What to know about fentanyl addiction + treatment with Ophelia

Despite the prevalence of fentanyl in the news, many people still don’t know exactly what fentanyl is. Fentanyl is a synthetic opioid that is approved by the Food and Drug Administration (FDA) for anesthesia and pain management. Prescription fentanyl treatment is available in several forms, including:

• Lozenges
• Lollipops
• Transdermal patches
• Shots 

Fentanyl was initially synthesized in 1960 by a Belgian chemist and became available as an intravenous anesthetic in the same decade. Today, doctors may prescribe fentanyl to help patients manage severe pain after surgery or chronic pain, especially if they have a physical tolerance to other opioids. 

People also use fentanyl recreationally, either alone or paired with illicit drugs. Illegal fentanyl is available as pills made to look like prescription opioids, powders, eye droppers, nasal sprays, and drops on blotter paper like candy. 

Since the 2010s, overdose deaths involving synthetic opioids like fentanyl have significantly increased, reaching over 70,000 reported overdose deaths in 2022. Fentanyl has been the main driver of this increase. It’s around 100 times more potent than morphine and 50 times more potent than heroin. This high potency increases the risk that people using fentanyl will overdose, especially if they are not aware that there’s fentanyl in their drugs. 

Illegal fentanyl is present in many other illicit drugs like methamphetamine, cocaine, and heroin, often without the knowledge of the people using those substances.

As a synthetic opioid, fentanyl binds to the opioid receptors in the brain. The opioid receptors are in the parts of the brain that control emotions and pain. When someone takes fentanyl and binds it to those receptors, the drug interrupts pain signals between the brain and the rest of the body, creating a pain-relieving effect. 

Other fentanyl side effects include euphoria, relaxation, sedation, nausea, vomiting, drowsiness, dizziness, confusion, sedation, and small pupils. 

Fentanyl can take effect very quickly, depending on the form a person is using. For example, a fentanyl injection will work almost immediately. But how long does fentanyl stay in your system? The amount of time it takes for your body to completely get rid of the fentanyl in your system depends on multiple factors, including:

• Height
• Weight 
• Age
• Genetics
• Dosage
• Frequency of fentanyl use
• Metabolism
• Use of other drugs
• Overall health 

Over time, a person builds up a tolerance to opioids. They would need to take larger doses of fentanyl or another opioid to experience the same pain-relieving effects as before. 

If someone takes too large a dose of fentanyl, they risk overdose or death. The dosage of fentanyl that will cause death depends on many factors, such as the person’s opioid tolerance level. According to the Drug Enforcement Agency (DEA), 2 mg of fentanyl or more is a lethal dose. For someone without any opioid tolerance, an even smaller dose could cause severe harm or even a life-threatening overdose.

Fentanyl is available in several forms, so it doesn’t always look the same. Sometimes, drug producers and distributors design fentanyl to look like Oxycodone pills or other legitimate medications. These pills may be bright and colorful, known as rainbow fentanyl. 

In 2024, the DEA seized over 47 million fentanyl pills and more than 5,000 pounds of fentanyl powder. Around 70% of these seized pills contain lethal doses of fentanyl. Often, counterfeit pills with fentanyl inside are difficult or even impossible to distinguish from authentic pills. They’re made to look just like the real pills, so people may not even realize there’s fentanyl in them.  

On its own, fentanyl powder is generally white. It’s sometimes packaged as a block that looks like sidewalk chalk. As a liquid, fentanyl is usually clear like water. Part of what makes it so hard to identify fentanyl is that it can easily be used to lace other illicit substances without it being apparent to the user. Additionally, fentanyl does not have much of a distinctive taste, so it’s very difficult to identify it in other drugs without using fentanyl test strips.

Many of the overdose deaths involving synthetic opioids are not the result of direct fentanyl use. Instead, they’re from using other drugs laced with fentanyl or another synthetic opioid, often without the person’s knowledge. Drug dealers are adding fentanyl to illicit drugs without telling people how much fentanyl they added or even that it’s there at all. But why?

Because fentanyl is so potent compared to other drugs like heroin and morphine, it’s easier for drug dealers to traffic smaller quantities that deliver the same or even stronger effects. Drug traffickers synthesize fentanyl in Mexico, China, and India, then export the finished powder to the United States. It’s much easier to hide and sneak in fentanyl than equivalent doses of other drugs because it takes up so much less space.  

Fentanyl is also inexpensive to produce compared to other drugs. It’s more profitable to sell a kilogram of fentanyl than a kilogram of heroin. Drug dealers may add fentanyl to the drugs they sell to stretch their supply and generate higher profits. Lacing a drug like heroin with fentanyl will increase its potency, allowing drug dealers to make more money selling the laced drugs. The people buying and using these drugs may not have any idea there’s fentanyl in them.

The presence of fentanyl in the street drug supply poses significant risks to anyone using illicit drugs. When someone unknowingly takes drugs laced with fentanyl, they have no way to control the fentanyl dose or the interactions between drugs. There may be a fatal dose of fentanyl in their drugs, and it’s usually impossible to tell from looking at or tasting them. Two milligrams of fentanyl can cause a fatal overdose, and 42% of the counterfeit pills seized by the DEA contained at least that much fentanyl. 

Drugs commonly mixed with fentanyl include MDMA, methamphetamine, cocaine, heroin, and counterfeit prescription medications such as Xanax. 

Drug dealers also add other forms of fentanyl to illicit drugs, such as carfentanil. Carfentanil is an analog of fentanyl that is only approved as a tranquilizer for large mammals because it is incredibly potent—up to 100 times more potent than fentanyl.   

There is no one conducting quality control or safety protocols for illicit drugs laced with fentanyl.   People may accidentally take drug doses that are much stronger than is safe because there’s no easy way to know whether there’s fentanyl in their drugs and, if so, how much. If someone is used to low opioid doses and then takes a small dose of heroin laced with a significant amount of fentanyl, they’re much more likely to experience an overdose. When someone overdoses after using drugs laced with fentanyl, the people around them do not know how to treat it as an opioid overdose, making treatment more difficult.

The opioid crisis has been a problem in the United States for decades, but the increased presence of fentanyl in the drug supply ushered in a new, more deadly wave of the crisis. The COVID-19 pandemic exacerbated the crisis even further, and fentanyl was one of the driving factors. In 2022, over 100,000 people lost their lives to overdoses. Overdose deaths involving synthetic opioids significantly outnumber overdose deaths involving any other drugs or drug categories, including prescription opioids and heroin. 

There are two main reasons why synthetic opioids like fentanyl are responsible for so many fatal drug overdoses:

• Potency: Fentanyl is very potent, so even small doses can be fatal. The drug also acts very quickly compared to other opioids. Within two to three minutes of taking fentanyl, a person can begin to overdose. The speed of these overdoses is often missing from the headlines about fentanyl, so people aren’t prepared.  
• Availability: Fentanyl is also much more abundant in the drug supply than it used to be. The DEA seizes pills and fentanyl powder that add up to hundreds of millions of deadly doses each year. 

It’s not clear whether the fentanyl crisis is still worsening. Overdose deaths involving opioids went down slightly in 2023, which was the first decrease since 2018. However, there were still more than 80,000 fatal opioid overdoses. Whether fatal opioid overdoses will continue to fall is still unclear.

Public perception is not always accurate, and that’s especially true regarding fentanyl. There are many fentanyl myths that mislead people about the drug and its impact. While sensationalized headlines may not seem like a big deal, improving public awareness of fentanyl is a key part of fighting the opioid crisis. 

For example, many people believe that it’s not possible to become addicted to fentanyl. That’s simply not true. The myth comes from the idea that because fentanyl is so potent, a person is likely to experience fatal fentanyl exposure before developing an addiction. However, it is possible to develop a fentanyl addiction. People dealing with this addiction benefit from knowing that the addiction is real, and they can seek fentanyl withdrawal treatment. 

When rainbow fentanyl, colorful fentanyl pills, became more prevalent, the public feared the drugs were meant to entice children. Around Halloween, parents, schools, and communities are especially on high alert. There’s no evidence drug dealers are using rainbow fentanyl to target children, however. 

Focusing on fentanyl myths like these distracts from the reality of the fentanyl crisis and the steps toward combating it. One of the most dangerous myths is that it’s not possible to treat fentanyl addiction. Increasing public awareness of treatment for opioid addiction, including fentanyl addiction, will make it easier for people to get the help they need.

It’s generally not obvious when drugs have been laced with fentanyl. People who use illicit drugs can use a fentanyl test strip to determine whether their drugs contain any fentanyl, helping them make more informed decisions to manage the risk of overdosing. The test strips will indicate that there either is or is not fentanyl present in the tested sample, but they cannot determine the concentration of fentanyl, if there is any. 

To test drugs using fentanyl test strips, first take a sample of the drugs and dissolve it in water. Next, place the test strip wavy side down into the dissolved drugs. After 15 seconds, remove the test from the liquid and set it aside. Your results should appear within one to two minutes. If there is only one line in the middle of the test strip, the drugs contain fentanyl. Two lines mean there was no fentanyl in the tested sample. While these tests are highly accurate, it’s important to keep in mind that pressed pills and powders can be heterogeneously mixed, so if a portion of drugs that don’t have fentanyl are tested, they could appear as negative.

However, since fentanyl may not be distributed evenly throughout illicit drugs, there may still be fentanyl in the untested portion. If you have any doubts about the drugs, it’s safest to avoid using them. In some states, fentanyl test strips are not legal since they’re classified as drug paraphernalia despite their effectiveness as harm-reduction tools. Be mindful of local laws when purchasing or using these tests.

Fentanyl overdoses can occur very quickly, meaning there’s a small window to administer treatment. If administered in time, Narcan does help those experiencing fentanyl overdoses. Narcan is a brand-name form of naloxone, an opioid agonist that rapidly reverses the effects of opioid overdoses. Naloxone binds to opioid receptors in the brain, displacing opioids like fentanyl and reversing their immediate effects. 

In an opioid overdose situation, administering Narcan can help the patient survive and access further emergency medical care. Naloxone only reverses opioid overdoses, not any other drug overdoses, which means it is effective for fentanyl overdoses. If there’s any reason to believe that someone experiencing an overdose took opioids, it’s best to administer naloxone. The medication isn’t harmful to patients who use drugs other than opioids—it just isn’t effective. 

Previously, patients needed a prescription to get naloxone, but it’s become much more available. All 50 states have laws about naloxone accessibility. In some states, individuals at risk of opioid overdose and even people who know at-risk individuals can get naloxone without a prescription from participating pharmacies. The more people have access to naloxone, the more likely it is that someone at the scene of an opioid overdose will be able to administer the life-saving medication.