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Why Is Fentanyl So Dangerous? Overdoses & Deaths

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Sep 26, 2023 • 13 cited sources

Fentanyl is one of the most powerful opioid drugs ever created. Just 2 mg of the drug — an amount small enough to fit on a pencil tip — is sufficient to kill the average American.[1]

Because fentanyl is so powerful, dealers don’t need to ship much of it to make hundreds of doses to sell to unsuspecting Americans. They often substitute it for weaker, harder-to-import drugs. And it’s impossible to tell if the dose you’re about to take contains something relatively mild (like Xanax) or something lethal (like fentanyl). 

What Is Fentanyl?

Fentanyl is an opioid drug between 50 and 100 times stronger than morphine.[2] In the 1960s, when the drug was introduced, it was used as an anesthetic.[3] Since then, it’s been closely linked to clandestine labs and overdoses. But legal forms of the drug remain. 

Legal Fentanyl

Pharmaceutical-grade fentanyl is designed to address persistent pain in people accustomed to opioids. Someone using a drug like oxycodone for cancer, for example, might need fentanyl as the disease grows stronger and more painful. 

Legal fentanyl is sold in many forms, including the following:[3]

  • Lozenges
  • Lollipops
  • Sprays 
  • Tablets 
  • Patches
  • Injections 

Sometimes, people steal these medications and sell them on the black market. Anyone who uses a fentanyl product without a prescription is breaking the law and putting their life at risk. 

Illicit Fentanyl

For decades, law enforcement officials have struggled to stop the painkiller trade. They were tightly focused on drugs like OxyContin and Vicodin until about 2005, when deaths associated with illegal fentanyl began to rise.[4]

Dealers turned to fentanyl when officials cracked down on painkillers and made importing drugs harder. They could make fentanyl in a lab and send just a tiny bit across the border. Once there, dealers could “cut” the fentanyl with inert substances and turn a little fentanyl into a lot of powders, pills and profits. 

While Mexico and China are primary fentanyl sources in the United States, India is entering the market.[5] Officials are trying to keep these drugs out of the country. But so far, it’s not working. 

Fentanyl Overdoses in the United States

As dealers began importing more fentanyl products into the country, death rates rose accordingly. In 2014, less than about 20,000 people died of fentanyl overdoses. By 2021, more than 70,000 people did.[6]

While other drugs, including heroin, cocaine and prescription painkillers, took lives between 2014 and 2021, the rise of fentanyl stands alone. When charting associated deaths, all other drugs have nearly straight lines clustered at the bottom. Fentanyl’s line shoots straight up like a rocket.[6]

Researchers call this a third wave of opioid-related overdose deaths, and they say the trend began in 2013.[7] 

While all age groups are affected, young people are particularly at risk. Overdose deaths in children and adolescents rose 83.6% between 2019 and 2020. The shift is attributed to a 110.6% increase in unintentional poisonings during this timeframe.[8]

Most contaminated drugs that could cause unintentional poisonings contain fentanyl. The United States Drug Enforcement Administration (DEA) says six in 10 fentanyl-laced pills now have a lethal dose.[9]

Since fentanyl is colorless, odorless and tasteless, it’s impossible to detect without a test. And it’s found in almost every type of drug, including those sold on the street as painkillers, cocaine and ecstasy. Anyone who takes these pills could overdose. 

Can a Fentanyl Overdose Be Reversed?

A fentanyl overdose can be lethal, but it doesn’t have to be. Administering naloxone, available over the counter in most states, can restore normal breathing within two to three minutes in someone who overdoses.[10]

Naloxone is typically sold in easy-to-administer nasal sprays. You may need to give more than one dose to someone overdosing on fentanyl since the drug is so powerful.[10] It’s not uncommon for more than two doses to be needed.[13]

People who are overdosing exhibit these symptoms:[10]

  • Pinpoint pupils 
  • Slow or absent breathing 
  • Discolored fingernails and lips 
  • Extreme drowsiness or unconsciousness
  • Limp body
  • Gurgling or gagging sounds

If someone is overdosing, take the following steps:[10]

  1. Administer naloxone. Don’t wait to confirm that the person took fentanyl. Naloxone won’t hurt someone who didn’t take the drug. Follow the instructions on the package, and deliver the dose quickly. 
  2. Call 911. Tell the operator where you are, what you see and when you administered naloxone. Stay on the phone. They may give additional instructions for you to follow.
  3. Administer more naloxone. If the person hasn’t awakened, give another dose about three minutes later. 
  4. Use the recovery position. Once the person awakens, turn them on their side. 
  5. Stay there. Wait until help arrives before leaving the scene. 

The person may need to go to the hospital for further treatment. If naloxone wears off and fentanyl molecules are still active in the person’s body, the overdose can return. Even if the person recovers after naloxone administration, further medical care is needed.

Other Fentanyl Dangers Explained 

Overdose is one of the most serious fentanyl dangers, but it’s not the only one. Several other problems are linked to fentanyl, especially in those who use the drug repeatedly. These are some of the issues: 

Opioid Use Disorder (OUD)

Regular opioid use alters brain chemistry. Changed cells can’t make critical chemicals like dopamine. 

And parts of your brain concerning your sense of reward and ability to control your behavior begin to atrophy. In time, drugs become the most important part of a person’s life. 

Very strong opioids like fentanyl cause intense changes in just a few doses. The brain whipsaws between intense euphoria and deep withdrawal. An OUD can develop very quickly when using a powerful drug like fentanyl. 

Poor Physical Health 

Regular opioid misuse can lead to several very serious health problems, including the following:

  • Increased risk of falls 
  • Endocrine abnormalities
  • Reduced immune system function
  • Abnormal pain sensitivity 

Poor Mental Health 

People who misuse opioids often struggle with depression. Often, symptoms appear after people start using these painkillers.[12] Changes in the drug’s pleasure centers, sparked by drug misuse, can make it harder for you to enjoy your life without drugs. 

Social Consequences

Anyone can develop an OUD, but the condition is often stigmatized. People with a fentanyl issue may not feel comfortable asking for help. And when they do, they may be blamed for using the drug. 

Family members and friends may be encouraged to use “tough love” tactics. They may push the person into homelessness as a way of making them face the OUD head on. 

As job losses and financial problems intensify, people may be increasingly isolated and alone. They may not feel mentally ready to ask for help or enter treatment. Dipping deeper into opioid misuse may seem like the only choice, as they have no one left to disappoint. 

How to Help Someone With a Fentanyl Addiction 

Someone struggling with an OUD caused by fentanyl may feel hopeless. You can change that with your compassion and advocacy. 

Medication for Addiction Treatment (MAT) programs use prescriptions like Suboxone to ease chemical imbalances caused by drugs. With Suboxone, the person may be able to get sober without feeling sick or craving drugs. Counseling can help them to build a new life in sobriety with fewer relapse risks. 

MAT is considered the gold standard of treatment for OUD. Combining medications and therapy can help people to tackle their OUD from two directions. The result is full healing and a better future. 

At Bicycle Health, we administer MAT through telemedicine. Visit with a talented treatment team via video, and pick up your Suboxone prescription at your pharmacy. Tackle the problem without sacrificing privacy or dignity. 

Contact us to find out if this is the right model for you or someone you love. Take our quick online assessment to get an answer in minutes. 

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. One pill can kill. United States Drug Enforcement Administration. Accessed August 18, 2023.
  2. Fentanyl. National Institute on Drug Abuse. Published December 2021. Accessed August 18, 2023.
  3. Fentanyl. Drug Enforcement Administration. Published December 2016. Accessed August 18, 2023.
  4. Millar A. Fentanyl: Where did it all go wrong? Pharmaceutical Technology. Published February 27, 2018. Accessed August 18, 2023. 
  5. Fentanyl flow to the United States. United States Drug Enforcement Administration. Published January 2020. Accessed August 18, 2023.
  6. Drug overdose death rates. National Institute on Drug Abuse. Published June 30, 2023. Accessed August 18, 2023.
  7. Understanding the opioid overdose epidemic. Centers for Disease Control and Prevention. Published August 8, 2023. Accessed August 18, 2023.
  8. Goldstick J, Cunningham R, Carter P. Current causes of death in children and adolescents in the United States. N Engl J Med 2022; 386:1955-1956 DOI: 10.1056/NEJMc2201761 
  9. DEA laboratory testing reveals that 6 out of 10 fentanyl-laced fake prescription pills now contain a potentially lethal dose of fentanyl. United States Drug Enforcement Administration. Accessed August 18, 2023. 
  10. Lifesaving naloxone. Centers for Disease Control and Prevention. Published April 21, 2023. Accessed August 18, 2023. 
  11. Long-term harms of opioids. Royal College of Anaesthetists. Accessed August 18, 2023. 
  12. Depression and opioid use go hand in hand. National Council for Mental Wellbeing. Published June 14, 2018. Accessed August 18, 2023. 
  13. Moss, R.B., Carlo, D.J. Higher doses of naloxone are needed in the synthetic opioid era. Subst Abuse Treat Prev Policy 14, 6 (2019).

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