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The Dangers of Fentanyl Misuse and How to Spot the Signs

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Oct 24, 2023 • 9 cited sources

Fentanyl is one of the most dangerous drugs when illicitly used. 

Fentanyl is extremely potent, even more so than heroin. It therefore carries a high risk of opioid use disorder (OUD). It also carries a high risk of overdose. Since it is often purchased illicitly, it is frequently contaminated with other substances.

If you’re using fentanyl, treatment can help. Your program should involve both counseling and medications to ease your cravings. With a structured treatment, you can discontinue fentanyl use. 

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What Is Fentanyl?

Fentanyl is a powerful synthetic opioid. It is used in the hospital for acute, severe pain like surgeries. It can also occasionally be prescribed as a patch for patients with severe chronic pain.

Today, fentanyl is most frequently discussed in the media because it is synthesized, sold and then used illegally. It can easily lead to fatal overdose when misused.[2]

Key Facts About Fentanyl

Here are key facts about fentanyl and its dangers:

  • Fentanyl is a synthetic opioid that is roughly 100 times more potent than morphine.[1,3]
  • Over the last decade, many fentanyl and fentanyl-like compounds have been mass-produced by the black market in numerous forms.
  • Fentanyl and other similar compounds are often added to heroin without the buyer’s knowledge.[4]
  • Fentanyl is a main driver behind the opioid overdose epidemic in the U.S., causing both fatal and non-fatal overdose.

Is Fentanyl Illegal?

There are a few situations in which fentanyl is legal. It can be used in the hospital and given through an IV, or it can be prescribed for pain treatment and taken as directed by your doctor.

However, when taken recreationally or purchased without a prescription, fentanyl is illegal. There are severe penalties for individuals found to be in possession of illegal fentanyl. 

Common Ways Fentanyl Is Misused

Illicitly manufactured fentanyl is sold in the form of a powder, dropped on blotter paper like small candies, in eye droppers or nasal sprays, or as pills that resemble real prescription opioids.[5]

When misused, fentanyl can be ingested through various mechanisms like these:[6]

  • Swallowed
  • Absorbed under the tongue
  • Injected
  • Inhaled or snorted 

Signs of Opioid Use Disorder

People who misuse fentanyl and other synthetic opioids can develop opioid use disorder (OUD). This means they have lost control of their use, are using the drug recklessly, and have a compulsive need to keep using it despite all the negative consequences in their lives.

People with OUD experience tolerance that prompts them to take more of the drug to achieve the same effect. Physical dependence forms, so they must continue taking opioids or they will enter withdrawal, which is incredibly uncomfortable.

The physical and psychological signs of fentanyl misuse, substance use disorder, and withdrawal are similar to those associated with other opioids and are well described in this article.

Effects of Fentanyl

Some of the most common effects of fentanyl and other opioids include the following:

  • Euphoria
  • Reduced anxiety
  • Drowsiness
  • Relaxation
  • Reduced respiratory drive
  • Constipation
  • Confusion
  • Urinary retention
  • Constricted pupils
  • Nausea
  • Itching
  • Cough suppression
  • Low blood pressure
  • Fainting

Common symptoms of overdose from fentanyl and other opioids include the following:[7]

  • Stupor
  • Cold and clammy skin
  • Bluish skin coloration
  • Pinpoint pupils
  • Coma
  • Respiratory failure
  • Death
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The Dangers of Fentanyl Misuse

As with other opioids, misuse of fentanyl, either pharmaceutical grade or illicitly manufactured, carries numerous risks.


All opioids can cause euphoria. If they are taken almost daily or daily, tolerance and withdrawal develop, leading to OUD. 

OUD often brings significant impairment in function, resulting in job loss, loss of friends and family, and financial strain. As OUD negatively affects mental health, this often prompts more drug misuse, deepening the cycle of addiction.

Overdose & Death

It is extremely easy to overdose on fentanyl because it is so potent. Overdose death rates from these compounds are now the most common cause of fatal opioid overdoses in the United States.[8] 

In 2020, over 56,000 people died of an opioid overdose involving synthetic opioids, and fentanyl was the primary contributor.[9]

Drug Contamination

Illicitly manufactured synthetic opioids like fentanyl are often laced with stimulants (such as methamphetamine, cocaine or MDMA) and other toxic chemicals. Therefore, additional adverse but unforeseen consequences can often occur if someone ingests them.

Getting Treatment for Fentanyl Dependence

There are solutions if you or your loved one needs help with fentanyl use.

For OUD, counseling and support groups greatly help, but the cornerstone of treatment involves using medications that reduce cravings and prevent relapse. This evidence-based approach is known as Medication for Addiction Treatment (MAT).

MAT involves using one of three classes of medication — buprenorphine (Suboxone), naltrexone and methadone — that have been established through numerous studies to improve function and reduce overdose risk.

Suboxone is an excellent first-line treatment for people with opioid use disorder due to fentanyl. If you are using fentanyl or other opioids and want help discontinuing use, reach out to us here at Bicycle Health for more information.

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. February 2022. Accessed March 2023.
  2. A Review: Fentanyl and Non-Pharmaceutical Fentanyls. Drug and Alcohol Dependence. February 2017. Accessed March 2023.
  3. Open-Label Trial of a Single-Day Induction Onto Buprenorphine Extended Release Injection for Users of Heroin and Fentanyl. The American Journal on Addictions. July 2021. Accessed March 2023.
  4. Steep Increases in Fentanyl-Related Mortality West of the Mississippi River: Recent Evidence From County and State Surveillance. Drug and Alcohol Dependence. November 2020. Accessed March 2023.
  5. Fentanyl Drug Facts. National Institute on Drug Abuse. June 2021. Accessed March 2023.
  6. Abuse of Fentanyl: An Emerging Problem to Face. Forensic Science International. June 2018. Accessed March 2023.
  7. Synthetic Opioids: Drug Fact Sheet. Drug Enforcement Administration. April 2020. Accessed March 2023.
  8. Drug Overdose Death Rates. National Institute on Drug Abuse. February 2023. Accessed March 2023.
  9. Synthetic Opioid Overdose Data. Centers for Disease Control and Prevention. June 2022. Accessed March 2023.

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