Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. It is a major contributor to fatal and nonfatal overdoses in the United States. There are two types of fentanyl: pharmaceutical fentanyl and illegally made fentanyl. Both are considered synthetic opioids. Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths. Even in small doses, it can be deadly. Two (2)mg of fentanyl, the amount on the tip of a pencil, can be enough to kill an average American. Over 150 individuals die every day from overdoses related to synthetic opioids like fentanyl.
Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer.
Most recent cases of fentanyl-related overdose are linked to illegally made fentanyl, which is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
Illicit drugs do not come with an ingredient list. Many contain deadly doses of fentanyl. Illegally made fentanyl (IMF) is available on the drug market in different forms, including liquid and powder:
Powdered fentanyl
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.
Fentanyl-laced drugs are extremely dangerous, and many individuals may be unaware that their drugs are laced with fentanyl.
Liquid fentanyl
In its liquid form, IMF can be found in nasal sprays, eye drops, and dropped onto paper or small candies.
Recognizing the signs of opioid overdose can save a life. Here are some things to look for:
Small, constricted “pinpoint pupils.”
Falling asleep or losing consciousness.
Slow, weak, or no breathing.
Choking or gurgling sounds.
Limp body.
Cold and/or clammy skin.
Discolored skin (especially in lips and nails).
Drugs may contain deadly levels of fentanyl, and an individual wouldn’t be able to see it, taste it, or smell it. It is nearly impossible to tell if drugs have been laced with fentanyl unless an individual tests their drugs with fentanyl test strips.
Fentanyl test strips (FTS) are a low-cost method of helping prevent drug overdoses and reducing harm. FTS are small strips of paper that can detect the presence of fentanyl in all different kinds of drugs (cocaine, methamphetamine, heroin, etc.) and drug forms (pills, powder, and injectables). FTS provide individuals who use drugs and communities with important information about fentanyl in the illicit drug supply so they can take steps to reduce risk of overdose. Test strips 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.
To test an individual’s drugs for fentanyl, here are steps when using FTS.
Depending on the types of drugs an individual is testing, the steps may be slightly different:
Step 1: The individual should put a small amount (at least 10mg) of their drugs aside in a clean, dry container.
Step 2: Add water to the container and mix together.
Please note: For most drugs, add ½ teaspoon of water.
For testing methamphetamines, use1 full teaspoon.
Step 3: Place the wavy end of the test strip down in the water and let it absorb for about 15 seconds.
Step 4: Take the strip out of the water and place it on a flat surface for 2 to 5 minutes.
One portion of a drug man contain fentanyl while another may not.
Step 5: Read results.
Positive results: A single pink line on the left-hand side indicates that fentanyl or a fentanyl analog has been detected in the drugs.
If there is a positive result, it is much safer to discard the batch.
Using it could kill the individual.
Illicitly manufactured fentanyl is extremely potent and can be deadly.
Negative results: Two pink lines indicate that fentanyl or a fentanyl analog has not been detected in the drugs.
Remember that no test is 100% accurate and the individual’s drugs may still contain fentanyl or fentanyl analogs even if they receive a negative result.
An individual should still take caution as FTS might not detect more potent fentanyl-like drugs, like carfentanil, and fentanyl might not be everywhere in their drugs and their test might miss it.
Invalid results: A single pink line on the right-hand side or no lines at all, indicates an invalid test.
If an individual gets an invalid result, they should test their drugs again using a new strip.
Fentanyl mixed with an animal tranquilizer called xylazine (also called “tranq” or “tranq dope”) is an emerging threat in the United States. Xylazine is a non-opioid sedative and is increasingly being found in the United States illicit drug supply and linked to overdose deaths. Although not acontrolled substancein the United States, xylazine is not approved for use in individuals. Xylazine is usually injected, although it can be swallowed or sniffed.
When used by individuals, xylazine can cause:
Sedation.
Difficulty breathing.
Dangerously low blood pressure.
Slowed heart rate.
Wounds that can become infected.
Severe withdrawal symptoms.
Death.
Xylazine can be life-threatening and is especially dangerous when combined with opioids like fentanyl. Individuals who use illegal drugs may not be aware of the presence of xylazine. The United States Drug Enforcement Administration (US DEA) has seized xylazine and fentanyl mixtures in 48 of 50 states, and the DEA laboratory system reported that approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA in 2022 contained xylazine.
Illegal drugs such as cocaine, heroin, and fentanyl can be mixed with xylazine, either to enhance drug effects or increase street value by increasing their weight. Due to its impact on the opioid crisis, fentanyl mixed (adulterated) with xylazine has been declared an emerging threat by the White House’s Office of National Drug Control Policy. On July 11, 2023, the White House released a National Response Plan to address the emerging threat of fentanyl mixed with xylazine.
In a recent study from CDC’s State Unintentional Drug Overdose Reporting System (SUDORS), among 20 states and Washington D.C. the monthly percentage of deaths involving illegally made fentanyl (IMF) with xylazine detected increased from 3% in January 2019 to 11% in June 2022. During January 2021–June 2022 in 31 states and Washington D.C., xylazine was detected in a higher percentage of IMF-involved deaths in the Northeastern United States.
The presence of xylazine in drugs tested in labs increased in every region of the United States from 2020-2021, with the largest increase in the South. Studies from specific areas found similar increases. One study from 10 US cities showed xylazine was involved in less than 1% of drug overdose deaths in 2015 and in nearly 7% in 2020.4 In samples from eight syringe service programs in Maryland tested between 2021 and 2022, xylazine was found in almost 80% of drug samples that contained opioids. In Philadelphia, Pennsylvania, xylazine was found in 31% of heroin and/or fentanyl overdose deaths in 2019.
It may be hard to tell whether an individual is high or experiencing an overdose. For those who aren’t sure, they should treat it like an overdose—you could save a life.
Call 9-1-1
For those who suspect an individual is overdosing on opioids and non-opioid xylazine, Call 911 Immediately.
For those who suspect an individual is overdosing on opioids and non-opioid xylazine:
Call 911 Immediately.
Administer naloxone, if available.
Naloxone is a life-saving medication that can reverse an overdose from opioids—including heroin, fentanyl, and prescription opioid medications—when given in time.
Naloxone quickly reverses an overdose by blocking the effects of opioids.
It can restore normal breathing within 2 to 3 minutes in a person whose breath has slowed, or even stopped, because of opioid overdose.
More than one dose of naloxone may be required when stronger opioids like fentanyl are involved.
Naloxone won’t harm someone if they’re overdosing on drugs other than opioids, so it’s always best to use it if an individual thinks someone is overdosing.
Naloxone is easy to use and small to carry.
Carrying naloxone is no different than carrying an epinephrine auto-injector (commonly known by the brand name EpiPen) for someone with allergies.
It simply provides an extra layer of protection for those at a higher risk for overdose.
If an individual or someone they know is at increased risk for opioid overdose, especially those struggling with opioid use disorder (OUD), they should carry naloxone and keep it at home.
Individuals who are taking high-dose opioid medications (greater or equal to 50 morphine milligram equivalents per day) prescribed by a doctor, people who use opioids and benzodiazepines together, and people who use illicit opioids like heroin should all carry naloxone.
Because an individual can’t use naloxone on themselves, they should let others know they have it in case they experience an opioid overdose.
There are two forms of naloxone that anyone can use without medical training or authorization: prefilled nasal spray and injectable.
If an individual is administered naloxone, stay with them until emergency help arrives or for at least four hours to make sure their breathing returns to normal.
Naloxone should be given in response toanysuspected drug overdose to reverse any possible opioid effects.
Naloxone will not reverse the effects of xylazine.
However, because xylazine is often used with opioids like fentanyl, naloxone should still be given.
It’s important to call 911 for additional medical treatment, especially since the effects of xylazine may continue after naloxone is given.
Try to keep the person awake and breathing.
For suspected xylazine overdose, give rescue breaths.
First responders have reported that rescue breaths are especially helpful for individuals who have used xylazine because it causes breathing to slow down.
To give rescue breaths to adults, make sure the person’s airway is clear; place one hand on the person’s chin, tilt the head back, and pinch the nose closed.
The individual should place their mouth over the person’s mouth to make a seal and give two slow breaths.
Watch for the person’s chest (but not the stomach) to rise and follow up with one breath every 5 seconds.
Lay the person on their side to prevent choking.
Stay with the person until emergency assistance arrives.
In January 2023, Governor Phil Murphy announced a nation-leading program to allow anyone 14 years or older to acquire naloxone anonymously and at no cost at participating pharmacies across New Jersey. The Department of Human Services partnered with the New Jersey Board of Pharmacy and its Medicaid division to craft and implement this unique program.
For a list of participating New Jersey pharmacies, visit: https://data.nj.gov/Human-Services/Naloxone365-NJ-Free-Naloxone-at-Pharmacies-Program/nfsa-3664/data.
For those individuals concerned about criminal penalties if they call 911 to save an overdose victim, most states have enacted Good Samaritan laws to help reduce overdose deaths and respond to opioid overdoses. Good Samaritan laws protect those who are overdosing and anyone assisting them in an emergency from arrest, charges, or a combination of these.
According to the United States Accountability Office, studies conducted suggest a pattern of lower rates of opioid-related overdose deaths among states that have enacted Good Samaritan laws, both compared to death rates prior to a law's enactment and death rates in states without such laws. In addition, studies found an increased likelihood of individuals calling 911 if they are aware of the laws.
A few simple tips can help everyone reduce the risk of overdose.
First, never use alone.
A leading reason why individuals die of an overdose is because there is no one there to help them.
Second, an individual should test their drugs: Fentanyl test strips may be available at syringe exchange programs or from other harm reduction services, and can help them to know if they are being exposed to more dangerous levels of opioids.
Third, carry Naloxone!
The Bergen-Hudson Chronic Disease Coalition, grant-funded by the NJ Department of Health Office of Cancer Control and Prevention, administered by the Bergen County Department of Health Services and the Jersey City Department of Health and Human Services in a shared agreement to conduct outreach in Hudson County, encourages men, women, and youth to be aware that fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths. Individuals who use illegal drugs may not be aware of the presence of fentanyl and they should use Fentanyl test strips (FTS) to detect the presence of fentanyl in other drugs. Individuals should also be aware that Xylazine can be life-threatening and is especially dangerous when combined with opioids like fentanyl.
Information for this release was researched through the websites of the Centers for Disease Control and Prevention (CDC) at: https://www.cdc.gov/stopoverdose/fentanyl/index.html,
https://www.cdc.gov/drugoverdose/deaths/other-drugs/xylazine/faq.html, National Institute on Drug Abuse at https://nida.nih.gov/videos/reducing-risks-fentanyl-in-us, U.S. Drug Enforcement Administration (DEA) at https://www.dea.gov/drug-information, and the New Jersey Department of Human Services at https://nj.gov/humanservices/stopoverdoses/.