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How to Tell if Someone Is on Fentanyl

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Nov 29, 2023 • 13 cited sources

Fentanyl is a dangerous and deadly opioid drug. Once a substance only used in hospitals and hospices, it has made its way out onto the street, becoming an increasing problem for people with opioid use disorder (OUD).

Knowing what fentanyl use looks like is critical, as the drug can be deadly. Fentanyl is so incredibly potent — up to 50 times more powerful than heroin and 100 times stronger than morphine — that even very small amounts can result in an overdose.[1]

The sooner a person recognizes that treatment is needed and connects with treatment, the sooner they are free of potential overdose, accidents while under the influence, and acute and chronic health conditions that can result from fentanyl use.

The Rise 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] 

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.

Because fentanyl is cheap to create and highly addictive, it creates a greater profit margin for dealers.[3] They add the drug to other opioids (like heroin) and completely different substances (like marijuana, cocaine and ecstasy). 

Researchers say that 6 in 10 prescription pills sold by dealers now contain a potentially lethal dose of fentanyl.[4] Death rates are rising accordingly. 

According to the Centers for Disease Control and Prevention (CDC), there were more than 80,000 overdose deaths due to opioids in 2021 and nearly 88% of these deaths involved synthetic opioids like fentanyl.[5]

How Does Fentanyl Make You Feel?

Like all opioids, fentanyl attaches to receptors within the brain, triggering the release of chemicals like dopamine, which can cause feelings of euphoria and relaxation. Almost all of the symptoms people experience are caused by this chemical release. 

Experts say fentanyl’s effects include extreme happiness.[6] The brain is flooded with chemicals that make the person feel an extreme ‘high’. The effect is short-lived and followed by sedation. 

After using fentanyl multiple times, brain cells adapt by producing less dopamine without drugs. People who regularly use end up struggling to experience pleasure from anything that isn’t fentanyl. An opioid use disorder (OUD) related to fentanyl use develops quickly.[6]

Signs of Fentanyl Use: What to Look Out For 

Several behavioral and physical changes 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.

Some of these symptoms are serious. Understanding what they look like is critical, as an overdose can be fatal. Spotting them could mean the difference between life and death. 

Physical Signs 

Symptom severity is based on how much fentanyl people take. The more you use, the more significant the difficulties. 

Common physical symptoms associated with opioid intoxication include the following:[7]

  • Sedation: Fentanyl can make people seem half-asleep.
  • Slow breathing: Sedation caused by fentanyl can make people breathe very slowly.
  • Stopped breathing: Some people develop blue-tinged fingernails and lips due to lack of oxygen. 
  • Nausea and vomiting: Opioid receptors are located in the intestines too, and fentanyl latching there can sometimes cause significant problems. 
  • Tiny pupils: Opioid use can cause pinpoint pupils, which are easily spotted by outsiders. 

Behavioral & Mental Signs 

Behavioral and mental changes can be as much of an indicator of fentanyl use as physiological changes. 

Mental health symptoms of fentanyl use can include the following:[7]

  • Confusion: Opioid latching in the brain can lead to severe sedation and poor oxygen saturation, making the brain work slowly. 
  • Delirium: The flooding of chemicals like dopamine throughout the brain can cause profound changes in mood. 
  • Reduced responsiveness: Intoxicated people can be slow to respond to questions and outside prompts. 

Researchers know how drug use changes adolescent behaviors. Many of these adjustments are seen in adults too. The following problems are common in those who regularly use fentanyl:[8]

  • Poor performance: People who are high can’t participate well in activities at work or school. 
  • Risk-taking behaviors: People who keep using drugs may face consequences like arrests. They may keep taking drugs regardless, leading to an accumulation of legal issues. 
  • Attempts to fund drug use: Fentanyl and other drugs are expensive. Some people resort to techniques like theft to pay for them.

Symptoms of Fentanyl Withdrawal 

Fentanyl withdrawal can be challenging and uncomfortable, 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:[9]

  • Poor mental health: Anxiety, agitation and insomnia are common when people quit using fentanyl. 
  • Pain: Aching muscles and abdominal cramping often occur during fentanyl withdrawal. 
  • Visible signs: Symptoms you might see include watery eyes, running nose, sweating and yawning. 
  • Abdominal discomfort. In the late stages of withdrawal, people experience diarrhea, nausea and vomiting. 

Symptoms typically begin about 12 hours after the last dose, and they can last for about a week.[9] Moving through this process alone is very difficult, and it can be dangerous. Treatment is important, particularly use of Medication for Addiction Treatment (MAT).

Fentanyl Overdose Signs 

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

Experts say an opioid overdose is identified by the following three signs and symptoms:[10]

  • Tiny pupils: The person’s pupils may be so small that you can’t even see them, and they don’t get bigger in a dark room. 
  • Severe sedation: The person may be unconscious and unresponsive when you shake or tap them. 
  • Slow or absent breathing: Some people breathe very shallowly, while others don’t breathe at all. 

What to Do if You Suspect a Fentanyl Overdose 

A fentanyl overdose can be fatal if it’s not handled quickly and properly. Fentanyl overdose can be stopped with medical treatment and the administration of naloxone. 

Naloxone binds to opioid receptors, kicking off fentanyl and immediately blocking its effects. If someone you love uses opioids, keep this medication with you at all times.

If you think someone is overdosing, take the following steps:[11-13]

  • Try waking the person up. Shake them and call their name. 
  • Call 911. Tell the operator that you think someone is overdosing. Provide your location, and do what the operator requests. 
  • Administer naloxone. The medication is typically sold as a nasal spray (Narcan), and it comes with directions. Follow those instructions carefully. In some cases, multiple doses of naloxone may be required to overcome the extremely potent effects of fentanyl.
  • Check for breathing. Put your head close to the person’s mouth to listen or feel for breath. If the person isn’t breathing and you know how to do CPR, provide it. 
  • Stay there. Wait for the officials to arrive, and follow the instructions the operator provides. 

Treatment for Fentanyl Addiction With Bicycle Health 

MAT can help people who are addicted to fentanyl stop using, avoid overdose risks and develop a healthier life. In the past, enrolling in MAT meant visiting a clinic every day. Bicycle Health is different. 

Bicycle Health offers MAT via telehealth appointments. Meet with a professional online and pick up a prescription at a pharmacy near you. Contact us to see if this model is right for you. 

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. Published September 6, 2023. Accessed October 13, 2023. 
  2. Fentanyl. U.S. Department of Justice. Published April 2020. Accessed October 13, 2023. 
  3. Fentanyl fact sheet. Colorado’s 17th Judicial District Attorney’s Office. Accessed October 13, 2023. 
  4. DEA laboratory testing reveals that 6 out of 10 fentanyl-laced prescription pills now contain a potentially lethal dose of fentanyl. United States Drug Enforcement Administration. Published October 13, 2023. 
  5. Drug overdose deaths. Centers for Disease Control and Prevention. Published August 22, 2023. Accessed October 13, 2023. 
  6. Fentanyl drug facts. National Institute on Drug Abuse. Published June 2021. Accessed October 13, 2023. 
  7. Opioid intoxication. U.S. National Library of Medicine. Published April 1, 2023. Accessed October 13, 2023. 
  8. Consequences of youth substance abuse. Drug Identification and Testing in the Juvenile Justice System. Published May 1998. Accessed October 13, 2023. 
  9. Opiate and opioid withdrawal. U.S. National Library of Medicine. Published April 30, 2022. Accessed October 13, 2023. 
  10. Opioid overdose. World Health Organization. Published August 29, 2023. Accessed October 13, 2023. 
  11. Opioid overdose basics. National Harm Reduction Coalition. Accessed October 13, 2023. 
  12. Naloxone for opioid overdose: Life-saving science. National Institute on Drug Abuse. Published March 30, 2017. Accessed October 15, 2023. 
  13. Hanson BL, Porter RR, Zöld AL, Terhorst-Miller H. Preventing opioid overdose with peer-administered naloxone: findings from a rural state. Harm Reduction Journal. 2020;17(1). 

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