Why Is Fentanyl So Dangerous and Hard to Spot?

Inconsistent Quality and Purity

Illicit fentanyl production has become increasingly common⁴ in the U.S., as fentanyl is cheap to produce and easy to transport. It can also be used to produce other synthetic opioids, like carfentanil,⁵ which is even more potent.

Counterfeit fentanyl is often produced in clandestine laboratories with little to no quality control. As such, the quality and purity of illicit fentanyl can vary widely from batch to batch. And because of its strength, even small variations can be deadly. An especially strong batch of fentanyl can lead to widespread overdoses. The Red Pheasant Cree Nation in Canada, for example, declared a state of emergency after 8 fentanyl overdoses⁶ in one weekend—a scenario that’s unfortunately all too common. 

Illegal fentanyl is often mixed with other drugs⁷ like heroin, cocaine, meth, and MDMA without the user’s knowledge. This vastly increases the risk of overdose and adverse reactions for people who don’t even intend to take fentanyl. 

Fentanyl Is Hard to Dose

Fentanyl’s extreme potency makes it very hard to dose accurately. Even a small mistake can lead to overdose.

Just 2 milligrams of fentanyl can be fatal. If someone is using a scale to measure fentanyl, but the scale is slightly off, they could easily take too much. Likewise, if someone injects fentanyl using their normal dose, but the product they’re using varies in potency from the last time, they could overdose. 

People who are new to using the drug can have a hard time gauging their dosage. But even experienced drug users can easily make fatal mistakes when dosing fentanyl. 

Tips for Avoiding Fentanyl Overdose

• Never use drugs alone.
• With any new drug, start with a small amount and wait at least 30 minutes before using more.
• Be aware of the signs of overdose, such as loss of consciousness, slow or shallow breathing, and blue lips or fingernails.
• If you suspect an overdose, call 911 immediately and administer naloxone if you have it.

Using Naloxone (Narcan) for Fentanyl Overdose 

Fentanyl overdose can happen quickly,⁸ even after a single use. They can also be hard to reverse, even with naloxone,⁹ a medication that’s commonly used to reverse opioid overdoses. People who overdose on fentanyl may need multiple doses of naloxone to be revived, and likely need to be hospitalized.

What to Do if You Suspect a Fentanyl Overdose

If you suspect that someone is overdosing on fentanyl, call 911 immediately. Administer naloxone if you have it available, but don’t wait for naloxone to arrive before calling 911.

Tips for Administering Naloxone

• If the person is unconscious, roll them onto their back and give them one dose of naloxone in the nose.
• If they’re still unconscious after 2-3 minutes, give them a second dose of naloxone.
• Continue to give naloxone every 2-3 minutes until they becomes responsive or help arrives.
• Stay with them until help arrives. Monitor their breathing and keep them warm.

Nalaxone Challenges

Naloxone is an effective medication for reversing opioid overdoses, but there are some challenges in using it with fentanyl.

Fentanyl is so potent that it can take multiple doses of naloxone to reverse the overdose. And because the effects of naloxone don’t last as long as the effects of fentanyl, people who overdose on fentanyl may need repeated doses of naloxone to stay alive.

Another challenge is that, because fentanyl is often mixed with other drugs, it’s difficult to know how much fentanyl is in someone’s system and how much naloxone they need.

There can also be delays in administering naloxone if the person is overdosing alone or if it takes time for help to arrive. Any delay in administering naloxone to someone who overdoses on fentanyl can reduce their chances of survival. 

“Though naloxone can block fentanyl’s effects, there is evidence to suggest that there is less time to save someone from a fentanyl-related overdose, in comparison to other opioids,” says Associate Professor of Clinical Neurobiology Jermaine Jones, PhD. That’s because fentanyl can cause respiratory depression and death very quickly.

Fentanyl Slows Breathing

Fentanyl depresses the central nervous system¹⁰—particularly the respiratory centers—meaning it slows down breathing and can even stop it altogether. 

Fentanyl binds to opioid receptors in the brain, which regulate pain, pleasure, and mood. This is how it produces its euphoric effect. But opioid receptors also regulate breathing. Respiratory depression is the main cause of death in fentanyl overdoses.¹¹ 

Prevalence and Overdose Statistics

Fentanyl is responsible for a growing number of overdose deaths¹² in the U.S.: 

• The DEA has found counterfeit fentanyl pills containing up to 5.1 milligrams of fentanyl, which is over twice the lethal dose.
• Fatal overdoses from synthetic opioids—mainly fentanyl—rose 55.6% from 2020 to 2021.
• Fentanyl is the leading cause of fatal overdose in the U.S.

Fentanyl plays a significant role in the opioid epidemic, and the number of fentanyl-related deaths continues to rise. The need to address this epidemic is urgent—and it starts with recovery from opioid use. 

If you’re using fentanyl or struggling with opioid dependence, getting help is crucial. Medically supervised detox can help you safely stop opioid use. And comprehensive addiction treatment can help you address the root causes of opioid use disorder, so you can start your journey toward a better life.

By addressing fentanyl addiction, we can save lives and reduce the impact of the opioid epidemic on our families and communities.

Frequently Asked Questions About Why Fentanyl Is So Dangerous