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Fentanyl Overdose Guide | Symptoms to Know to Save a Life

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Oct 2, 2023 • 7 cited sources

Fentanyl overdose can manifest as slow or stopped breathing, extreme drowsiness, confusion, bluish skin or lips and pinpoint pupils. 

If you suspect someone is experiencing a fentanyl overdose, call 911 immediately and administer naloxone (Narcan) if you have it available.

What Is Fentanyl?

Fentanyl is a very powerful synthetic opioid that is used medically for pain management related to severe injuries or surgical procedures. It is also made and sold on the street and used to amplify the effects of other street drugs. 

Fentanyl is estimated to be up to 100 times more powerful than morphine, its closest peer, and 50 times more powerful than heroin, making it a highly dangerous drug.[1] Prescriptions for the substance are monitored closely by prescribing doctors and law enforcement. 

Very high potency in very small amounts means that fentanyl has been a huge part of the reason why opioid overdose deaths have continued to rise in recent years. Whether it is taken alone or inadvertently ingested because it is mixed in with other street drugs, use of the drug can be deadly. 

Causes & Risks of a Fentanyl Overdose

Fentanyl overdose can happen for several reasons. Some issues that can contribute to the development of an overdose include the following:

Mixing Substances

Fentanyl becomes even more dangerous when mixed with other drugs, which exponentially increases the risk of overdose. This means that it’s important to avoid drinking alcohol or taking any other sedative substances when prescribed fentanyl. Purposefully mixing fentanyl with other substances for recreational use is incredibly risky.

Tolerance & Dependence

With ongoing use of fentanyl, the body develops a tolerance to the drug, meaning that the original dose stops having the desired effect and more is required. This physical dependence could contribute to accidental overdose if the person tries to take more to address the problem and inadvertently takes too much.

Lack of Awareness That Fentanyl Is Present

Fentanyl may be mixed in with other street drugs, so people who think they are buying heroin or prescription pills may not realize that fentanyl has been mixed in until it’s too late.[3] This lack of awareness makes it impossible to moderate intake, which in turn increases the risk of accidental overdose.

Short Duration of Effects

Fentanyl’s short duration of effect can lead people to take additional doses before the drug has had a chance to fully process out of the body. Even though the effects may not be as strong, taking another full dose too soon after the last one can trigger an overdose.[2]

Reduced Respiratory Function

Fentanyl depresses the respiratory system, leading to slow or shallow breathing and could potentially cause breathing to stop altogether. This is the primary issue of concern in an overdose situation. If treatment is not received in a timely manner, the results can be brain damage or death.[4] 

Naloxone Reversal

Naloxone can save your life during a fentanyl overdose, but in severe cases, more than one dose might be required in order to reverse the effects of fentanyl.[4] For this reason, it is recommended that friends and family members always keep multiple doses of the drug on hand and call emergency medical help even if they think they can save the person’s life using naloxone. 

Individual Sensitivity 

Everyone responds differently to fentanyl. A dose that is non-problematic for one person may be deadly for another. 

What Are the Symptoms of a Fentanyl Overdose? 

A fentanyl overdose can have severe and life-threatening consequences, and it’s important to recognize the signs as early as possible and respond right away. Even just a few minutes can mean the difference between life and death. 

The symptoms of a fentanyl overdose can vary from person to person but generally include the following:[3,4]

  • Constricted (very small) pupils
  • Severe respiratory depression, such as slow or shallow breathing
  • Cold, clammy skin
  • Grayish, bluish or pale skin
  • Blue or purple lips and nails
  • Respiratory arrest (stopped breathing)
  • Extreme decreases in levels of consciousness or responsiveness
  • Limp arms and legs
  • Slurred speech or inability to speak
  • Loss of consciousness

A fentanyl overdose can occur rapidly, and prompt medical attention is needed. Even if there are doses of naloxone available, call 911 first to ensure quick access to emergency care if naloxone proves ineffective or additional medical care is needed. 

How to Prevent a Fentanyl Overdose

To safeguard against a fentanyl overdose, take proactive measures about the purchase, use and storage of the drug.[1.4] 

  • If you’re prescribed fentanyl, follow the doctor’s orders regarding proper use precisely, store it safely away from those who might accidentally take it or misuse it, and avoid mixing its use with other substances.[3] If you have concerns about how you feel while taking the drug or its potential interactions with other medications that you are prescribed, talk to your doctor. 
  • If you purchase fentanyl on the street, know that you will not be able to guarantee how much fentanyl is in a given dose, even if you purchase it in pill form. Drug dealers are notorious for mixing fentanyl into a wide variety of substances, and it is impossible to know exactly how much of what is in any given dose. 
  • Keep naloxone on hand as a life-saving precaution, particularly if you or someone you know regularly uses opioids.[4] This is a good idea even if you only use the drug as prescribed. 
  • Avoid using the drug alone, especially if use is recreational. This is true for all types of opioid misuse. If you overdose, you are much more likely to survive if someone can administer naloxone. People who are alone are more likely to experience fatal overdose. 
  • If you are prescribed fentanyl and have extra that you won’t use, dispose of it properly rather than storing it for off-label use at a later time. 

How to Treat a Fentanyl Overdose

When facing a suspected fentanyl overdose, swift action is a matter of life and death. Your immediate priority should be to call 911 even if you have naloxone on hand.

Stay on the line with the dispatcher. Stay with the person, monitoring their breathing and heart rate. If you have access to naloxone, administer it following the instructions provided, as it can temporarily counteract the overdose effects.[5]

If you do not have naloxone and/or it doesn’t work and the person is not breathing, the dispatcher will likely guide you through administering CPR. If the person is breathing and no naloxone is available, position the person on their side to prevent choking if they vomit.

Online MAT Treatment Programs for Fentanyl Addiction 

For individuals dealing with opioid use disorder (OUD) related to fentanyl use, finding effective treatment is essential for long-term prevention of overdose. At Bicycle Health, we provide an innovative approach with our online Medication for Addiction Treatment (MAT) program.[6] 

Our program integrates Suboxone, an FDA-approved medication to treat OUD, with counseling to reduce relapse.[7] This life-changing treatment can reduce the risk of a fatal fentanyl overdose. 

Contact us for more information. We’re ready to help you via our telehealth services today.

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 | Opioids. Centers for Disease Control and Prevention. Published 2023. Accessed August 19, 2023.
  2. Fleischman RJ, Frazer DG, Daya M, Jui J, & Newgard CD. Effectiveness and safety of fentanyl compared with morphine for out of hospital analgesia. Prehospital Emergency Care. 2009;14(2):167–175.
  3. Fentanyl facts. Centers for Disease Control and Prevention. Published 2023. Accessed August 19, 2023.
  4. Schiller EY, Goyal A, Mechanic OJ. Opioid overdose. StatPearls Publishing.
  5. What is naloxone? Substance Abuse and Mental Health Services Administration. Published 2023. Accessed August 19, 2023.
  6. Information about medication assisted treatment (MAT). U.S Food & Drug Administration. Published 2023. Accessed August 19, 2023.
  7. Velander JR. Suboxone: Rationale, Science, Misconceptions. Ochsner J. 2018;18(1):23-29.

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