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Fentanyl: Signs of Overdose


The United States is in the middle of an opioid crisis, and one of the most dangerous versions of the narcotic is a synthetic drug called fentanyl. Used frequently to treat cancer pain, it is 50 to 100 times stronger than morphine. People who use it illegally often turn to a street version laced with heroin and/or cocaine to increase the high, but they may not know what the other ingredients are, making it even more deadly.


The Fentanyl Pandemic

Doctors prescribe legal fentanyl as tablets, lozenges, nasal sprays, injections, and transdermal patches. Forms of illicit use include powder or pills, nasal sprays, eye drops, and candy-like drops on blotter paper. Street pills often look like legitimate pharmaceuticals, but their ingredients are usually unknown to users and may include other harmful drugs and chemicals.

In the late 1990s, drug companies told medical providers that patients wouldn’t get addicted to opioid painkillers. They were wrong, and widespread use made addiction a problem. Attitudes changed, and the U.S. Department of Health and Human Services declared their use a public health emergency and developed a treatment plan called the 5-Point Strategy to Combat the Opioid Crisis in 2017.

Between 1999 and 2018, approximately 450,00 Americans died from prescribed or illicit opioid overdoses. The Center for Disease Control and Prevention lists three waves of deaths. The first fatalities coincided with the increase in prescription opioids. In 2010, the second wave started and led to steep increases in heroin deaths. In 2013, the third wave began with the rise in overdose deaths from synthetic opioids, especially illegally made fentanyl. The epidemic continues with counterfeit pills and the addition of heroin and cocaine to illicit fentanyl. Many fentanyl deaths also included drugs like stimulants and marijuana.


What Are the Symptoms of Fentanyl Withdrawal?

The brain has opioid receptors that control emotions and pain, and opioids work by attaching to the receptors. With continued use, the brain changes and becomes less sensitive to the drug, decreasing its effects. It takes increasing amounts of the substance to get high, and the search for the drug becomes the driving force in life. Substance use disorder, the name of the medical diagnosis for tolerance or addiction, may be mild or severe, and it affects performance at home and work.

Fentanyl affects people in different ways. The size of the dose, the size of the user, the strength of the drug, and what it’s mixed with all play a role. Like other opioids, it carries the risk of tolerance, abuse, and addiction.

Symptoms of physical dependence start in the 12 hours after fentanyl use stops and may include the following:

  • Feelings of euphoria
  • Dry mouth
  • Constricted pupils
  • Pain relief
  • Relaxation
  • Sedation or extreme sleepiness
  • Dizziness
  • Confusion
  • Slow breathing
  • Nausea
  • Vomiting
  • Insomnia
  • Runny nose
  • Inability to empty the bladder or bowels
  • Tightness in the throat
  • Stiff, tight muscles

Because fentanyl is so potent, it can lead quickly to addiction. Doctors warn patients they may become dependent and even addicted to pharmaceutical versions. Research shows that synthetic opioids, especially fentanyl, cause more overdose deaths in the U.S. than any other drug. In 2017, over 20,000 people died of fentanyl overdoses. From 2015 to 2016, the number of fentanyl deaths was twice as high as the previous year.

Prescription fentanyl is known by the brand names Duragesic®, Sublimaze® and Actiq®. Street names of illicit fentanyl include Dance Fever, Goodfellas, Friend, Jackpot, Tango, Murder 8, and Cash.


What Are the Signs of Fentanyl Overdose?

Because fentanyl is so potent, even a tiny dose as light as 2 milligrams or small as TWO grains of salt is deadly for most people. One dose, especially when it’s taken illicitly or a prescription is abused, can cause a fatal overdose.

Signs and symptoms of an overdose may include the following:

  • Slow or erratic heartbeat
  • Shallow breathing
  • Clammy, cold skin
  • Difficulty speaking or walking
  • Being unresponsive or unconscious
  • Severe sleepiness or sedation
  • Confusion, dizziness, or feeling lightheaded
  • Purplish skin in light complexions or grayish skin in dark complexions
  • Limp body
  • Choking or gurgling noise
  • Purplish or blue lips and fingernails
  • Slow or no pulse


Why Is Accidental Exposure So Dangerous?

Fentanyl is especially dangerous because it takes so little of it to suppress the nervous and respiratory systems, and it’s odorless. It is up to 80 times as strong as morphine and hundreds of times more potent than heroin. In 2002, the Russian military used a fentanyl derivative to free hostages held by terrorists in a Moscow theater. No one knows if the fentanyl was mixed with other chemicals, but the substance killed 127 hostages.

The drug can show up as fine particles in the air or in fentanyl-contaminated water. It can also find its way into food and agricultural products. First responders, health care workers, law enforcement agents, and even police dogs are at risk of accidental fentanyl poisoning. In 2020, a police officer was packing up drug evidence while wearing protective gloves and collapsed. His fellow officers came to his aid and treated him with Narcan, saving his life.

The Federal Drug Administration warns caregivers, medical professionals, and patients that overdoses and death can occur when individuals, especially children, are exposed to some brands of transdermal fentanyl patches. How often accidental fentanyl exposure occurs and how much risk it poses are still being studied.


What Is the Treatment for Fentanyl Overdose?

Fortunately, there is a medication that can quickly reverse an opioid overdose. Naloxone, an opioid antagonist, binds to opioid receptors, as opiates do, and blocks fentanyl’s effects. It rapidly restores normal breathing that has slowed or stopped from an overdose. The FDA has approved three forms of naloxone: an injection, an auto-injection, and a nasal spray.

In an injection, trained professionals draw the medication from a vial and inject it into the thigh muscle. Sometimes, experienced health care providers inject naloxone into a vein or beneath the skin.

The second form is a prefilled auto-injection device that nonmedical individuals, such as family and friends, can inject. The person giving the injection activates the device and follows the oral directions it gives.

Narcan, the third option, is a pre-filled nasal spray that’s ready to spray into one nostril. When administered by first responders, all three versions of naloxone are effective. In 2019, one study showed higher levels of the injected medication in the blood than from the nasal device.

Doctors recommend that anyone who struggles with opioids keep naloxone handy and tell friends and family how to use it in an emergency. It’s a good idea to assign a trustworthy person to keep naloxone nearby and ready to administer. If there is a suspected overdose, someone should still call 911.

The use of naloxone to reverse and block opioid overdose is growing among police officers, emergency technicians, and first responders. Most states provide training for people who live with or know someone at risk of an opioid overdose. Pharmacists can usually help with instructions and training.

After being given, naloxone is effective for 30 to 90 minutes. Because fentanyl can stay in the system longer than other opioids, the effects of an overdose may return after the medication stops working. That’s why it’s so important to call 911 for immediate backup, especially until researchers find formulas that work longer for strong opioids. After giving the naloxone, the person should be watched until help arrives. Breathing can still slow down or stop for up to two hours after the last dose of fentanyl.

Some states sell naloxone without a prescription, and others require a prescription. In some communities, organizations or medical providers provide it for no charge. Naloxone is safe and effective, but more than one dose may be needed.


The Takeaway – 14 Facts to Remember

  1. Fentanyl is a strong synthetic opioid used to relieve pain, but it also comes in an illegal street version.
  2. Oral prescriptions contain enough fentanyl to be fatal to a child.
  3. There is a thin line between a deadly dose and a therapeutic one.
  4. Many illicit forms of fentanyl are even stronger than prescriptions.
  5. Heroin addicts sometimes use fentanyl as a substitute for heroin.
  6. Addicts who substitute fentanyl for heroin without knowing its potency risk deadly overdose.
  7. Fentanyl and other synthetic opiates are the most common cause of overdose fatalities.
  8. Illicit labs mix fentanyl with other drugs, such as meth, MDMA, cocaine, or heroin, without telling the user.
  9. Illegal fentanyl comes as a powder, drops on paper, eye drops, or pills that look like legitimate prescriptions.
  10. Fentanyl binds to opioid receptors in the brain that control emotions and pain.
  11. Effects may include feelings of extreme pleasure, sleepiness, nausea, agitation, confusion, sedation, dependence, addiction, respiratory depression and arrest, lack of consciousness, coma, and death.
  12. Fentanyl’s potency makes its use risky, and users may not know how much they’re taking or what is in it. It’s easy to make errors when calculating the strength, often leading to an overdose.
  13. A medication, naloxone, can reverse a fentanyl overdose, but it might take more than one dose, depending on how strong and how big the opioid dose was.
  14. Cognitive-behavioral therapy may be effective in treating fentanyl addiction.


Granite Recovery Centers Can Help

If you or someone you love has a problem with opioids, it’s time to get help. At Granite Recovery Centers, our team of experienced professionals works with adults who are dependent on alcohol or drugs. Located in New Hampshire, our rehab centers integrate evidence-based psychotherapy with a traditional 12-step program. Services include medical detox, medication-assisted treatment, primary and extended care, and outpatient counseling. Granite Recovery Centers provides medical detoxification for people who do not need immediate medical intervention, are not a danger to themselves, and are capable of self-evacuation in the event of an emergency.

A successful treatment for substance use disorder usually begins with detox, followed by inpatient or outpatient rehab. Depending on individual needs, we offer 24-hour medical supervision for inpatients and an outpatient program for those who choose to live in a supportive environment away from our facility. We also provide an extended care program to assist patients after they complete rehab and sober living homes for those who want a structured environment.

We know substance use disorder often occurs with, or because of, other mental conditions, such as depression or anxiety. At Granite Recovery Centers, we know how to treat both disorders at the same time. Our curriculum includes traditional counseling and medical supervision, but we also incorporate holistic therapies like therapeutic writing, meditation, and exercise. Our Uniformed Professionals Treatment Program caters to members of the military, law enforcement, and other uniformed professionals struggling with substance use disorders and/or mental conditions.

For more information about our services, visit our recovery blog. To schedule an appointment, contact us online or call 855.712.7784.