Fentanyl Overdose Signs, Symptoms, and Treatment

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Fentanyl has become increasingly dangerous leading to an increased risk of fentanyl overdose amongst users. The growth patterns of fentanyl overdose with fatal or long-lasting harmful effects raise important questions:

  • What is fentanyl overdose?
  • What happens when you overdose?
  • Who is at higher risk of misusing fentanyl?
  • What can you do if you or someone you know experiences fentanyl overdose symptoms?
  • How can you get treatment for or prevent fentanyl overdose?

When minutes matter, knowing how to manage a fentanyl overdose might save your life.

How a Fentanyl Overdose Happens

Fentanyl overdose can occur when taken orally or nasally, ingested through the skin, or injected directly into your blood vessels.2 Crushing and snorting or smoking fentanyl can have a high risk of overdose, even if you believe it is safer than injecting the medication.3

Lozenges allow for absorption of fentanyl through the mouth, like cough drops. Using mucous membranes, such as lips or rectal walls, to absorb fentanyl can also place you at risk for fentanyl overdose.

Illegally manufactured fentanyl can come in powder, liquid, spray, and blotter paper form.4 Using any form of fentanyl, including illegally produced forms that look like pills, can have severe health consequences.

With its high level of strength and potency, the effects of fentanyl intoxication and overdose appear rapidly, “within seconds to minutes,” after use.5 Though its biological effects may look similar to heroin, fentanyl’s quick effects on the body and brain make overdose, even more, dangerous.6

Signs of a Fentanyl Overdose

Common fentanyl overdose signs include2,5,6,7:

  • Lips turning blue
  • Difficulty breathing
  • Hypoxia
  • Gurgling sounds while breathing
  • Lethargy
  • Stiff muscles
  • “Wooden chest”
  • Behavior that looks like seizures
  • Foaming mouth
  • Confusion
  • Abnormal mood changes
  • Unconsciousness
  • Coma
  • Death

If you or someone you know shows signs of a fentanyl overdose, seek medical attention immediately. The potential rapid onset of fentanyl overdose requires fast-acting intervention to minimize the risk of severe health consequences up to and including death.

Difficulty breathing or suffocation can result in a loss of oxygen to the brain and other parts of the body.8 This has left some who have used fentanyl with severe brain damage. Brain damage can impact your functioning for the rest of your life, making it harder to achieve full recovery.4

Due to its high potency, you only need a small amount of fentanyl to overdose.7 If you use fentanyl, talk about the risks of overdose with someone you trust. Having a source of support to help you when you need it can save your life.

Call 800-681-1058 (Info iconWho Answers?) if you are addicted to fentanyl and want to avoid an overdose. A treatment specialist can help you get the help you need.

Who Is At Risk of a Fentanyl Overdose?

Research indicates that healthcare personnel with access to the medication may have a higher risk of misusing fentanyl.2 Further research has indicated that individuals with a history of substance use disorders or addiction face a higher risk of misusing and overdosing on fentanyl. This includes individuals who receive opioid medication for the treatment of other physical health disorders.2,9

A history of poly-substance use also places you at higher risk of misuse and fentanyl overdose. Many individuals who have died as a result of fentanyl use have had other substances in their system such as:2

The increased risk of a fentanyl overdose in urban areas received greater national attention when rates surged between 2013 and 2016. Impure or “cut” medications have seen growing popularity in illicit markets. Manufacturers of other substances including cocaine, MDMA, ecstasy, heroin, and meth may add fentanyl to increase their profits.11

The low manufacturing costs of fentanyl may invite people with severe substance use dependencies to use it when they can afford little else. Because of unchecked manufacturing practices and fentanyl’s various forms, you cannot always guarantee that the dosage you receive will remain the same each time.

Doses may vary if you get a new dealer, purchase substances online, or travel to a different area for purchase. A new source may give you a higher dosage than your body can safely tolerate.

Another challenge that fentanyl potentially poses relates to cross-tolerance. Using some substances results in a higher tolerance to other substances, especially if those substances share the same classification, such as opioids.12 Fentanyl, though closely related to other opioids, may not increase tolerance the same way that heroin does.7 Even if you develop a tolerance to a certain dosage of heroin, taking the same amount of heroin laced with fentanyl may place you at higher risk of overdose.

Some test strips can determine whether substances have fentanyl in them.13 Using these strips can help you stay informed and make safer decisions regarding substance use.14

Whatever your source of fentanyl, medical or illicit, taking too much can result in an overdose with potentially deadly or life-threatening consequences.

Why Do People Misuse Fentanyl?

Some people may want to misuse fentanyl for its intoxicating effects, which include:4,10

  • Euphoria
  • Sedation
  • Altered-mood state
  • Pain relief
  • Self-medication for the effects of withdrawal

How to Treat an Overdose

Get medical attention immediately if you suspect that you or someone else has overdosed on fentanyl. Emergency responders may use naloxone to counter the effects of an overdose.15

Naloxone is an antagonist for opioid receptors, meaning it counters the effects of an opioid overdose when administered.15 Given the high potency of fentanyl, you may need higher dosages of Naloxone to ensure recovery from an overdose.4

Emergency responders may administer naloxone to prevent death or other severe health concerns associated with overdose. Some people have access to take-home kits with dosages of naloxone for self-administration or administration by non-medical persons.15

Naloxone can come injectable, with a needle, or nasal spray forms.4 Call 800-681-1058 (Info iconWho Answers?) to speak with a treatment professional about what options you may have for harm reduction and overdose management.

Taking fentanyl in the company of someone you trust and who understands fentanyl overdose can reduce your risk of serious harm. Talk with your loved ones if you face the risk of overdose from intentional or unintentional consumption of fentanyl.

Transitioning to Long-Term Treatment

Whether you have overdosed, received emergency medical treatment, or have concerns about your risk for overdose, professionals can help you manage the impact of fentanyl on your life.

Continued use of fentanyl or other opioid substances can result in a substance use disorder.12 Some signs of a substance use disorder or dependence include:

  • Spending a lot of time seeking the substance
  • Using the substance despite the risk of health issues
  • Neglecting life activities to use the substance
  • Need for increased amounts of the substance for the same effect
  • Difficulty quitting use because of physical or mental withdrawal symptoms

Medication-Assisted Treatment (MAT)

Medication-assisted treatment employs different medications to treat substance use disorders you might develop when using fentanyl or any other opioid substance. Some medications that providers use to treat substance fentanyl dependence include:16

Buprenorphine and methadone work to curb cravings and withdrawal symptoms associated with opioid misuse.16 Naltrexone can block opioid receptors and the effects of oral or injected opioid use.17

Emergency room or medically-assisted treatment can serve as a bridge between overdose treatment and long-term recovery.17 The effects of withdrawal may motivate a person to quit using. The effects of addiction can make quitting an intense and challenging experience.12


Mental health and addiction counseling can help you or a loved one cope with the lasting effects of an overdose and the challenges associated with early recovery.

Motivational interviewing techniques, cognitive-behavioral therapy, group activities, case management services, and peer-led support can help you develop the skills you need to stay safe as you manage the effects of a substance use disorder.4

As you start your journey of recovery, you may learn that other painful experiences contribute to your likelihood of misusing or overdosing on fentanyl. Long-term counseling and medical services can help you develop a treatment plan to manage physical or psychological suffering.

This support can help you safely manage other issues affecting your health and reduce your risk of developing an opioid dependence or overdose. Call 800-681-1058 (Info iconWho Answers?) today to speak with a treatment specialist about which program is best for you.

What is Fentanyl?

First developed in the late 1950s by a Belgian pharmaceutical company, fentanyl has received attention from medical professionals for its potential for pain management.2 Then and now, fentanyl has received fame and notoriety for its fast-acting effects. The potency of fentanyl far outpaces that of other opiate-type substances, including morphine and heroin.

Prescription brands for fentanyl include:4

  • Actiq
  • Duragesic
  • Sublimaz

Common street names for fentanyl include:3

  • China white
  • China girl
  • The bomb
  • Friend
  • Murder
  • Poison
  • Dance fever
  • Jackpot
  • Goodfella
  • TNT
  • Tango and Cash


  1. Centers for Disease Control and Prevention. (2020, December 18). Overdose Deaths Accelerating During COVID-19.
  2. Kuczyńska, K., Grzonkowski, P., Kacprzak, Ł., & Zawilska, J. B. (2018). Abuse of fentanyl: An emerging problem to face. Forensic Science International, 289, 207–214.
  3. Kohlmetz, E. M. (2019). Fentanyl. Salem Press Encyclopedia of Health.
  4. National Institute on Drug Abuse. (2019, February 28). Fentanyl DrugFacts. Retrieved on 2021, March 29.
  5. Somerville, N.J., O’Donnell, J., Gladden, R.M., et al. Characteristics of fentanyl overdose – Massachusetts, 2014-2016. MMWR: Morbidity & Mortality Weekly Report, 66(14), 382-386.
  6. Hill, R., Santhakumar, R., Dewey, W., Kelly, E., & Henderson, G. (2020). Fentanyl depression of respiration: Comparison with heroin and morphine. British Journal of Pharmacology, 177(2), 254–266.
  7. Gill, H., Kelly, E., & Henderson, G. (2019). How the complex pharmacology of the fentanyls contributes to their lethality. Addiction, 114(9), 1524–1525.
  8. Martinson, J., & Watson, B. (2019, November 2). Alive but not the same: B.C. woman survives overdose but left with brain damage. The Canadian Broadcasting Corporation.
  9. Krause, D., Plörer, D., Koller, G., Martin, G., Winter, C., Adam, R., Canolli, M., Al-Iassin, J., Musselmann, R., Walcher, S., Schäfer, F., & Pogarell, O. (2017). High concomitant misuse of fentanyl in subjects on opioid maintenance treatment. Substance Use & Misuse, 52(5), 639–645.
  10. Cheema, E., McGuinness, K., Hadi, M. A., Paudyal, V., Elnaem, M. H., Alhifany, A. A., Elrggal, M. E., & Hamid, A. A. (2020). Causes, nature and toxicology of fentanyl-associated deaths: A systematic review of deaths reported in peer-reviewed literature. Journal of Pain Research, 13, 3281.
  11. Behavioral Health Services – County of Santa Clara. (2020, September 3). Fentanyl Takes Friends.
  12. American Psychiatric Association. (2013). Substance-related and addictive disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).
  13. Reed, M. K., Roth, A. M., Tabb, L. P., Groves, A. K., & Lankenau, S. E. (2021). “I probably got a minute”: Perceptions of fentanyl test strip use among people who use stimulants. International Journal of Drug Policy.
  14. Jacka, B. P., Goldman, J. E., Yedinak, J. L., Bernstein, E., Hadland, S. E., Buxton, J. A., Sherman, S. G., Biello, K. B., & Marshall, B. D. L. (2020). A randomized clinical trial of a theory-based fentanyl overdose education and fentanyl test strip distribution intervention to reduce rates of opioid overdose: study protocol for a randomized controlled trial. Trials, 21(1).
  15. Parkin, S., Neale, J., Brown, C., Jones, J. D., Brandt, L., Castillo, F., Campbell, A. N. C., Strang, J., & Comer, S. D. (2021). A qualitative study of repeat naloxone administrations during opioid overdose intervention by people who use opioids in New York City. International Journal of Drug Policy, 87.
  16. Jaeger, J. S., & Fuehrlein, B. (2020). Buprenorphine initiation to treat opioid use disorder in emergency rooms. Journal of the Neurological Sciences, 411.
  17. Bradley, E. S., Liss, D., Carreiro, S. P., Brush, D. E., & Babu, K. (2019). Potential uses of naltrexone in emergency department patients with opioid use disorder. Clinical Toxicology (15563650), 57(9), 753–759.
  18. Verified.org. (2021). Don’t Fall for This COVID Vaccine Scam: Vaccines Are Free
Pen iconAuthor
Ruben Bermea, LPC
Licensed Professional Counselor, Author
Ruben Bermea, LPC, is a Licensed Professional Counselor who has had the privilege of serving Texans as they navigate personal and mental health challenges. Ruben has provided therapy to clients in inpatient, residential, private practice, and community mental health settings. His personal and professional interests include the intersection between technology and mental health, the impact of misinf