The facts on fentanyl

What is fentanyl?

• Fentanyl is a strong synthetic opioid, meaning it is manufactured in a laboratory and does not come from natural ingredients.
• Fentanyl is both a regulated legal prescription drug used for pain medication and is also produced and used illegally.
• Fentanyl is dangerous because even a very small amount can be lethal, with less than 2 mg (0.00007 ounces) leading to death, without intervention.
• Fentanyl can be used to cut other substances, meaning that people may not even be aware they are consuming it.

Facts and statistics

• A lethal dose of heroin is 100 mg, but a lethal dose of fentanyl is 2 mg, with doses as small as 0.25 mg (equivalent to a single grain of sand) placing the person at a high risk for overdose. 
• Since 2012, fentanyl-involved overdoses have risen nationally at a rate 2.5 times that of heroin. 
• In 2023, illegally made fentanyl was involved in 51,285 overdose deaths in the United States, as reported by 37 states and Washington, D.C.

Intended use

• Fentanyl is used as a prescribed pain reliever in small doses after surgery.
• Small doses of fentanyl are sometimes given intravenously as an anesthetic or used in combination with another anesthetic for procedures.
• Fentanyl has been shown to successfully address pain associated with chronic conditions and cancer when taken as prescribed.
• Recreational use of controlled prescription fentanyl and use of illicitly made fentanyl are both illegal.

Desired effects of recreational use

• Feeling of euphoria and relaxation
• Pain relief

Common names

• Apache, blonde, blues, China girl, China town, dance fever, fenty, freddy, friend, fuf, goodfellas, great bear, he-man, jackpot, king ivory, murder 8, opes, poison, and Tango & Cash.

Prescription names

• Abstral®, Actiq®, Duragesic®, Fentora®, Lazanda®, Subsys®1

Forms

Controlled prescription forms

• Injected as part of anesthesia before surgery
• Taken orally as a pill
• Transdermal patches placed on upper torso
• Mouth lozenges placed against the cheek
• Tablets placed under the tongue or near gums
• Intranasal fentanyl nasal spray

Illicit forms

• Taken orally as a pill
• Snorting the grinded powder up the nose
• Smoking
• Removing gel from patches and injecting or ingesting the contents
• Oral transmucosal lozenges (“lollipops”)

How fentanyl works

• Fentanyl works by binding to opioid receptors in the brain and interrupting the signaling of pain between the central nervous system and the body.
• While fentanyl works similarly to morphine, it is roughly 100 times more potent and 50 times more potent than heroin for pain relief.
• Over time, the body becomes less sensitive to fentanyl, meaning that larger quantities of the drug are required to gain the same effect. This can lead to fentanyl addiction.

Short-term health effects

• Pain relief
• Sedation and drowsiness
• Confusion
• Dizziness
• Loss of consciousness
• Nausea and vomiting
• Rash/skin irritation
• Constriction of the pupils
• Overdose

Long-term health effects

• Dysregulation of organ systems, increasing the risk of slowed and ineffective breathing, constipation, and sleep disturbances
• Urinary retention
• Increased risk of fractures, especially in the elderly
• Increased risk of mental illness
• Addiction to and misuse of fentanyl
• Overdose

Withdrawal symptoms

• Muscle or bone pain
• Sleep disturbance
• Vomiting
• Diarrhea
• Goose bumps accompanied by cold flashes
• Severe cravings
• Uncontrollable movement of the legs

Given the symptoms of withdrawal, a person may need medical supervision to ensure their safety during the process.

Overdose:

• An overdose is a serious, life-threatening emergency that requires an immediate medical response.
• An overdose occurs when a person takes a large enough dose of fentanyl to have serious adverse health effects, including life-threatening symptoms or death.
• Signs of fentanyl overdose: change in pupil size, slowed and ineffective breathing, cold or clammy skin, blue or grayish skin and coma.
• In the event of a suspected fentanyl overdose: 
  • Call 911
  • Administer naloxone. Due to the potency of fentanyl, multiple doses of naloxone may be needed.
  • Administer CPR if breathing has stopped.

Addiction treatment

Studies have shown that a combination of medications and therapeutic interventions is the most effective treatment for fentanyl addiction.

Medications

• The following medications are used to aid addiction recovery through the regulation of brain chemistry, by diminishing fentanyl cravings, and by reducing withdrawal symptoms.
  • Buprenorphine
  • Methadone
  • Naltrexone

Therapeutic interventions

• Cognitive behavioral therapy, a type of psychotherapy, addresses emotional triggers to reduce relapse and support recovery.
• Contingency management uses rewards to incentivize desired behavior.
• Motivational interviewing or motivational enhancement therapy uses empathy to support change driven by the individual.

References

• Department of Justice/Drug Enforcement Administration. Drug Fact Sheet. Fentanyl. 2020. Accessed October 15, 2025.
• National Institutes of Health. National Institute on Drug Abuse. Fentanyl. 2025. Accessed October 15, 2025.
• Health Direct. Fentanyl. 2025. Accessed October 15, 2025.
• Baldini, A., M. Von Korff and E. Lin E. A review of potential adverse effects of long-term opioid therapy, a practitioner’s guide. The Primary Care Companion for CNS Disorders. 2012;14(3).
• Stanley, T. The fentanyl story. The Journal of Pain. 2014;15(12):1215-26.
• The National Center for Drug Abuse Statistics. Fentanyl Abuse Statistics. 2020. Accessed October 15, 2025.
• Alcohol and Drug Foundation. Withdrawal. Accessed Oct. 15, 2025.
• U.S. Centers for Disease Control and Prevention. SUDORS Dashboard: Fatal Drug Overdose Data. 2025. Accessed October 15, 2025.
• U.S. Centers for Disease Control and Prevention. Treatment of Opioid Use Disorder. 2024. Accessed October 15, 2025.
• Carley, J.A., and T. Oesterle. Therapeutic Approaches to Opioid Use Disorder: What is the Current Standard of Care? International Journal of General Medicine.