Yes, fentanyl is indeed an opioid.

This synthetic, or lab-made, opioid is 50 times stronger than heroin and 100 times stronger than morphine, according to the Centers for Disease Control and Prevention (CDC). And that’s not necessarily a bad thing. When used correctly, pharmaceutical fentanyl can be a powerful tool for managing severe pain.

But you’ve likely heard about fentanyl being found in other drugs, creating an ongoing overdose crisis. Keep in mind that the majority of fentanyl-related overdose deaths in the United States involve illegally manufactured fentanyl. This is different from pharmaceutical fentanyl — more on this later.

Read on for a closer look at what fentanyl is, including what it can and can’t do.

Opioids are a group of drugs mainly used to treat pain. Along with fentanyl, some other opioids include:

The effects of opioids, including fentanyl, vary depending on the dose and whether they’re mixed with alcohol or other drugs.

Some of the common effects of opioids include:

In higher doses, opioids can cause your breathing and heart rate to slow, and lead to unconsciousness or even death.

Pharmaceutical fentanyl is prescribed for the treatment of severe pain, usually as a transdermal patch or lozenge.

It’s typically used to treat pain in people who:

  • just had surgery
  • have advanced stage cancer with breakthrough pain
  • developed a tolerance to other opioids and pain management medications

Fentanyl also has a sedative effect. Sometimes, healthcare professionals administer it intravenously as a sedative for people who are intubated.

Pharmaceutical fentanyl and illegally manufactured fentanyl are both synthetic opioids. But there are some key differences in how they’re made and used.

Pharmaceutical fentanyl is manufactured in tightly regulated labs. The package is clearly labeled with dosing information and instructions for use. It comes in the form of:

  • nasal sprays
  • sublingual sprays
  • lozenges
  • pills
  • patches

Illegally manufactured fentanyl, on the other hand, is produced without any kind of regulation or oversight. It’s found in pill, liquid, and powder form, usually without any kind of information about its potency or dosing guidelines. And since it’s not regulated, it can also contain unknown “cutting” agents. Manufacturers use these substances to cut costs. This is the type of fentanyl that’s behind most opioid-related deaths.

There’s no single reason behind the recent uptick in illegally manufactured fentanyl. Instead, it’s likely fueled by a combination of factors, including:

  • Increased profits. Illegal drug manufacturers and sellers sometimes mix fentanyl with other drugs, including heroin, methamphetamine, and cocaine, because it’s less expensive to produce and a little goes a long way. Some illegally manufactured fentanyl is made into pills that look like other opioids. These drugs are often sold to people who have no idea they contain fentanyl.
  • Reduced access to opioids. Efforts to control opioid prescribing have made it more difficult to obtain opioids, even for some people who rely on them for pain management. With fewer options for obtaining pharmaceutical opioids, some people opt for illegally manufactured fentanyl because it’s both easier to get and less expensive.
  • Tolerance to other opioids. If you regularly consume opioids, you’ll eventually build a tolerance. This means you’ll need to consume more to achieve the same effects. For people with a high tolerance, fentanyl can be a more cost-effective option due to its potency.
  • Accidental contamination. Remember, illegally manufactured fentanyl is usually made in an unregulated lab. In some cases, these labs are also producing other drugs. Without strict protocols in place, like you’d have in a regulated lab, cross contamination becomes a very real possibility.

Regardless of how it’s made and whether people consume it intentionally, fentanyl is a potent drug that can potentially lead to a fatal overdose for those who are exposed to larger amounts of opioids than they’re used to. For someone who doesn’t regularly take opioids, that could mean a relatively small amount.

Fentanyl is strong, but not that strong. The idea that someone could overdose from touching fentanyl or even a powerful fentanyl analog is a myth. According to a 2021 report, this myth came about after the Drug Enforcement Administration published some misinformation in 2016.

Since then, there have been anecdotal reports about this kind of “passive exposure” to fentanyl, particularly among police officers.

Passive exposure to fentanyl might involve accidentally touching a fentanyl transdermal patch or powder, or accidentally breathing it in. This type of exposure is unlikely to produce any side effects, let alone a lethal overdose.

That’s because fentanyl and its analogs don’t easily cross the skin barrier. They also don’t aerosolize well, meaning they don’t easily travel through air.

You’d need to apply and wear a patch, or spend 200 minutes breathing the highest possible airborne concentration of fentanyl, just to get a therapeutic dose, according to 2018 research. That’s not even a life threatening one.

Using fentanyl — whether it’s pharmaceutical or illegally manufactured —can only cause an overdose if you snort, inject, or inject it, or apply multiple patches and wear them for an extended period of time.

Fentanyl is a potent synthetic opioid that can be a safe, effective medication for managing severe pain. But its potency also means it carries a higher chance of causing an overdose, particularly if it’s used in a way that’s not prescribed.

If you’ve been prescribed fentanyl, make sure to follow your prescriber’s instructions when taking it.

If you or someone else consumes unprescribed or illegally manufactured fentanyl, or other drugs that could be contaminated, make sure you know how to recognize the symptoms of an opioid overdose. They include:

  • slow or shallow breathing
  • a rattling sound when breathing
  • small pupils
  • clammy, pale, or ashen skin
  • blue or gray fingertips
  • nausea or vomiting
  • loss of consciousness

Call your local emergency number right away if someone experiences these symptoms.

You may also want to consider carrying fentanyl test strips and naloxone, which can reverse an opioid overdose, Make sure those around you know how to use them. NEXT Distro can help you find test strips and naloxone in your area and even send you some by mail.

Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.