Why Is Fentanyl So Dangerous

Fentanyl is a very powerful synthetic opioid-a class of drugs used to treat pain. Used properly, as directed by a doctor, fentanyl is an effective way to help people living with severe and chronic pain.

The problem is that fentanyl is highly addictive and can lead to overdose and death-even in very small amounts. It's also cheaper and easier to make than other opioids, like heroin, making it desirable as a street drug.

"Fentanyl is becoming so common and it's finding its way into other drugs sold illegally," says Tyler Trahan, M.D., an internal medicine doctor and addiction specialist at Henry Ford Health. "It's showing up in counterfeit pain pills, and even in drugs like cocaine and street marijuana."

What Does Fentanyl Do?

When you take fentanyl, it binds to the opioid receptors in the brain, located in brain regions that control pain and emotions. Other opioids (like heroin, morphine and oxycodone) work similarly.

In addition to blocking pain sensations, fentanyl can also produce feelings of euphoria (a high). "And because it's so much more potent than other opioids, the high it creates is more intense," says Dr. Trahan. "That sets off the reward system in the brain and makes people want more of it."

How Do People Use Fentanyl?

In medical settings, fentanyl is prescribed as pain medication. It's sometimes given along with anesthesia during surgery. It's also prescribed for people with chronic cancer-related pain.

But far more commonly, fentanyl is showing up in street drugs. People may intentionally use it on its own or ingest it along with other drugs.

Often, though, people don't know they're taking it. Drug suppliers and dealers are making fentanyl and mixing it into other drugs. It's now very common to find it in many different illegal drugs. Most pills sold illegally online or on the street now typically contain fentanyl.

"It's actually a rarity now to find street pills that don't contain fentanyl," says Dr. Trahan. "A lot of the people I see in clinic are shocked to learn that whatever drug they're taking also has fentanyl in it."

Fentanyl Addiction

Like other opioids, fentanyl can be highly addictive. And because it's so much more potent than other drugs, it can lead to even more problems. When someone becomes addicted to fentanyl, they may experience intense withdrawal symptoms.

Fentanyl withdrawal symptoms can include:

• Bone and muscle pain
• Cold flashes
• Diarrhea
• Uncontrollable leg movements
• Vomiting

Fentanyl withdrawal is so painful and unpleasant that it drives people to use even more to get relief. And because it's being mixed with other, also addictive drugs, the problem is even worse. "Having fentanyl mixed into another substance makes that substance much more addictive," says Dr. Trahan.

Risk Of Fentanyl Overdose

The prevalence of fentanyl in the drug supply has created an epidemic of overdoses. According to the Centers for Disease Control and Prevention (CDC), more than 80,000 people died of opioid overdose (mostly fentanyl) in 2023.

"The overdose risk from fentanyl is so high because it's so potent," says Dr. Trahan. "Just 2 milligrams-which is the weight of just a few grains of sand-can be a lethal dose." Plus, many people don't even know they're getting fentanyl in their drugs, or how much might be in there. But just one pill may easily contain a lethal dose.

Getting Help

If you or a loved one uses street drugs, there are steps you can take to stay safer. "Having fentanyl test strips and testing your supply before using can help you know if what you're taking contains the drug," says Dr. Trahan. But he also notes that a negative test isn't a guarantee. "The amount can be so small that you could miss it simply by testing one side of a pill and not the other."

He also urges everyone to carry naloxone (Narcan) and know how to use it. This lifesaving drug-given as a nasal spray to someone who has overdosed on fentanyl or another opioid-can reverse an overdose. "But because fentanyl is so powerful, it typically takes multiple doses to fully reverse an overdose," says Dr. Trahan. After administering it, call 911. If the person goes back into overdose, give them another dose of Narcan while waiting for help to arrive.

For someone who's ready to get treatment for their addiction, the first step is reaching out for help. "As providers, we know how to manage fentanyl addiction and it's very treatable," says Dr. Trahan. "Despite its potency, we're able to help people recover from fentanyl addiction."

Reviewed by Dr. Tyler Trahan, an internal medicine doctor and addiction specialist who sees patients at Henry Ford Hospital and Henry Ford Maplegrove.