Fentanyl Overdose Symptoms, Effects & Treatment

What is Fentanyl?

Fentanyl is a synthetic opioid approximately 50 times more potent than heroin and 100 times more potent than morphine.³ Pharmaceutical fentanyl refers to fentanyl that is prescribed by a medical provider, usually to treat severe pain, whereas illicitly manufactured fentanyl is manufactured and distributed illegally.³

A significant portion of the recent concerns associated with fentanyl are linked to illicitly manufactured fentanyl.³ Unfortunately, illicit fentanyl is frequently mixed with other illicitly-sourced substances, such as cocaine, methamphetamine, ecstasy, and other opioids like heroin.⁴ These illicit combos amplify the risks of fentanyl overdose and toxicity, as drug effects become dangerously combined with those of the illicit drugs its mixed with, and sometimes, a person may not know they are consuming fentanyl.³

Unfortunately, because fentanyl is commonly mixed with other substance, someone doesn’t have to intentionally use fentanyl to be at risk for a fentanyl-involved overdose. ⁵ One study examining overdoses in 10 states found that roughly 57% of people who suffered a fatal overdose tested positive for fentanyl also tested positive for cocaine, methamphetamine, or heroin.⁵

For someone who has no tolerance to opioids whatsoever, consuming fentanyl (knowingly or unknowingly) can be especially dangerous. Some drug dealers also advertise and sell fentanyl as highly potent heroin, posing profound danger to unwitting purchasers.⁶

Fentanyl Overdose Causes & Risk Factors

A fentanyl overdose, or opioid toxicity, involves severely adverse effects and potentially life-threatening symptoms that develop after consuming too much of this substance.⁴ A person who consumes fentanyl without knowing it (such as when it is mixed with other substances) may be at an increased risk for overdose since they might not be used to opioid effects as potent as those of fentanyl.⁴ The amount of fentanyl that will result in fentanyl toxicity varies depending on individual factors, such as a person’s size/weight, tolerance, and history of past fentanyl use.⁷

Other risk factors for fentanyl and other opioid overdose include:⁹

• Consuming fentanyl with illicit substances, such as alcohol, benzodiazepines, cocaine, and methamphetamine.
• Ingesting fentanyl with certain prescribed drugs, including prescription opioids.
• Ingesting fentanyl after a period of abstinence, of having a low or nonexistent tolerance for opioids.
• Taking fentanyl not as prescribed, such as taking higher doses or using fentanyl more frequently than prescribed (in instances of pharmaceutical use).
• Consuming illicitly manufactured fentanyl.
• Having a history of overdose.
• Using fentanyl or consuming a substance that could contain fentanyl alone.

Fentanyl Overdose Treatment

Emergency medical personnel that arrive on the scene of an overdose may need to manage the airway of the person who is overdosing if they aren’t breathing. Endotracheal intubation, or placing a breathing tube into the windpipe through the mouth or nose, may be performed in an emergency setting to protect the airway and facilitate mechanical ventilation, if needed.^6,9

If a person with a suspected fentanyl overdose is brought or presented to the emergency department, medical professionals may need to perform CPR, take blood samples, and administer supportive care.^6,9

The person who has overdosed may be admitted to the hospital until stabilized. Medical providers may work with patients to begin long-term medications for opioid use disorder (MOUD) and help transfer a patient to additional rehab and recovery.^6,9

Fentanyl Addiction Treatment

Often, treating an opioid use disorder begins with medical detox to help someone manage their withdrawal symptoms with opioid agonist treatment (e.g., buprenorphine or methadone). People who undergo a medically supervised withdrawal and shortly after discontinue without additional care may be more likely to return to opioid misuse and at risk for opioid overdose.⁹ Beyond the detox period, more comprehensive opioid use disorder (OUD) treatment options include ongoing pharmacological support in tandem with behavioral therapies and other psychosocial supports. Such a range of therapeutic interventions for OUD and treatment settings include:¹¹

• Medications for Addiction Treatment (MAT). Medications, such as methadone and buprenorphine, can help reduce opioid misuse in recovery by managing withdrawal and curbing cravings for fentanyl and other opioids.⁴
• Counseling for substance use disorders, including OUDs, could include behavioral therapies for addiction to opioids like fentanyl. Such interventions can help people modify their attitudes and behaviors regarding their substance misuse. Some behavioral therapy interventions for the treatment of an opioid use disorder can include cognitive behavioral therapy (CBT), contingency management, and motivational interviewing.
• Inpatient or residential treatment. This is a setting of care in which a person undergoes treatment at a facility where they stay for the duration of treatment. Inpatient rehab programs incorporate a variety of group and individual behavioral therapy and counseling sessions to help the person reduce their substance use and build solid relapse prevention skills.¹¹
• Outpatient therapy. Treatment medications and behavioral therapies may also be effective in the treatment of opioid use disorders on an outpatient basis.⁴ This may include counseling delivered in individual and/or group formats. There are different types of behavioral therapies that can help people identify triggers, learn effective coping skills, and change thoughts and behaviors related to opioid use.¹¹

Outlook for Fentanyl Overdose

In a fentanyl overdose, the major cause for death is usually respiratory depression. Sometimes people may also experience seizures, lung injury, or adverse cardiac events. If an overdose on fentanyl is treated in time, recovery is fully possible.⁶ Sometimes, however, people who survive a fentanyl overdose may experience some adverse effects such as acute long-term lung injury, infections, and withdrawal.⁶ Again, it’s critical to ensure that someone who may be overdosing on fentanyl receives the medical attention they need as soon as possible, and that naloxone is administered to this person promptly and properly.

Recovery from fentanyl or opioid addiction is possible, with medications for opioid use disorder and addiction targeting behavioral therapies being effective methods for treating opioid use disorders, decreasing illicit opioid use, and lowering the risk of opioid-related harms such as overdose.¹³ Other things that may prevent overdose include only taking any opioid medications prescribed to you in the way they were prescribed, not ingesting substances alone, not taking more than one substance at the same time, having naloxone readily available, and knowing how to administer naloxone if it’s needed.⁹ 

Sources:

1. 1. Centers for Disease Control and Prevention. (2022, June 1). Fentanyl.
   2. Centers for Disease Control and Prevention. (2021, November 18). Other drugs.
   3. Centers for Disease Control and Prevention. (2022, February 23). Fentanyl facts.
   4. National Institute on Drug Abuse. (2021, June 1). Fentanyl DrugFacts.
   5. National Institute on Drug Abuse. (2022, May 12). What is fentanyl?
   6. Ramos-Matos CF, Bistas KG, Lopez-Ojeda W. (2022). Fentanyl.
   7. National Institute on Drug Abuse. (2022, January 11). Naloxone DrugFacts.
   8. Drug Enforcement Administration. (n.d.). Facts about fentanyl.
   9. Substance Abuse and Mental Health Services Administration. (2021). Medications for opioid use disorder. Treatment Improvement Protocol (TIP) Series 63 Publication No. PEP21-02-01-002. Rockville, MD.
   10. Substance Abuse and Mental Health Services Administration. (2018). SAMHSA opioid overdose prevention toolkit. HHS Publication No. (SMA) 18-4742PT2. Rockville, MD.
   11. National Institute on Drug Abuse. (2019, January 17). Treatment approaches for drug addiction DrugFacts.
   12. Centers for Disease Control and Prevention. (2022, June 8). Linking people with opioid use disorder to medication treatment.