A fentanyl overdose may result in signs and symptoms such as:

• stupor (dazed or nearly unconscious)
• pupil constriction
• cold and clammy skin, looking pale
• stiff or limp body
• cyanosis (blue / purple tint to skin, lips or fingernails)
• vomiting
• gurgling sounds
• frothing at the mouth
• slowed or absent breathing (respiratory depression or failure)
• coma (cannot be awakened, unable to speak)
• heartbeat slows or stops
• death

The presence of unconsciousness or a coma, pupil constriction, and respiratory depression (slowed or absent breathing) occurring together strongly suggests an overdose with an opioid like fentanyl.

Fentanyl works in the brain to block pain and is in the same class of drugs as morphine or hydrocodone but is about 50 to 100 times more potent. A very small amount of this drug can lead to death. It blocks opioid receptors and its most dangerous side effect is respiratory depression (slowed or absent breathing), which can quickly lead to coma and death. Users may not realize the street drug they are buying from a dealer contains this potentially lethal compound.

Street names for fentanyl include: Apache, China Girl, China White, Dance Fever, TNT, and Crush.

How do you treat a fentanyl overdose?

Naloxone can reverse a fentanyl overdose if an adequate dose is given right away when symptoms appear.

• If you have access to naloxone, administer it first to the person who overdosed, then call emergency medical services by calling 911 (in the US) after you have given a dose of naloxone.
• Lay the person on their side to prevent choking and try to keep them awake and breathing if possible.
• You may need to readminister naloxone at 2 minute intervals if no response occurs and you have additional doses available.
• Stay with the person until emergency personnel arrive and start to administer care.

Naloxone is a safe medication. You can get naloxone from your pharmacist without a prescription. Insurance will usually pay for it. It may quickly reverse an opioid overdose, usually in a matter of minutes, but you may need to use more than one dose. It comes as an injection or is sprayed into the nose to rapidly block the effects of the opioid on the body.

Can you overdose by touching illegal fentanyl?

• In general, brief exposure of illicit fentanyl powder to intact skin of first responders has not led to serious adverse events.
• Skin exposure of illicit fentanyl is not expected to lead to toxicity due to its poor penetration of the skin barrier, and symptoms of intoxication from skin exposure are unlikely.
• Emergency first-responders should follow their employers guidelines, and review the NIOSH (National Institute for Occupational Safety and Health) recommendations to help prevent emergency responders’ exposures to illicit drugs, including fentanyl.

Many reports in the media have suggested that illicit fentanyl encountered by first responders such as law enforcement, emergency medical personnel and others can be easily absorbed through intact skin and lead to an overdose. For skin exposure, clinical toxicology experts state that the risk of clinically significant exposure to emergency responders is extremely low.

If your skin is exposed to illicit fentanyl, you should wash the area with soap and water right away. Do not use alcohol based hand sanitizers or bleach; they do not effectively wash opioids off skin and may increase skin absorption of fentanyl.

Fentanyl powder

Illicit (illegal) fentanyl is often smuggled into the US in powder form and may be pressed into fake pills or mixed with other drugs like cocaine, heroin, and methamphetamine ("meth"). The fake pills often look just like the real prescription products, and they are difficult, if not impossible, to distinguish for the average lay-person. Fentanyl test strips are now available and are the best way to find out if fentanyl is in a product.

You cannot overdose on illicit fentanyl powder just by touching it, as it must get into your blood to get to your brain, according to the Tennessee Dept. of Mental Health and Substance Abuse Services. However, if you suspect you may have touched fentanyl, do not touch your eyes, nose or mouth as it may enter your body from there. Wash your hands right away with soap and water. Do not use hand sanitizer or bleach as it will not remove the substance from your hands.

Fentanyl liquid

One case describes the accidental occupational skin exposure of a worker with a large volume of pharmaceutical grade fentanyl citrate (10 microgram fentanyl base per mL). The exposure occurred over a large skin surface area. In addition, the fentanyl was in contact with some areas of broken skin increasing the risk for fentanyl absorption.

After exposure, the patient underwent a standard decontamination procedure and a brief medical exam. According to the report, no clinical effects of opioid exposure were observed.

Prescription forms of fentanyl

Prescription fentanyl products can be dangerous or lethal if handled inappropriately or accidentally consumed by someone it was not prescribed for, including adults and children.

Fentanyl brand names include:

• Duragesic
• Actiq
• Fentora
• Lazanda
• Subsys

If you have been prescribed fentanyl, never give anyone else this medicine. They could die from taking it. Selling or giving away any form of prescription fentanyl is against the law.

Always keep fentanyl in a safe place away from children, teens, visitors, pets and from anyone for whom it has not been prescribed. Protect fentanyl from theft. Tell your healthcare provider if you live in a home where there are small children or someone who has abused street or prescription drugs.

Read the Medication Guide that comes with your specific prescription fentanyl product to learn about how to safely store and dispose of your used, expired, unwanted, or unused medicine and device. Some products need to be flushed down the toilet and not put in the trash. If you are not sure how to dispose of your medicine, ask your doctor or pharmacist.

What is the fentanyl death pose?

The “fentanyl death pose” is a phrase that has been used in media to refer to the stiffening of the body when someone overdoses on fentanyl. Fentanyl-induced muscle rigidity of the torso may also be known as “wooden chest syndrome”.

• In one case report, a 52-year old man who had injected illicit fentanyl was found by nursing staff. He was seated with “elbows flexed, fists clenched, and neck flexed and stiff; his eyes were open, but he was unresponsive to verbal stimuli or sternal rub.” He was also described as having a bluish tint (cyanotic), with a rigid chest and not breathing on his own.
• The man received 0.4 mg of naloxone by subcutaneous injection to treat his overdose. Within 6 minutes of the naloxone administration, the rigidity had subsided, his arms and neck were relaxed, his eyes were open when spoken to, and he was breathing on his own.
• These symptoms commonly subside within seconds to minutes after naloxone administration, but can also take longer.

Risk factors for fentanyl-induced muscle rigidity may include rapid injection, high doses of fentanyl, age over 60 years, underlying neurologic or metabolic conditions, Parkinson's disease, or use of certain medicines that may increase norepinephrine and serotonin levels, such as certain antidepressants.

Atypical overdose characteristics described by respondents during suspected fentanyl overdose included:

• immediate blue discoloration of the lips
• gurgling sounds with breathing
• stiffening of the body or seizure-like activity
• foaming at the mouth
• confusion or strange affect before unresponsiveness

For more information, you can contact find evidence-based treatment and service options near you by visiting https://findtreatment.gov or by calling the 24/7, National Helpline at 800-662-HELP (4357).

This is not all the information you need to know about fentanyl and does not take the place of your healthcare provider's advice. Discuss this information and any questions you have with your doctor or other health care provider.