Fentanyl is estimated to be about 100 times more potent than morphine and 50 times more potent than heroin as a pain reliever. It is an effective medication for managing severe pain when properly prescribed and monitored by a clinician. However, when misused it can cause death.
Types of Fentanyl
Fentanyl is a synthetic opioid. There are two types.
- Pharmaceutical fentanyl is FDA-approved and used as an anesthetic during surgeries as well as to treat severe pain, especially following surgery and for cancer pain. It is a Schedule II controlled substance according to the United States Drug Enforcement Administration (DEA). Patients prescribed fentanyl for severe pain are typically also being treated with other narcotic medications and monitored by their clinician for potential drug misuse. It may cause serious breathing problems or death.
- Illegally made fentanyl often takes the form of a fine-grain powder pressed into counterfeit pills to make them look pharmaceutical. It is often mixed with other illicit drugs, such as heroin or cocaine, to increase their potency. The people who use those drugs may or may not be aware they contain fentanyl, which can lead to a much higher risk of overdose.
“In health care, we dose fentanyl in micrograms,” explains Amanda N. Donald, MD, an addiction medicine physician at Northwestern Medicine. “There is no way to know what doses are going around on the street. To patients with a substance use disorder, fentanyl is what has dramatically increased the risk of not just overdose, but also the risk of severe and prolonged withdrawal.”
Lethal Dose of Fentanyl
Depending on a person’s size, tolerance and history of drug use, 2 milligrams of fentanyl can be deadly. The DEA has found counterfeit pills with fentanyl content up to 5.1 milligrams per tablet: more than double the lethal dose.
How to Tell if Someone Has Overdosed on Fentanyl
Key signs of an opioid overdose include coma, pinpoint pupils, and slow or difficult breathing. Other signs include:
- Falling asleep or loss of consciousness
- Choking or gurgling sounds
- Limp body`
- Bluish-purple skin (in people with light skin), gray or ashen skin (in people with dark skin), or cold skin






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