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Fentanyl: Understanding This Deadly Opioid

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Mar 13, 2024 • 5 cited sources

The data suggests that fentanyl is the opioid that causes the most overdose deaths.[1] It and other synthetic opioids have signaled a deadly upward trend in the already serious opioid overdose epidemic

Fentanyl comes in many forms. It can come in pills in a variety of shapes and colors, on blotter paper, as a powder and in other forms. It can’t be reliably identified by sight, and it is one of the main reasons black market drug purchases are viewed as so dangerous. 

Why Recognizing Fentanyl Pills Matters

It’s important to emphasize that fentanyl has proven to be a central contributor to the ongoing opioid overdose epidemic all over the world.[1] This epidemic began in the 1990s with prescription opioids, saw a spike in overdose deaths with the rise of heroin use in 2010, and then began seeing a massive spike with the widespread introduction of synthetic opioids onto the street market. 

These synthetic opioids represented a fundamental, dangerous shift in the damage opioids were doing year after year. While they have some legitimate medical uses, these use cases are limited. 

Fentanyl is generally regarded as the most widespread of these opioids. It is often combined with heroin, cocaine or other drugs, without a buyer necessarily knowing this is the case.

The opioid overdose epidemic has largely been getting worse, not better. The third wave of opioid overdose deaths has represented a massive spike in what was already a serious problem. Synthetic opioids kill over 20,000 people each year, which is many times more than non-synthetic opioids like heroin do each year.[1]

Common Characteristics of Fentanyl Pills

Fentanyl is sold illegally in many forms, often shaped and colored to look like other types of opioid painkillers.[2] 

In many cases, these pills will be sold to a buyer as a different opioid, such as oxycodone. The pills purchased may or may not contain the drug mentioned by the seller, but fentanyl will be mixed in. This can make the drugs more intense and potentially more profitable to the seller. Often, a seller will not mention that the drugs being sold contain fentanyl despite it generally being a much more potent opioid than whatever the pill is being advertised as containing. 

Fentanyl can also be spiked onto blotter paper or sold as a powder. Like many other opioids, it can be injected, snorted, smoked or taken orally. 

Tricky to Spot

One should never assume drugs purchased on the black market cannot contain fentanyl. Criminals possess the ability to dye drugs in a variety of colors and press them into many forms. It is both possible and common for pills containing fentanyl to look identical or nearly identical to legitimate opioid prescription medications one might get at a pharmacy.[2] 

Many pills have subtle markings imprinted on them intending to signal to experts what type of drug they are. While there’s value in learning how drugs are marked, this is generally only relevant when one can reliably trust that a drug is from a legitimate, legal supplier. Criminal suppliers aren’t regulated. They can print whatever markings they want on a drug. 

Variations & Counterfeit Pills

Fentanyl can’t be reliably identified without expertise and testing. It comes in a wide variety of forms and is often sold in the form of counterfeit pills, which look nearly identical to legitimate medications. 

Considering this drug is being sold and used illegally, where a buyer may not even know how much fentanyl a purchase contains, it, unfortunately, becomes relatively easy to understand why so many people are dying as this drug spreads through the black market.[1] 

Essentially, counterfeit pills can be made to look identical to standard medications. There isn’t a way to reliably detect fentanyl visually. A test is required.

Why Is Fentanyl Laced Into Other Drugs?

Dealers can smuggle small amounts of fentanyl and then sell products of a similar potency compared to if they smuggled larger amounts of less potent opioids. Criminal operations generally prioritize profits over buyer safety. 

To better understand the dangers this practice can present to buyers, it should be noted that a  2 mg dose of fentanyl can be fatal. Pills containing fentanyl contain varying amounts (the exact amount both a buyer and seller might not know) and can often contain more than 5 mg of fentanyl.[5]

Like other opioids, fentanyl can hijack the brain’s reward systems, and it is highly addictive. Dealers aren’t incentivized to intentionally cause buyers to overdose, but they are incentivized to get buyers addicted to the products they sell. An individual addicted to their product is likely to be a repeat customer. Mixing fentanyl with other drugs, including non-opioids, can help to make them more addictive. 

FAQs: What Do Fentanyl Pills Look Like?

Some frequently asked questions about identifying fentanyl include the following:

Are all fentanyl pills the same color?

Not all fentanyl pills are the same color or shape. You cannot visually identify whether a given pill might contain fentanyl. It is fairly easy for criminals to dye pills to whatever color they desire and press them into different shapes. Oftentimes, pills that are laced with fentanyl are made to look like other, less potent drugs.

Do legitimate medications contain fentanyl?

Fentanyl is sometimes prescribed to treat severe pain, but it should only be prescribed with great care and for the minimum time necessary to provide a person with needed pain relief. This is most common for pain resulting from surgeries and for advanced-stage cancer patients.[3] 

How can I identify fentanyl pills accurately?

It is possible to test for the presence of fentanyl using fentanyl testing strips, which are relatively inexpensive and give results fairly quickly.[4] However, even if a strip tests negative, it doesn’t mean a drug is necessarily safe. It only means it is unlikely to contain fentanyl (assuming the test was conducted correctly).[3] 
It also doesn’t mean that every pill one purchased doesn’t contain fentanyl. Fentanyl tests can only definitely test what they’re used on. It isn’t impossible or even especially difficult for a dealer or manufacturer to mix pills that contain fentanyl with those that do not.

Why is fentanyl so dangerous?

Synthetic opioids tend to be many times more powerful than other kinds of opioids. For reference, fentanyl is about 100 times as potent as morphine, which is often used as the standard reference point when determining how potent a given opioid is. Fentanyl is about 50 times more potent than heroin.[2]

A Small Dose Can Be Fatal

Fentanyl is cheap to manufacture. Criminal labs are able to produce large quantities of the drug. It’s also versatile—able to be mixed with other substances and sold in many different forms.[5]

It’s important to stay vigilant when it comes to the spread of fentanyl and to acknowledge that, no matter how careful you are, you can never be certain drugs purchased from the black market don’t contain the drug.

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. Understanding the opioid overdose epidemic. Centers for Disease Control and Prevention. Published August 2023. Accessed February 12, 2024.
  2. Fentanyl FAQ’s. United States Attorney’s Office. Published September 2023. Accessed February 12, 2024.
  3. Fentanyl facts. Centers for Disease Control and Prevention. Published September 2023. Accessed February 12, 2024.
  4. Olson R, Case P, Palacios WR, Hunter A, Lopes-McCoy V, Green TC. Law enforcement and community provision of fentanyl test strips to people who use drugs for engagement and referral to services. Journal of Public Health Management and Practice. 2022;28(Supplement 6):S343-S346. 
  5. 5 things everyone should know about fentanyl. University of Colorado. Published September 2023. Accessed February 12, 2024.

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