten in candy form, or injected with a needle. In addition, virtually any other illicit drug can have fentanyl added to it.
The drug has contributed to record numbers of drug overdose deaths. In 2021, there were an estimated 107,622 drug overdose deaths in the United States; most of these fentanyl or other synthetic opioids.
Someone experiencing an overdose from an opioid such as fentanyl may have small pupils, lose consciousness, breathe slowly or stop breathing, make gurgling sounds, go limp, or have cold or discolored skin. If you see these signs or symptoms, call 911 immediately and then administer naloxone if you have it. Try to keep the person awake and place them on their side so they don’t choke.
Certain risk factors make it more likely that you or a loved one could misuse or become dependent on any opioid, including fentanyl, whether the drug is prescribed by a health professional or obtained illegally. These include:
Age, lifestyle, and medical history. Dependence is more likely if you use or have used other drugs, have an untreated mental illness, or live in a situation that enables drug misuse. You may be at greater risk of overdosing on prescription opioids if you are over age 65 or have a health condition such as sleep-disordered breathing, end-organ dysfunction, or lung disease. Meanwhile, the rate of nonmedical opioid use is highest among people ages 18 to 25, and most people who misuse prescription opioids start using the drug in their early to late 20s. Prescription opioid overdose deaths occur mostly among people aged 25 to 54.
Long-term use. Using opioids for even a few days raises your risk of becoming dependent and experiencing side effects. An estimated 1 in 4 people receiving prescription opioids long term in a primary care setting become dependent, according to research summarized by the CDC.
High dosage. Taking a higher dose comes with a greater risk of dependence than taking a lower dose does, but even taking a low dose is risky, according to CDC prescribing guidelines.
Extended-release formulations. Dependence is more common with drugs that act over a longer period than with those that act more immediately, CDC guidelines say.
More than other opioids, fentanyl is associated with fatal and nonfatal overdoses. To avoid serious harm and even death, be aware of these additional risks:
- If you don’t test drugs to know what else might be in them, you may accidentally take a fatal dose of fentanyl.
- If you use drugs when you are alone and overdose, there may be no one around who can administer naloxone.
- If you recently experienced a nonfatal overdose, you are at heightened risk of overdosing again.
- You are in grave danger of overdosing if you mix opioids with other substances, especially those that make you drowsy (e.g., alcohol; benzodiazepines such as Xanax or Valium; muscle relaxants like Soma; and sleep aids such as Ambien).
- If you inject drugs such as fentanyl, you increase your chances of contracting hepatitis B or C, HIV, and tetanus.
