Fentanyl Overdose Symptoms, Effects & Treatment

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Last updated: 02/05/2025

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Fentanyl is a powerful opioid, and it is important to be aware of what a fentanyl overdose looks like and how to treat it. 

Fentanyl is an opioid 100 times more potent than morphine, and many opioid overdoses involve fentanyl. Because fentanyl is so strong, a small amount can be deadly.

What Is A Fentanyl Overdose?

Fentanyl is a synthetic opioid that is significantly more potent than morphine—some sources estimate it to be 50 to 100 times stronger. It can be prescribed for severe pain conditions, such as pain following major surgery or in late-stage cancer. However, much of the fentanyl associated with overdoses is produced illicitly and mixed with other substances like heroin, cocaine or counterfeit prescription pills. Because of fentanyl’s potency, even a tiny amount can be lethal.

A fentanyl overdose occurs when you take more fentanyl than your body can handle. The drug’s primary danger lies in how it depresses the central nervous system. In an overdose, respiration can slow to a halt, depriving the body of oxygen and leading to life-threatening complications such as brain damage or cardiac arrest. Overdose can happen with both prescription fentanyl (when misused) and illicitly manufactured fentanyl found on the street.

Due to fentanyl’s high potency, many people may not even be aware they are ingesting it. Street drugs are sometimes laced with fentanyl without the individual’s knowledge, and what seems like a small amount of a familiar drug can become lethal. This risk is exacerbated by the fact that fentanyl’s effects are rapid. Overdose deaths can occur within mere minutes, leaving little time for intervention if a person is using alone or in a secluded setting.

Understanding the severity and suddenness of fentanyl overdose highlights why education, harm reduction and access to treatment are critical. By recognizing the signs of overdose and knowing what to do in an emergency, individuals and communities can help save lives.

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What Causes a Fentanyl Overdose?

Fentanyl’s potency is the primary reason why overdose risk is so high. Even people who have experience using opioids may not anticipate how powerfully fentanyl affects the body. Below are some of the most common scenarios in which a fentanyl overdose can occur:

  • Illicit Drug Contamination: Fentanyl is often used to cut or “lace” other drugs, such as heroin, cocaine or even counterfeit prescription pills. Because fentanyl can be nearly invisible, people who believe they are purchasing one drug could unknowingly be buying a drug laced with fentanyl.
  • Misuse of Prescription Fentanyl: While pharmaceutical fentanyl may be prescribed as patches, lozenges or injections, any deviation from doctor-prescribed usage—such as using more frequent doses or combining it with other central nervous system depressants—can lead to overdose.
  • Low Tolerance Levels: After a period of abstinence or relapse, tolerance to opioids declines quickly. A dose that was once tolerable may become dangerous or even fatal if reintroduced after a break.
  • Polydrug Use: Mixing fentanyl with other substances, including alcohol or benzodiazepines, dramatically increases overdose risk. Multiple central nervous system depressants can compound respiratory depression, leading to more severe overdoses.
  • Incorrect Dosing or Measurement: Because fentanyl is so potent, the difference between a dose that achieves a high and a dose that causes an overdose can be minuscule. Users often do not measure it accurately, leading to unintentional overdose.

Overall, fentanyl’s presence in the illicit drug market, its extreme potency and its quick action on the central nervous system create a perfect storm for overdose. Understanding these causes is the first step in preventing them.

Fentanyl Overdose Symptoms

Because fentanyl is so strong and is present in many other drugs, it is important to be aware of what a fentanyl overdose looks like. Because fentanyl is an opioid, symptoms of a fentanyl overdose are similar to other opioid overdoses. Overdose symptoms commonly include

  • Pale, clammy skin that may turn blue or ashen
  • Blue or black fingernails
  • Pinpoint pupils 
  • Vomiting
  • Going “limp”
  • Not talking or responding to the outside environment 
  • Loss of consciousness 
  • Choking, snoring or “gurgling” noises 
  • Slowed breathing (or no breathing at all) 
  • Slowed pulse (or no pulse at all) 

These signs can set in quickly. Because fentanyl works faster than many other opioids, the window for intervention can be brief. If you witness any of these indicators, call 911 immediately and administer naloxone if you have it on hand. Stay with the person until help arrives, continuing to monitor breathing and responsiveness.

Risk Factors For A Fentanyl Overdose

Opioid overdose can happen to anyone, but specific factors increase the likelihood when fentanyl is involved:

  • Previous Overdose History: People who have overdosed in the past are at higher risk of overdose in the future. Overdose events can leave individuals with decreased tolerance or may be tied to underlying medical conditions.
  • Co-occurring Substance Use: Using multiple drugs simultaneously—such as combining opioids with alcohol, benzodiazepines or other medications—dramatically raises the risk of respiratory depression.
  • Recent Abstinence or Relapse: Tolerance to opioids diminishes when someone stops using for a period. If they relapse at a dose they once tolerated, it can trigger an overdose.
  • Underlying Health Issues: Respiratory problems, such as asthma or chronic obstructive pulmonary disease (COPD), and co-occurring mental health disorders can increase overdose risk.
  • Unknowingly Using Fentanyl: People who believe they are taking prescription pills or other street drugs may not realize they are actually consuming fentanyl. This lack of awareness can lead to taking too high a dose.
  • Social Circumstances: Using alone is particularly dangerous. If an overdose occurs, there is no one to administer naloxone or call for help. Additionally, individuals experiencing homelessness or lacking consistent health care are at elevated risk.

By understanding these factors, friends, family members and health professionals can more effectively target prevention efforts. Simple steps, such as testing substances for fentanyl, never using alone or carrying naloxone, can substantially reduce the likelihood of overdose.

Prevalence Of Fentanyl Overdose

In recent years, the rate of fentanyl-related overdoses has surged in the United States. According to the Centers for Disease Control and Prevention (CDC), synthetic opioids—primarily illicit fentanyl—are now the most common drugs involved in overdose deaths, with over 74,000 in 2023 alone.

Missouri and Kansas, like many other states, have not been immune to the rise in fentanyl-related overdoses. Public health agencies in these areas have reported an uptick in emergency department visits and fatalities linked to synthetic opioids. Fentanyl’s prevalence has extended beyond traditional opioid markets, showing up in seized cocaine, methamphetamine, and illicit benzodiazepines. This change means that a broader segment of drug users is at risk, including those who do not typically seek out opioids.

The rising numbers underscore the need for increased awareness, harm reduction measures and accessible treatment options. While these statistics are alarming, they also drive home the point that opioid addiction and overdose can impact virtually any community. Efforts to educate the public, equip first responders with naloxone and expand access to evidence-based treatment are more urgent than ever.

Steps To Take When Someone Overdoses on Fentanyl

Fentanyl overdoses can be deadly, so it is important to act quickly to get the person overdosing prompt medical attention. 

  • Check the person’s responsiveness by rubbing your knuckles hard against the chest plate — also known as a “sternal rub.” 
  • Give the person naloxone if you have access to it.
  • Call 911 — it is important not to skip this step. Even if someone responds to naloxone, the medication wears off quickly, and they can slip back into an overdose if there is still fentanyl (or other opioids) left in their system. They may require additional doses. 
  • Provide rescue breathing if the person isn’t breathing and chest compressions if the person has no pulse. 
  • Roll the person on their side in the “recovery position.” Lay them on their side, bend their knee and roll their face to the side. This helps prevent choking if they vomit. 
  • Stay with the person until help arrives. 

Harm Reduction Strategies

Harm reduction strategies aim to lower the potential damage that drug use can cause, particularly in the context of a powerful opioid like fentanyl. By encouraging safer use, education, and rapid response, these measures can save lives.

Naloxone

Naloxone (brand name Narcan) is an opioid antagonist that can rapidly reverse the effects of opioids, including fentanyl. When administered during an overdose, naloxone helps restore breathing by blocking the opioid receptors in the brain. While multiple doses may be required in the case of fentanyl, the availability of naloxone can be the difference between life and death.

  • How To Use Naloxone: Naloxone commonly comes in two forms: a nasal spray and an injectable solution. If a person is unresponsive and you suspect an overdose, administer naloxone immediately and call emergency services.
  • Where To Get Naloxone: Many pharmacies, community organizations and harm reduction programs distribute naloxone, often without a prescription. In some states, standing orders allow anyone to obtain naloxone from a pharmacy.

Altered Practices

While the safest option is not to use illicit substances at all, people who do use can still reduce the likelihood of overdose by adopting safer practices.

  • Never Use Alone: Overdoses that occur when a person is alone often prove fatal because no one is present to call for help or administer naloxone.
  • Start With a Test Dose: If you must use a substance that could contain fentanyl, taking a small test dose first may reveal if the batch is unusually potent.
  • Avoid Mixing Drugs: Combining opioids with other depressants like alcohol or benzodiazepines greatly increases overdose risk.

Fentanyl Test Strips

Fentanyl test strips (FTS) are a quick way to detect the presence of fentanyl in a drug sample. Originally designed for urine drug testing, they can be repurposed to test drug residue or a small amount of the substance dissolved in water.

  • Advantages: FTS provide a warning if fentanyl is present, allowing individuals to make more informed decisions about whether or how to proceed.
  • Limitations: Test strips can sometimes detect only certain fentanyl analogs. A negative result does not guarantee the substance is entirely fentanyl-free. Additionally, test strips do not measure quantity or potency, so an overdose is still possible even when fentanyl is detected at low levels.

Harm reduction does not promote drug use; it acknowledges that drug use occurs and tries to mitigate its most dangerous consequences. By encouraging practices like carrying naloxone, using test strips and avoiding polydrug use, communities can help reduce the staggering number of fentanyl overdoses.

Get Help For Fentanyl Addiction

While harm reduction strategies are essential to saving lives in the immediate sense, the most comprehensive way to prevent fentanyl overdose is to treat opioid addiction at its root. If you or someone you care about struggles with fentanyl or any opioid use, professional treatment can be transformative.

At The Recovery Village Kansas City, we recognize that addiction is a complex disease that often co-occurs with mental health issues and other life stressors. Our multidisciplinary team offers evidence-based treatment, including:

  • Medically Assisted Detox: Withdrawal from fentanyl can be physically and psychologically challenging. Under medical supervision, detox can be safer and less uncomfortable, thanks to tapering protocols and medications like buprenorphine or methadone.
  • Inpatient Rehab: These programs provide a structured therapeutic environment. In inpatient rehab, you receive 24/7 support, individual therapy, group sessions and relapse prevention planning.
  • Behavioral Therapies: Techniques such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT) and motivational interviewing (MI) are used to address the emotional and psychological components of addiction.
  • Aftercare and Ongoing Support: Recovery is a lifelong journey. Alumni programs, follow-up therapy sessions, and support groups like Narcotics Anonymous (NA) can help maintain sobriety after formal treatment ends.

No matter how far addiction has progressed, recovery is possible. Seeking help is not a sign of weakness; it’s a courageous step toward reclaiming your health and well-being. If you suspect you need professional support for fentanyl or opioid use, consider reaching out for an assessment or consultation. With the right combination of medical care, counseling and peer support, you can break free from the cycle of addiction and reduce the risk of a potentially fatal overdose.

Fentanyl Addiction Treatment 

If you or a loved one are struggling with a fentanyl addiction, there is hope. Several highly effective treatments are available for opioid use disorder, including fentanyl as the substance of choice. Treatments include medications for opioid use disorder (such as methadone, buprenorphine or naltrexone) and individual and group counseling. 

The Recovery Village Kansas City is made up of an experienced team of dedicated board-certified addiction specialists. We offer different treatment settings, including residential rehab, partial hospitalization and intensive outpatient programs. Our beautiful campus includes outdoor areas and several art and recreational activities to help build a strong foundation for recovery. We also offer medications for opioid use disorder if appropriate. Speak to a Recovery Advocate today to see how we can help you on your recovery journey.

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