In 2021, fentanyl and its analogues accounted for over 75% of all U.S. fatal drug overdoses with an estimated 71,238 deaths.[1] Fentanyl is a Schedule II controlled drug.[2] It is a synthetic opioid legally manufactured and used as a prescription pain management medication, mainly post-operatively for short duration medical care. It is also sold and used illicitly as a recreational drug, often mixed with other drugs (e.g., heroin, cocaine, benzodiazepines, or methamphetamine) and pressed into tablets disguised to look like OxyContin, Xanax, Adderall, and other commonly abused drugs.
What Makes Fentanyl So Concerning?
A 0.1 mg dose of fentanyl is equivalent in therapeutic relief to a 10 mg dose of morphine. Fentanyl is approximately 100 times stronger than morphine or about 50 times stronger than heroin. A two mg dose of fentanyl is deadly. (For scale, one regular strength Tylenol capsule is 325 mg.) Therefore, its potential for a deadly overdose is extreme. Between 2018 to 2020, among those ages 10-19 years in California:
- ED visits related to non-fatal opioid overdoses more than tripled.
- Opioid-related overdose deaths increased by 407 percent, largely driven by fentanyl.
- Fentanyl-related overdose deaths increased 625 percent.
Fentanyl Overdose Response
Fentanyl has a rapid onset, and its effects generally last under two hours. The most common adverse reaction is respiratory failure. This can include the sudden onset of rigidity of the abdominal muscles and diaphragm known as wooden chest syndrome. Importantly, its potentially deadly overdose effects can be neutralized by naloxone. Naloxone:
- Is a life-saving medication used to reverse an opioid overdose, including heroin, fentanyl, and prescription opioid medications.
- Is safe and easy to use, works almost immediately, and is not addictive.
- Can be quickly given through nasal spray (Narcan) or through an auto- injector into the outer thigh.
- Is available for free via California’s Naloxone Distribution Project (NDP).[3]
One Pill Can Kill
The most effective fentanyl solution is prevention. The message is one of avoidance—do not take any pill from a non-trusted source (i.e., your parents or a medical provider) because it could be laced with fentanyl and therefore be deadly. The Drug Enforcement Administration’s (DEA’s) “One Pill Can Kill” program emphasizes that:
- Criminals are mass-producing and marketing fake pills as legitimate prescription pills.
- Fake pills are easy to purchase, widely available, often contain fentanyl, and can be deadly.
- Fake prescription pills are easily accessible and often sold on social media and e-commerce platforms, making them available to anyone with a smartphone, including minors.
- Fake pills are made to look like prescription opioids such as oxycodone (Oxycontin®, Percocet®), hydrocodone (Vicodin®), and alprazolam (Xanax®) or prescription stimulants such as amphetamines (Adderall®).[4]
Preventing Fentanyl Exposure
Persistent myths have circulated among first responders about the lethality of fentanyl through contact exposure. Specifically, there have been alleged reports of police officers being hospitalized after touching powdered fentanyl. Such transdermal contact with or inhalation of fentanyl is unlikely to cause intoxication or overdose (except in cases of prolonged exposure with relatively large quantities of fentanyl), and most people are at minimal risk of fentanyl poisoning through accidental contact with intact skin. Nevertheless, SROs, school nurses, and other staff who might potentially administer naloxone in an overdose scenario should be aware of NIOSH’s best practices to prevent exposure to illicit drugs.[5]
[1]See “U.S. Overdose Deaths In 2021 Increased Half as Much as in 2020 – But Are Still Up 15%”.www.cdc.gov. 11 May 2022.
[2] See https://www.dea.gov/drug-information/drug-scheduling
[3] See https://www.dhcs.ca.gov/individuals/Pages/Naloxone_Distribution_Project.aspx
[4] See https://www.dea.gov/onepill .
[5] See https://www.cdc.gov/niosh/topics/fentanyl/risk.html