Fentanyl Overdose: Definition, Risk Factors, Symptoms, and Prevention

A fentanyl overdose takes place when an individual consumes a toxic amount of fentanyl, a powerful synthetic opioid. Fentanyl overwhelms the body’s ability to manage its effects and potentially causes life-threatening symptoms like respiratory depression, extreme drowsiness, confusion, pinpoint pupils, and unconsciousness.

Table Of Contents:

• What is Fentanyl Overdose?
• What are the Risk Factors of Fentanyl Overdose?
• What are the Symptoms of Fentanyl Overdose?
• What are the Effects of Fentanyl Overdose?
• How to Respond to A Fentanyl Overdose?
• How Long Do Fentanyl Overdose Symptoms Last?
• What is Fentanyl?

The main risk factors for fentanyl overdose include using high doses of the drug, mixing fentanyl with other substances like alcohol or benzodiazepines, lack of tolerance in new users, or consuming fentanyl unknowingly in adulterated street drugs. The main symptoms of a fentanyl overdose are severe drowsiness, slowed or stopped breathing, pinpoint pupils, cold and clammy skin, and loss of consciousness. The main effects of a fentanyl overdose include respiratory failure, brain damage due to oxygen deprivation, and in severe cases, death.

What is Fentanyl Overdose?

Fentanyl overdose is when an individual consumes fentanyl, that overwhelms the body’s ability to process the drug which leads to life-threatening effects such as respiratory depression, coma, or death. Fentanyl is a synthetic opioid and is 100 times more powerful than morphine and 50 times more powerful than heroin. Fentanyl is used medically for severe pain but causes significant risks when used illicitly. Even small amounts of fentanyl are potentially lethal, as little as 2 milligrams capable of causing death, depending on the individual’s tolerance and body size according to the research titled “Facts About Fentanyl” published by the United States Drug Enforcement Administration”.

The prevalence of fentanyl overdoses has risen sharply in the United States. In 2022, synthetic opioids, primarily fentanyl, accounted for 68% of overdose deaths in the U.S. The rate of overdose deaths involving synthetic opioids (other than methadone) increased by 4% from 2021 to 2022 according to the research titled “Fentanyl” published by the U.S Centers For Disease Control and Prevention. Counterfeit pills containing fentanyl, often known as legitimate prescription drugs, have been a key factor in these deaths. 42% of pills tested for fentanyl contained potentially fatal doses. One kilogram of fentanyl, trafficked illegally, has the potential to kill 500,000 people, underscoring the extreme risk posed by the drug’s proliferation​ according to the DEA.

What are the Risk Factors of Fentanyl Overdose?

The risk factors of Fentanyl overdose are Opioid Dependence, High Doses, Co-usage with other drugs, and Lack of Awareness About Potency.

Below is the detail of the risk factors of fentanyl overdose:

• Opioid Dependence: Individuals with opioid use disorder are at higher risk of fentanyl overdose, specially due to its high potency and frequent presence in the illicit drug supply. Drug tolerance leads to usage of higher doses, increasing the risk of unknowingly consuming lethal amounts of fentanyl. Psychiatric conditions further increase these risks by contributing to patterns of risky drug use.
• High Doses: Fentanyl is 50/100 times more powerful than morphine, and even small miscalculations in dosage lead to fatal outcomes according to the research titled “Risk Factors for Opioid Misuse, Addiction, and Overdose” published by the U.S. DEPARTMENT OF LABOR. Users switching from less powerful opioids to fentanyl without proper adjustment are particularly vulnerable to overdosing​.
• Co-Usage with Other Drugs: Combining fentanyl with substances like benzodiazepines, alcohol, or other central nervous system depressants significantly increases overdose risk by intensifying respiratory depression according to the research titled “Alcohol or Benzodiazepine Co-involvement With Opioid Overdose Deaths in the United States, 1999-2017” written by Marco E Tori.
• Lack of Awareness About Potency: Fentanyl overdoses occur because users are unaware that the drug is mixed with other substances. Counterfeit pills or laced street drugs often contain lethal amounts of fentanyl​.

What are the Symptoms of Fentanyl Overdose?

The symptoms of Fentanyl overdose are Respiratory Distress, Unconsciousness, Blue-tinged Skin, Seizures, Cold and Clammy Skin, Slow, weak, or not breathing, and Pinpoint Pupils.

Below is the detail of fentanyl symptoms:

• Respiratory Distress: Fentanyl suppresses the respiratory system, leading to slowed or stopped breathing. Respiratory distress is the most critical physical symptom and often the direct cause of fatal outcomes during an overdose.
• Unconsciousness: Fentanyl overdoses frequently cause individuals to lose consciousness or slip into a coma, making them unresponsive and unable to seek help.
• Blue-Tinged Skin: Cyanosis, or bluish discoloration of the skin, lips, or nails,occur as a result of oxygen deprivation when the body struggles to circulate oxygen effectively. Blue Tinged skin symptom is common due to the fentanyl’s powerful respiratory depressant effects, which slow or stop breathing, leading to insufficient oxygen delivery to tissues.
• Seizures: High doses of fentanyl trigger seizures, adding further complications and increasing the risk of brain damage.
• Cold and Clammy Skin: Individuals who overdose on fentanyl show cold, damp skin as a sign of shock and poor circulation caused by the drug.
• Slow, Weak, or No Breathing: Fentanyl slows the respiratory rate to a dangerous level, and in severe cases, breathing may stop altogether, requiring immediate intervention.
• Pinpoint Pupils:​​ Pinpoint pupils are a sign of opioid overdose, including fentanyl, where the pupils become unusually small and fail to respond to light. Fentanyl’s powerful suppression of the central nervous system is a primary driver of this effect, accompanying other life threatening symptoms such as respiratory depression. Recognizing pinpoint pupils in the context of a suspected fentanyl overdose can be critical for timely intervention.

What are the Effects of Fentanyl Overdose?

The effects of Fentanyl overdose are Respiratory Failure, Permanent Damage to the Brain, Permanent Organ Damage, Death, and Leukoencephalopathy.

Below is the detail of the effects of fentanyl overdose:

• Respiratory Failure: Fentanyl causes respiratory depression so severe that it leads to a complete cessation of breathing. Respiratory failure happens rapidly, before a person becomes unconscious, making it one of the leading causes of fatal overdoses according to the research titled “Study reveals fentanyl’s effects on the brain” published by The Harvard Gazette.
• Permanent Brain Damage: Prolonged oxygen deprivation from respiratory failure causes irreversible brain damage. Fentanyl-induced hypoxia results in toxic encephalopathy, marked by symmetrical abnormalities in the brain’s gray and white matter, according to the research titled “Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy” written by Christopher O Eden.
• Permanent Organ Damage: The lack of oxygen during an overdose affects other vital organs, including the kidneys, liver, and heart, causing long-term dysfunction or irreversible damage. Multi-organ impact stems from systemic hypoxia and the drug’s toxic effects on cellular metabolism​.
• Death: Fentanyl overdose deaths have risen significantly in recent years. The CDC reported over 100,000 overdose deaths in the U.S. in 2021, with fentanyl implicated in more than 70% of cases.
• Leukoencephalopathy: Fentanyl misuse, especially through inhalation, can result in leukoencephalopathy, a rare but severe condition that involves white matter brain injury. This condition severely impacts cognitive and motor functions, often leaving survivors with permanent disabilities​.

How to Respond to A Fentanyl Overdose?

To respond to a fentanyl overdose, start by calling Emergency Services, Checking Breathing and Administering Naloxone. Below is the detail of these responses:

• Calling Emergency Services: Call your local emergency number immediately to summon professional medical assistance. Provide as much information as possible about the person’s condition and any substances they might have taken. Rapid response is essential to prevent fatal outcomes.
• Checking Breathing: Assess the individual’s breathing and pulse. If breathing is slow, irregular, or absent, administer rescue breaths if trained. Place the person in the recovery position if unconscious but breathing to prevent choking.
• Administering Naloxone: Naloxone is an opioid antagonist that reverses the effects of fentanyl by binding to the same receptors in the brain. Naloxone restores breathing and consciousness within minutes. Administer naloxone via nasal spray or injection as per the instructions in the kit. If no response occurs after 2-3 minutes, administer a second dose. Naloxone is available over the counter in many pharmacies, through harm reduction organizations, and sometimes free from local health departments. It is important to consult a medical doctor (MD) or healthcare professional if possible, to determine the appropriateness of naloxone for specific situations, especially if there are any pre existing health conditions or uncertainties about its use.

How Long Do Fentanyl Overdose Symptoms Last?

The symptoms of a fentanyl overdose last for 1-7 hours, depending on factors like dose, the individual’s metabolism, and whether naloxone has been administered. The severe phase of overdose symptoms, especially respiratory depression, typically lasts for 1-3 hours, which is when the risk of death is highest. Secondary symptoms, like confusion or drowsiness, persist longer as the drug continues to metabolize in the body.

Fentanyl’s half life is approximately 3-7 hours, but its effects are prolonged due to the potency of the drug and its accumulation in fatty tissues, specifically in individuals with compromised liver function. After administering naloxone, symptoms may return because naloxone’s effects last 30-90 minutes, which is shorter than fentanyl’s duration of action. Naloxone’s repeated doses and continuous medical monitoring are necessary to manage recurring symptoms.

What is Fentanyl?

Fentanyl is a very powerful synthetic opioid, 50 to 100 times stronger than morphine, and is used in medicine to manage severe pain, such as in cancer patients or post-surgery. Fentanyl works by binding to opioid receptors in the brain to reduce the sensation of pain. Because of its potency, small amounts lead to dangerous effects, including respiratory depression.

Illegally manufactured fentanyl, often mixed with other drugs like heroin or cocaine, is a major driver of the opioid overdose crisis, significantly contributing to overdose deaths worldwide.

What Does Fentanyl Look Like?

Fentanyl appears in various forms, such as patches, tablets, lozenges, or injectable solutions. Illegal fentanyl is manufactured as a white powder or pressed into counterfeit pills that resemble prescription medications like oxycodone or Xanax. Some versions are mixed with other drugs or dyed in bright colors, like “rainbow fentanyl,” to appeal to younger users or disguise its presence.

Why Is Fentanyl Dangerous?

Fentanyl is dangerous because of its extraordinary potency. It is 50-100 times more powerful than morphine and lethal in extremely small doses, as little as 2 milligrams. Fentanyl is fast-acting, leading to rapid respiratory depression, unconsciousness, and even death.

What Is Rainbow Fentanyl?

Rainbow fentanyl refers to brightly colored fentanyl pills or powder designed to resemble candy, likely to attract younger users or mask the drug’s presence. These forms of fentanyl are as powerful and deadly as traditional versions. Public health officials warn that the colorful appearance leads to accidental ingestion, especially among children and adolescents, exacerbating the overdose crisis.

How Does Fentanyl Kill You?

Fentanyl kills by causing respiratory failure. Fentanyl binds opioid receptors in the brain, slowing or stopping breathing, which deprives the body of oxygen. This leads to hypoxia, brain damage, or cardiac arrest within minutes. The drug’s potency and rapid onset make it especially lethal, with a much higher risk of fatal overdose compared to other opioids.

What Are the Uses of Fentanyl?

Fentanyl is used medically for managing severe and chronic pain, especially in cancer patients, helping patients in post surgical recovery and serving as an anesthetic during medical procedures. It is administered under strict supervision in forms such as transdermal patches, lozenges, and injections. Due to its potency, it is reserved for cases where other painkillers are ineffective.

Can Fentanyl Addiction Lead to Overdose?

Yes, fentanyl addiction can lead to overdose. The body builds a tolerance to opioids over time, and fentanyl addiction pushes individuals to increase their doses to achieve the same effect. With fentanyl’s high potency, even small increments can result in accidental overdose.

How does fentanyl overdose compare to overdoses from other substances?

Fentanyl overdose compares to overdoses from other substances by being far more lethal than heroin or cocaine because of its extreme potency and rapid onset. Fentanyl requires much smaller doses to cause fatal respiratory depression compared to heroin. Unlike cocaine overdoses, which often result from cardiovascular complications, fentanyl primarily causes death through respiratory failure. This makes fentanyl uniquely dangerous in the context of the opioid crisis.

Is fentanyl overdose more lethal than heroin overdose?

Yes, fentanyl overdose is more lethal than heroin overdose. Fentanyl is 100 times stronger than heroin which makes it far more likely to cause fatal respiratory depression at much smaller doses. Heroin overdose also leads to respiratory failure, fentanyl’s rapid onset and higher potency result in a much narrower window for intervention, making it far more dangerous.

Can naloxone (Narcan) be used to reverse both fentanyl and cocaine overdoses?

No, naloxone (Narcan) only reverses opioid overdoses, including those from fentanyl. Naloxone works by binding to the same receptors in the brain that opioids like fentanyl affect, temporarily reversing the effects of respiratory depression and sedation. Naloxone is ineffective in reversing overdoses caused by stimulants like cocaine, which affect different parts of the brain. Cocaine overdose requires other forms of medical interference, like managing cardiovascular symptoms and seizures.

Does crystal meth overdose require a different emergency response compared to fentanyl overdose?

Yes, crystal meth overdose requires a different emergency response compared to fentanyl overdose. Crystal meth, a stimulant, causes dangerous cardiovascular symptoms such as rapid heart rate, high blood pressure, and potential heart attack or stroke. Emergency response or involving sedatives or medications to control agitation and prevent seizures. Fentanyl overdose causes respiratory depression, and naloxone is used to reverse the effects.

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