Key points
- While fentanyl is a powerful synthetic opioid that can be used for surgery or treat severe pain, the majority of fentanyl-related harms and overdoses are linked to illegally made fentanyl.
- Fentanyl and related substances have contributed to a dramatic rise in drug overdose deaths in the United States.
- Increase awareness and education in your community to reduce rates of overdose deaths.
What is fentanyl?
There are two types of fentanyl - pharmaceutical fentanyl and illegally made fentanyl, both are synthetic (lab made) opioids.
- Phamaceutical fentanyl is a synthetic opioid approved for treating severe pain, typically advanced cancer pain.1 It is 50 to 100 times more potent than morphine.234 It is prescribed in the form of transdermal patches or lozenges and can be diverted for misuse.
- Illegally made fentanyl is a synthetic opioid available on the drug market in different forms, including liquid and powder.5 Drugs mixed with fentanyl are extremely dangerous, and many people may be unaware that their drugs contain it.
- Powdered fentanyl looks just like many other drugs. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that are made to resemble other prescription opioids.
- In its liquid form, illegally made fentanyl can be found in nasal sprays, eye drops, and dropped onto paper or small candies.
- Powdered fentanyl looks just like many other drugs. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that are made to resemble other prescription opioids.
Deaths involving illegally made fentanyl are rising
Synthetic opioids like fentanyl contribute to nearly 70% of overdose deaths.6 Even in small doses, it can be deadly.4 Over the last few years, nonfatal and fatal overdoses involving fentanyl have continued to rise.789
- Rates of overdose deaths involving synthetic opioids (other than methadone), increased 4% from 2021 to 2022.7
- The rate of overdose deaths involving synthetic opioids (other than methadone) in 2022 was nearly 25 times the rate in 2010.7
- Nearly 74,000 drug overdose deaths involved synthetic opioids (other than methadone) in 2022.7
Drugs may contain deadly levels of fentanyl, and you wouldn't be able to see it, taste it, or smell it. It is nearly impossible to tell if drugs have been mixed with fentanyl unless you test your drugs with fentanyl test strips.
Test strips to detect fentanyl are inexpensive and typically give results within 5 minutes, which can be the difference between life or death. Even if the test is negative, take caution as test strips might not detect more potent fentanyl-like drugs, like carfentanil.10
What can be done?
The increase in overdose deaths highlights the need to ensure people most at risk of overdose can access care, as well as the need to expand prevention and response activities. Additionally, there is the need to promote harm reduction by increasing the availability and access to high-quality harm reduction services, decreasing negative effects of substance use, and reducing stigma related to substance use and overdose.
CDC issued a Health Alert Network Advisory to medical and public health professionals, first responders, harm reduction organizations, and other community partners recommending the following actions as appropriate based on local needs and characteristics:
- Expand distribution and use of naloxone and overdose prevention education
- Expand awareness about and access to and availability of treatment for substance use disorders
- Intervene early with individuals at highest risk for overdose
- Improve detection of overdose outbreaks to facilitate more effective response
- Nelson L, Schwaner R. Transdermal fentanyl: Pharmacology and toxicology. J Med Toxicol. 2009;5(4):230-241. doi:10.1007/BF03178274
- Suzuki J, El-Haddad S. A review: Fentanyl and non-pharmaceutical fentanyls. Drug and Alcohol Dependence. 2017; 171:107–116.
- Ciccarone, D. Editorial for "US Heroin in Transition: supply changes, fentanyl adulteration and consequences." International Journal of Drug Policy. 2017;46:107-111.
- Comer, SD, Cahill, CM. Fentanyl: receptor pharmacology, abuse potential and implications for treatment. Neuroscience Biobehavioral Reviews. 2019; 106:49-57.
- Drug Enforcement Administration. Drug Fact Sheet: Fentanyl
- Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2022. Available at http://wonder.cdc.gov.
- Drug overdose deaths in the United States, 2002–2022. NCHS Data Brief, no 491. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc:135849
- Casillas SM, Scholl S, Mustaquim D, et al. Analysis of trends and usage of ICD-10-CM discharge diagnosis codes for poisonings by fentanyl, tramadol, and other synthetic narcotics in emergency department data. Addictive Behaviors Reports, Volume 16, 2022, 100464, ISSN 2352-8532, https://doi.org/10.1016/j.abrep.2022.100464
- Centers for Disease Control and Prevention. State Unintentional Drug Overdose Reporting System (SUDORS). Final Data. Atlanta, GA: US Department of Health and Human Services, CDC; [2024, March 8].
- Bergh MS, et al. Selectivity and sensitivity of urine fentanyl test strips to detect fentanyl analogues in illicit drugs. Int J Drug Policy. 2021 Apr;90:103065. doi: 10.1016/j.drugpo.2020.103065. Epub 2020 Dec 14.