Fentanyl Overdose Symptoms, Effects & Treatment

Last Updated: December 1, 2023

Editorial Policy | Research Policy

Fentanyl use can lead to overdose and other negative effects. But there are ways to prevent and treat its symptoms.

In recent years, there has been a lot of discussion surrounding the opioid overdose epidemic in the United States. The rate of overdoses increased rapidly beginning in 2013, and synthetic opioids like fentanyl have been at the center of this crisis. Between 2013 and 2019, overdose deaths involving synthetic opioids increased by 1,040%. The effects of this on communities and families have been devastating. Learning more about fentanyl, its associated risks and available treatment options has the potential to save lives. 

What Is Fentanyl? 

Fentanyl is a synthetic opioid, meaning the chemical compound has been developed to mimic naturally occurring opioids. When considering dosing and the potential for toxicity, fentanyl is often thought to be 100 times more potent than morphine. Over the years, a variety of prescription products have been developed, with applications ranging from intravenous solutions for hospital use to patches and even lollipops for chronic pain management. 

In medical practice, fentanyl is generally reserved for hospital use or for patients considered opioid-tolerant—i.e., taking 60 mg of morphine or equivalent daily for a week or more. Because of fentanyl’s potency, exposure to doses perceived as small has the potential to cause toxicity. 

As fentanyl produced illicitly has become more available over the last decade, there has been an associated increase in fatal overdoses. Without quality control measures monitoring accurate delivery of dosing and the potential for impurities, the risks of inadvertently taking more than intended are substantial. Adding to this risk is the fact that many individuals may not be aware they are using fentanyl at all. Unfortunately, the practice of lacing drug products like heroin or cocaine has become more commonplace. 

Fentanyl Overdose Symptoms

Due to the relative potency of fentanyl, the potential for overdose is higher compared to other opioids and opiates like heroin. As opioid receptors in the brain become overloaded and toxicity develops, the following symptoms can occur

  • Pinpoint pupils
  • Slow, shallow, labored breathing or stopped breathing
  • Cyanosis, e.g., lips or fingernails turning blue, purple or white 
  • Nausea or vomiting 
  • Drowsiness, difficulty speaking or loss of consciousness

Respiratory depression is a primary concern during opioid overdose. As opioid receptors are overwhelmed, the body no longer sends the appropriate signals necessary to continue normal breathing. If this process stops altogether, it can be deadly. 

Fentanyl Overdose Causes and Risk Factors

Whether someone takes fentanyl intentionally or unintentionally, fentanyl has the potential to overwhelm the body’s opioid receptors once in your system. Various factors can increase the risk of this occurring: 

  • Opioid tolerance and the need for progressively higher doses
  • Unintentional dosing, e.g., lacing or replacing other products with fentanyl
  • Dosage inconsistencies introduced by illicit manufacturing
  • Using other substances like alcohol or benzodiazepines at the same time, which can make respiratory depression more likely
  • Intravenous administration, allowing for rapid onset and higher peak levels

An interesting and troubling phenomenon associated with opioids is differential opioid tolerance. This means that over time, opioids become less effective at producing pain relief or euphoria, but tolerance to effects like constipation and respiratory depression is not developed as quickly. The longer an opioid is used, the higher the likelihood that you will need higher doses for effect and the higher the risk of respiratory depression. 

Steps To Take When Someone Overdoses on Fentanyl

If you suspect someone is overdosing on fentanyl, it can be frightening. Familiarity with the signs of overdose and a plan of action could save a life. Fentanyl overdose is a medical emergency, so the steps to follow are: 

  • Call 911 if you notice any of the following:
    • Signs of respiratory depression
      • Shallow, slow, labored or no breathing
      • Lips or fingernails have turned blue, purple or white
    • Unresponsiveness; the body is limp, unable to awaken or speak
    • Gurgling noises in the throat or vomiting
    • Slowed or stopped heartbeat
  • Administer naloxone, if available
  • If you suspect the person is no longer breathing or their heart has stopped beating, perform CPR until paramedics arrive on the scene

Keep Naloxone on Hand

Naloxone is currently accessible without a prescription as part of a nationwide initiative aimed at improving its availability. Much like how individuals with asthma carry an inhaler for emergencies, having a form of naloxone like Narcan readily available serves as a safety net. It can potentially save the lives of loved ones and community members. Removing the stigma is important; naloxone is recommended to keep on hand regardless of whether an opioid was prescribed or is being used in other capacities. 

Treatment Options for Fentanyl Overdose

Outside of a clinic or hospital setting, the best treatment option for fentanyl overdose is naloxone. The improved availability, including the ability to purchase these products without prescriptions, means naloxone can be carried or kept on hand by anyone. With naloxone being in the hands of more people, more lives may be saved. 

Regardless of whether naloxone has been administered, fentanyl overdose is still a medical emergency requiring close monitoring by a physician. Medical management of fentanyl overdoses in the emergency department follows a standardized approach common among opioids: 

  • Reestablishing and maintaining oxygen levels, with ventilation often required
  • Recognizing and appropriately treating any other substances also present, if needed
  • Managing withdrawal symptoms
  • Establishing psychosocial support for continued withdrawal management and opioid use recovery

Care in the emergency department hinges on managing oxygen levels and respiratory depression. Additional supportive care is provided depending on individual needs as the individual is stabilized. 

Fentanyl Addiction Treatment

After initial overdose treatment, longer-term social, mental and emotional support becomes crucial. Treatment options involving medications, individualized therapy and group settings also provide comprehensive help for anyone wanting help managing fentanyl or opioid use. 

The Recovery Village Indianapolis Drug and Alcohol Rehab Center offers compassionate, nonjudgmental care customized to your individual needs. Get in touch today and find out more about our commitment to empowering you on your journey to recovery.


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National Library of Medicine. “Fentanyl Transdermal Patch, Extended Release.” May 2023. Accessed September 29, 2023.

Ciccarone, Daniel. “The Rise of Illicit Fentanyls, Stimulants and the Fourth Wave of the Opioid Overdose Crisis.” Current Opinion in Psychiatry, July 2021. Accessed September 29, 2023. 

Parthvi, Rukma; Agrawal, Abhinav; Khanijo, Sameer; Tsegaye, Adey; & Talwar, Arunabh. “Acute Opiate Overdose: An Update on Management Strategies in Emergency Department and Critical Care Unit.” American Journal of Therapeutics, May 2019. Accessed September 29, 2023. 

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