Fentanyl is a potent synthetic opioid, meaning it is entirely lab-made, not derived from natural ingredients. It is primarily used in medical settings to manage severe pain, such as after surgery or for chronic conditions like cancer pain. However, fentanyl is also widely present in the illicit drug supply, often mixed with other drugs like heroin, cocaine, or methamphetamine, sometimes without the user’s knowledge. Its high potency means that even a small amount can be dangerous, contributing to a significant rise in overdose deaths.
How Fentanyl Works in the Body
Fentanyl exerts its effects by interacting with opioid receptors located throughout the central nervous system, which includes the brain and spinal cord. Specifically, fentanyl has a strong affinity for the mu-opioid receptor, which is responsible for pain relief, feelings of pleasure, and also respiratory depression. When fentanyl binds to these receptors, it inhibits the release of neurotransmitters that typically transmit pain signals, thereby reducing the perception of pain.
This interaction also triggers an increased release of dopamine in the brain’s reward centers, contributing to the euphoric effects associated with fentanyl use. Fentanyl is known for its rapid onset of action and relatively short duration due to its high lipid solubility, allowing it to quickly cross the blood-brain barrier. Its potency is considerably higher than other opioids, being approximately 50 to 100 times stronger than morphine and about 50 times more potent than heroin.
Common and Adverse Responses
Even when prescribed, fentanyl can cause reactions not indicative of an overdose. Common side effects include nausea and vomiting, which typically subside within a few days. Constipation is another frequent occurrence, often requiring dietary adjustments or laxatives for relief. Drowsiness and fatigue are also common, particularly as the body adjusts to the medication over one to two weeks.
Other responses can include confusion, dizziness, and lightheadedness. Some individuals might experience dry mouth, stomach pain, or difficulty urinating. Less common reactions include muscle stiffness or a rash, especially with transdermal patches. These effects are generally manageable and differ from the severe, life-threatening signs of an overdose.
Identifying a Fentanyl Overdose
Recognizing a fentanyl overdose is important due to its rapid and severe effects. A primary indicator is severe respiratory depression, characterized by breathing that is very slow, shallow, or stopped. The rate of breathing may drop below 12 breaths per minute, or there could be long pauses between breaths. The individual may also make gurgling sounds or a snore-like noise, sometimes referred to as a “death rattle,” which signals severe respiratory distress.
Another sign is pinpoint pupils, which become extremely small even in dim lighting. This abnormal pupil size indicates significant opioid activity in the central nervous system. The skin may appear pale, clammy, or cold. For lighter-skinned individuals, the skin, lips, and fingernails may turn bluish-purple, while for those with darker skin, they might appear grayish or ashen.
A person experiencing a fentanyl overdose will be unresponsive, unable to be roused by shouting or physical stimulation like a sternum rub. Their body may become limp, and they might lose consciousness, entering a state of stupor or coma. Given fentanyl’s potency, these symptoms can develop quickly, sometimes within five minutes, requiring immediate action.
Immediate Actions for Overdose
If a fentanyl overdose is suspected, immediate action can save a life. The first step is to call emergency services (e.g., 911) immediately, stating someone is unresponsive and not breathing. Providing the exact street address and location is important for emergency responders.
If naloxone (Narcan) is available, administer one dose without delay. Naloxone temporarily reverses opioid overdose effects by blocking opioid receptors. It can be given as an injection into a muscle or as a nasal spray. If the person is still not breathing effectively after 2-3 minutes, a second dose may be necessary. Additional doses can be given every two minutes if there is no response.
While waiting for emergency personnel, stay with the person and perform rescue breathing if they are not breathing or are breathing slowly. Lay the person on their back, tilt their head back to open the airway, pinch their nose, and give one slow breath every five seconds, watching for their chest to rise. Once the person starts breathing regularly, roll them into a recovery position on their side.