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How to Tell if Someone Is on Fentanyl

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated May 13, 2023 • 9 cited sources
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Fentanyl is a dangerous and deadly opioid drug. Once a substance that was relegated to hospitals and hospices only, it has made its way out onto the street market in the past decade, becoming an increasing problem for people who struggle with opioid use disorder (OUD). 

Because fentanyl is incredibly potent — up to 50 times more potent than heroin and 100 times more potent than morphine — even very small amounts can result in an overdose.[1]

For this reason, early identification of an opioid use disorder related to fentanyl is imperative. The sooner the person recognizes that treatment is needed and connects with treatment, the sooner they are free of potential overdose, accident while under the influence, and acute and chronic health conditions that can result from fentanyl use. 

If your loved one is living with a fentanyl use problem or any kind of OUD, we can help. Call Bicycle Health now to learn more about how Medication for Addiction Treatment (MAT) can help your loved one begin the healing process. 

The Impact of Fentanyl Use in the United States 

Fentanyl, a synthetic opioid, was first synthesized in 1959 and used primarily as an anesthetic and pain reliever during surgical procedures in a hospital setting.[2] In the 1990s, pharmaceutical companies began producing fentanyl patches and oral lozenges for the treatment of severe pain, something usually reserved for cancer patients and those in the end stages of their lives.

However, in recent years, fentanyl has made its way out of hospitals and hospices and onto the black market, becoming a significant public health concern in the United States. Illicitly manufactured fentanyl, which is often mixed with other drugs such as heroin, cocaine, or counterfeit prescription pills, has been the primary cause of a dramatic increase in overdose deaths in recent years. 

The rise of illicit fentanyl can be traced back to China, where it was first produced and exported to North America in the early 2000s. Since then, the production and distribution of the drug have become more commonplace, spreading around the world through criminal organizations seeking to make a profit.

The impact of fentanyl use in the United States has been devastating. According to the Centers for Disease Control and Prevention (CDC), there were more than 68,000 overdose deaths due to opioids in 2020, and more than 82% of these deaths involved synthetic opioids like fentanyl.[3]

There are few areas of the country that have not seen steadily higher rates of death due to synthetic opioid overdose. All but 11 states saw an increase in synthetic opioid overdose death rates from 2019 to 2020.[4]

Efforts to combat the fentanyl crisis in the United States have focused on increasing access to addiction treatment and harm reduction measures, such as naloxone distribution and needle exchange programs. Law enforcement agencies have also cracked down on the production and distribution of illicit fentanyl, both domestically and internationally. However, much more work is needed to address the complex factors contributing to the fentanyl crisis and prevent further loss of life. 

What Are the Physical Signs That Someone Is Using Fentanyl? 

There are a number of behavioral and physical changes that occur when someone is under the influence of fentanyl. These changes, or signs, can indicate a fentanyl use disorder if the person does not have a prescription for the drug.

Some common signs of fentanyl use include the following:

  • Constricted pupils: One of the most common signs of opioid use is pinpoint pupils, which means the pupils are extremely small and do not respond to changes in light.
  • Slow breathing: Fentanyl use can depress the respiratory system, slowing down the user’s breathing, which may be recognized as shallow or labored breathing.
  • Nausea and vomiting: Stomach upset that manifests as nausea, vomiting, and stomach cramps is not uncommon. Lack of appetite or disinterest in eating can be an indicator of this. 
  • Confusion: Fentanyl can cause confusion, disorientation, and impaired judgment.
  • Itchiness and scratching: Itchiness and excessive scratching are not uncommon among people using opioids.

It is important to note that these signs can also indicate use of other opioids, and some of the signs can indicate use of any substance. In some cases, one or more of the signs can be symptoms of other medical conditions as well. Therefore, if someone shows signs of some of these symptoms, that on its own is not definitive evidence that they are using fentanyl.

What Are Some of the Behavioral & Mental Changes When Someone Is Using Fentanyl?

Behavioral and mental changes can be as much of an indicator of fentanyl use as the physiological changes. These can include the following: 

  • Mood changes: Fentanyl can cause drastic shifts in mood, including euphoria, anxiety, and depression. It can also translate into anxiety, agitation, and paranoia, often without any discernible cause.[6]
  • Social withdrawal: Regular use of opioids can lead to social withdrawal and isolation, especially if the person must choose between a social event and using drugs. 
  • Financial problems: Fentanyl and all street drugs can be expensive. Those who use it regularly often run out of money quickly, especially if they are unable to maintain employment.
  • Euphoria: Use of any opioid can produce a feeling of intense pleasure and well-being, often described as a “rush” or “high.”
  • Loss of motivation: Opioids slow down everything in the body, which then triggers a decrease in motivation as well as apathy and disinterest in activities that were previously enjoyed.
  • Impaired judgment: In addition to the risk of using fentanyl, questionable and often dangerous choices are made while under the influence or in pursuit of more drugs.
  • Personality changes: In addition to mood changes and potential mental health issues, loved ones may notice a change in routine, friendships, and responses that were once a dependable part of their personality. For example, they may steal or lie as a part of keeping the flow of drugs going and covering their tracks. 

It is not uncommon for someone living with a substance use disorder to also struggle with a co-occurring mental health disorder. In some cases, the mental health issues predate the opioid use disorder. Many people report use of substances to help them manage mental health symptoms. In other cases, mental health problems begin or are worsened by drug use.[7]

How Can You Tell if Someone Is Going Through Fentanyl Withdrawal?

Fentanyl withdrawal can be a challenging and uncomfortable experience, both physically and mentally. Here are some signs and symptoms that may indicate that your friend or family member may be going through fentanyl withdrawal:

  • Gastrointestinal distress: Diarrhea, vomiting, and abdominal cramping are the norm during fentanyl withdrawal.
  • Anxiety and restlessness: Feeling restless physically and mentally as well as anxious and paranoid may be signs of fentanyl withdrawal. 
  • Insomnia: Due to extreme physical and mental distress, sleeping during fentanyl detox is difficult. As a result, people may be up at odd hours.
  • Goosebumps and chills: Fentanyl withdrawal can cause goosebumps and chills, a symptom that precipitated the phrase cold turkey. These symptoms are most likely when someone stops using fentanyl or any opioid suddenly.
  • Body aches and pain: Joint pain, back pain, muscle aches, and more characterize fentanyl detox. 
  • Mood changes: Moody behavior during fentanyl detox can include paranoia, anger and anxiety based on delusion, irritability caused by physical discomfort and lack of sleep, and depression. These symptoms are most acute during the early phase of withdrawal.

How Can You Tell if Someone Is Overdosing on Fentanyl?

Fentanyl overdose can be deadly, so early identification is key. The sooner that someone gets medical treatment, the more likely they are to survive without long-term consequences.

Signs of fentanyl overdose may include the following: 

  • Respiratory depression: Fentanyl binds to the opioid receptors in the brain, slowing down the respiratory system, causing shallow breathing, or even triggering respiratory arrest, which means breathing is slow, low, or stopped. 
  • Pinpoint pupils: Excessive fentanyl use, which occurs before but also during overdose, can cause pupils to become very small, or “pinpoint.” In addition, pupils will not react to changes in light.
  • Cold, clammy skin: The slowing down of the systems in the body comes with a lowering of body temperature, which causes the skin to become cold and clammy to the touch.
  • Bluish lips and nails: A lack of oxygen due to shallow or stopped breathing can cause a bluish tint to the skin, especially the lips and fingernails.
  • Unresponsiveness: When a person is overdosing on an opioid, they will not be able to respond to stimuli. Even if they appear to be awake, they will not answer questions or respond when you call their name or shake them. They essentially can’t be woken up.
  • Confusion and disorientation: Even if the person is still conscious, if they are overdosing, they will still be unable to carry on a conversation. They may seem confused about where they are and what is happening. 
  • Seizures: Convulsions and seizures may also occur during fentanyl overdose. It is a less common symptom, but if it occurs in conjunction with other symptoms, it can indicate an opioid overdose. 

Fentanyl overdose can be stopped with medical treatment and the application of a drug called naloxone.[9] Naloxone binds to the opioid receptors, kicking off fentanyl and immediately stopping its effects. 

In some cases, multiple doses of naloxone may be needed due to the potency of fentanyl. As long as the physical symptoms are not being caused by other drugs in the system and the overdose is recognized in time, the medication can save someone’s life. 

If you believe that you or someone you love is experiencing a fentanyl overdose, call 911 immediately. First responders usually carry naloxone and will be able to give the drug to someone who is overdosing if none is available. Further medical treatment is needed after naloxone is given, so don’t delay in calling 911.

Treatment for Fentanyl Use Can Start Today

In addition to naloxone, there are medications that can help people to navigate fentanyl withdrawal safely and successfully stop taking the drug with minimal withdrawal symptoms. With drugs like methadone and Suboxone, used under the supervision of a medical team, symptoms caused by fentanyl detox can be managed. 

Use of these medications can also help to decrease the risk of relapse. If you attempt to detox from fentanyl on your own, relapse is likely.

Contact Bicycle Health today to learn more about Medication for Addiction Treatment and how to get started on a regimen that’s right for you or your loved one. MAT can change everything when it comes to recovery from OUD.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Fentanyl Facts. Centers for Disease Control and Prevention. September 2022.  Accessed March 2023.
  2. Fentanyl Facts. Drug Enforcement Agency. April 2020. Accessed March 2023.
  3. Death Rate Maps and Graphs. Centers for Disease Control and Prevention. June 2022. Accessed March 2023.
  4. Synthetic Opioid Overdose Death Data. Centers for Disease Control and Prevention. June 2022. Accessed March 2023.
  5. Opioid Use Disorder. American Psychiatric Association. Accessed March 2023.
  6. Opioid Abuse. American Society of Anesthesiologists. Accessed March 2023.
  7. Common Comorbidities with Substance Use Disorders Research Report Part 1: The Connection Between Substance Use Disorders and Mental Illness. National Institute on Drug Abuse. April 2020. Accessed March 2023.
  8. Opioid Addiction and Withdrawal: What You Should Know. UConn Today. June 2022. Accessed March 2023.
  9. Reverse Overdose to Prevent Death. Centers for Disease Control and Prevention. November 2021. Accessed March 2023.
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