Key points
- Fentanyl is a powerful synthetic opioid that can be used for surgery or to treat severe pain. The majority of fentanyl-related harms and overdoses are linked to illegally made fentanyl (IMF).
- Fentanyl and fentanyl analogs have contributed to a dramatic rise in U.S. drug overdose deaths.
- You can detect fentanyl in drug products using fentanyl test strips.
- Naloxone can reverse an overdose from opioids, including fentanyl.
What is fentanyl?
There are two types of fentanyl - pharmaceutical fentanyl and illegally made fentanyl. Both types are synthetic (lab made) opioids.
- Pharmaceutical fentanyl is a synthetic opioid made by a drug company that is used for surgery or for treating severe pain, typically 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 illegal drug market. It is most commonly found in powder form or pressed into counterfeit pills and can be smoked, snorted, injected, or ingested.5 Drugs mixed with fentanyl are extremely dangerous and many people might be unaware their drugs contain it.
- Powdered fentanyl looks just like many other drugs and can be mixed with drugs like heroin, cocaine, and methamphetamine.5
- Illegally made fentanyl is also increasingly pressed into counterfeit pills, commonly resembling oxycodone pills (e.g., M30 pills) or alprazolam pills (Xanax). Pharmaceutical fentanyl does not come in pill form.5
Deaths involving illegally made fentanyl are rising
Approximately 69% of all drug overdose deaths in 2023 involved synthetic opioids other than methadone (primarily reflects illegally made fentanyl).6Nonfatal and fatal overdoses involving fentanyl have risen sharply over the past decade.789
- Nearly 73,000 drug overdose deaths involved synthetic opioids (other than methadone) in 2023. This is approximately a 1% decrease from the number in 2022.7
- The rate of overdose deaths involving synthetic opioids (other than methadone) decreased approximately 2% from 2022 to 2023.7
- The rate of overdose deaths involving synthetic opioids (other than methadone) in 2023 was approximately 22 times the rate in 2013.7
Drugs may contain deadly levels of fentanyl, and you wouldn't be able to see it, taste it, or smell it.
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 large number of overdose deaths involving fentanyl highlights the need to ensure people most at risk can access care, as well as the need to expand prevention and response activities.
In 2020, 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; 2024 National Drug Threat Assessment.
- Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2023. Available at http://wonder.cdc.gov.
- Garnett MF, Miniño AM. Drug overdose deaths in the United States, 2003–2023. NCHS Data Brief, no 522. Hyattsville, MD: National Center for Health Statistics. 2024. DOI: https://dx.doi.org/10.15620/cdc/170565.
- 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.