An unconscious person lies on a bed next to an open bottle of fentanyl pills

Recognizing Fentanyl Overdose (OD) Signs and Symptoms

Fentanyl is one of the strongest and deadliest drugs in the world.

Fentanyl, especially when mixed with other drugs, is the leading cause of the skyrocketing overdose fatality rates in the United States.

Every year, tens of thousands of Americans die as a result of fentanyl overdose. Luckily, most fentanyl overdoses are reversible if treated in time. This makes recognizing fentanyl overdose (OD) signs critical.

What Is Fentanyl and How Does it Compare to Other Opioids?

What Is Fentanyl and How Does it Compare to Other Opioids
Fentanyl is a synthetic (manufactured) opioid drug. As with all opioids, the chemical structure of fentanyl is very similar to that of heroin or oxycodone. Fentanyl is legally available and can be prescribed to treat pain.

Fentanyl works because its chemical structure is similar to that of opioids naturally produced in the body, which allows it to bond to their receptors and block the transmission of pain signals. By blocking signals from your brain to other parts of the body, fentanyl can cause vital organs to slow and entirely shut down.

Initially intended to treat the extreme pain terminal cancer patients experience, fentanyl is incredibly strong, much stronger than most other opioids. In fact, fentanyl is 100 times stronger than morphine and 50 times stronger than heroin.

Because of its strength, fentanyl can produce euphoric “highs” that are much stronger than most other opioids. Fentanyl’s strength also makes it highly addictive; it is widely believed to be not only one of the most addictive opioids but one of the most addictive substances in the world.

Most fentanyl overdose deaths happen because it causes the respiratory system to shut down. As the body’s breathing rate slows, less and less air is available for the lungs to pump through the body. This worsens as the heart starts to beat slower. Eventually, your body no longer has enough oxygen to function properly. This is why the lips and fingernails of opioid overdose victims turn blue or purple—they are starved for air. If lifesaving intervention is not conducted at this point, the victim will die from respiratory failure.

In rarer cases, fentanyl overdose can kill by asphyxiation. Victims who have either passed out or are unable to move due to fentanyl use may vomit. If they are on their backs, they may choke to death on their own vomit.

What Are the Signs of Fentanyl Overdose (OD)?

Although fentanyl overdose can cause death within minutes, there are treatments available that will reverse the overdose and prevent death if provided quickly enough.

It is therefore very important to recognize the signs and symptoms of fentanyl overdose. Some of the most common or serious signs of fentanyl overdose include:

  • Blue or purple lips or fingernails
  • Clammy or cold skin
  • Inability to be woken up
  • Inability to speak
  • Lack of awareness
  • Limp body
  • Pale face and skin
  • Slowed or stopped breathing
  • Slowed or stopped heartbeat
  • Small, constricted pupils (“pinpoint” pupils)
  • Vomiting or gurgling noises

What to Do if You Suspect a Fentanyl or Other Opioid Overdose

Although fentanyl kills quickly, reversing a fentanyl overdose can be just as quick. If you see the signs and suspect a fentanyl overdose (OD), you should take the following steps immediately.

  1. Call emergency medical services. In the United States, you can do this by dialing 911 (most countries will have their own unique number).
  2. If the person is unconscious, try to wake them up.
  3. If naloxone, often known by the brand name Narcan, is available, provide it to the victim immediately. Naloxone comes in three primary forms:
    1. A nasal spray that can be administered through the nose.
    2. An auto-injector that can be administered through the thigh.
    3. A liquid form that can be injected into the bloodstream (typically through the thigh) via a syringe.
  4. Attempt to revive their breathing through rescue breathing or CPR.
  5. Turn the person on their side or stomach if they are lying on their back. If they are seated, make sure that their head is pointed down toward the feet rather than backward facing the sky. This is to prevent death by choking on vomit.
  6. Remain with the person until emergency services arrive, or the victim arrives at a hospital or other emergency care facility.
  7. Provide support to the victim after they recover and help them find a treatment program that will prevent future overdoses.

You can purchase Narcan without a prescription at your local pharmacy. It is a fast-acting drug that reverses the effects of fentanyl—and could save a loved one’s life.

Psychiatric mental health nurse practitioner (PMHNP) Valerie Puffenberger says, “The availability of Narcan to be purchased over the counter could significantly reduce the number of deaths caused from opioid overdose.”

If you’re concerned a loved one may run the risk of overdosing on fentanyl, Puffenberger recommends:

  • Completing a first-aid course to recognize the signs and symptoms of opioid overdose
  • Learning CPR
  • Learning how to give naloxone (Narcan)
  • Purchasing fentanyl test strips, as it is nearly impossible to know if drugs have been laced with fentanyl

How Fentanyl and Other Opioid Overdoses Are Treated

Fentanyl overdoses must be immediately treated medically to prevent death. Once the patient is stabilized, they must receive long-term treatment to help ensure that another fentanyl overdose does not happen in the future.

Fentanyl overdoses are treated primarily by the drug naloxone (Narcan). Naloxone blocks the effects of opioids and does so almost immediately. If administered properly, naloxone can help the body return to normal breathing rates within two to three minutes. Naloxone is available over the counter in most states in either the nasal spray (Narcan) or auto-injector forms. Most police departments and emergency medical departments require their workers to carry naloxone in some form.

Other medical treatments are also available to fentanyl overdose victims, depending on their needs. Examples of some of the emergency services provided to those exhibiting signs of fentanyl overdose include CPR, shock treatment, and rehydration.

Once an individual has been stabilized, it is highly advisable that they enter a rehab program of some kind. There are thousands of different fentanyl rehab programs throughout the country, each unique. Most programs are either inpatient or outpatient, however.

Inpatient fentanyl rehab programs require patients to reside in the treatment facility. Outpatient fentanyl rehab programs require patients to reside elsewhere and come to the treatment facility for several days a week for treatment.

Inpatient rehab is typically more expensive and disruptive to the patient’s life, but it provides the greatest likelihood of achieving and maintaining sobriety. Outpatient rehab is typically cheaper and allows patients to continue meeting professional, personal, and familial obligations. But it provides a lower likelihood of success.

Preventing a Fentanyl Overdose

Fentanyl is an incredibly dangerous drug. There is no safe way to use fentanyl without medical supervision. If an individual continues to use fentanyl (or virtually any other drug because fentanyl is so commonly mixed into other substances), they will constantly be gambling with their lives.

The ONLY way to prevent fentanyl overdose is to completely refrain from using fentanyl without medical supervision.

If you or someone you love is having trouble quitting fentanyl or even reducing the amount that they consume, it is very likely that a fentanyl use disorder, more commonly known as a fentanyl addiction, has developed. Addiction is a terrible disease with terrible consequences, especially when the substance is a drug as deadly as fentanyl.

Untreated addiction can make it very hard to prevent future fentanyl overdoses. That means that treatment is critical. Both inpatient and outpatient fentanyl rehab programs are some of the most important tools in treating fentanyl addiction, and therefore preventing fentanyl overdose.

Get Help for Fentanyl Addiction

You don’t have to wait for the first signs of fentanyl overdose to appear. Getting help now is the best way to save a life.

If you or a loved one is struggling with a fentanyl use disorder, the best thing you can do is find a treatment program immediately. Legacy Healing Centers offer treatment programs designed to help people get their lives back on track.

We believe that a holistic approach to rehab is the best way for their clients to achieve lasting sobriety. To heal minds, bodies, and spirits, Legacy provides patients with clinical therapy, proper medication management, and aftercare.

Don’t wait until it’s too late. Call 888-534-2295 today to talk to the staff at Legacy Healing to learn about your fentanyl addiction treatment options.

Fentanyl Overdose FAQs

How do I support someone after a fentanyl overdose?

The best way for a loved one to support someone after a fentanyl overdose is by encouraging them to attend treatment and help with their healing journey. If you are looking to help a loved one who has experienced a fentanyl overdose, call Legacy Healing Center at 888-534-2295. The staff at Legacy Healing Center can help you find treatment options that could save your loved one’s life.

Why is fentanyl so dangerous?

Fentanyl is so dangerous for three reasons: It’s very strong, it’s very addictive, and it is frequently combined with other drugs. Fentanyl is one of the most powerful painkillers on the market. While that makes it more effective, it also makes it much deadlier. The odds of overdosing on fentanyl are simply much higher than the odds of overdosing on most drugs. Even a tiny amount of fentanyl can be deadly.

Fentanyl is so addictive that many people suffering from fentanyl addiction continue to misuse it despite the well-known risk of death. It is actually very common for fentanyl addiction sufferers to overdose multiple times in a single day, sometimes only hours after they are resuscitated by emergency personnel. This means that users are more likely to continue to put themselves at risk of death.

Fentanyl is one of the most common cutting agents found in street drugs. There are many reasons why so many drugs are cut (mixed) with fentanyl, including cost, strength, addictive properties, and ease of shipment. Unfortunately, most drug buyers are unaware that their drugs were cut with fentanyl (and other substances). Although the dosage of the drug they are buying would not be fatal, the amount of fentanyl present is.

How can I reduce my risk of fentanyl overdose?

The only way to reduce your risk of fentanyl overdose is to not take fentanyl. Fentanyl is so dangerous that there is no other way. Ideally, an individual would refrain from using illicit drugs entirely. At the very least, users of other drugs should purchase fentanyl test strips to make sure that what they are using is not cut with fentanyl.

Although naloxone (Narcan) can reverse a fentanyl overdose, it cannot reduce the risk of the overdose happening in the first place. If you or a loved one regularly uses opioids (or other illicit drugs), it is critical that you keep several doses of Narcan in the home because it is so effective at reducing the risk of death from a fentanyl overdose.



  1. United States Drug Enforcement Administration. (no date). Fentanyl.
  2. Centers for Disease Control and Prevention. (2023, June 27). Fentanyl Facts.
  3. UC Davis Health. (2023, January 11). Fentanyl Facts, Overdose Signs to Look For, and How You Can Help Save a Life.
  4. Texas Health and Human Services. (no date). Fighting Fentanyl.
  5. Florida Department of Health in St. Johns County. (2022, July 8). Florida Public Health and Safety Alert: Fentanyl Overdoses.
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About the Author

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Jeffrey Juergens

Jeff Juergens is a leading author in the addiction and recovery field, dedicating the last seven years of his life to helping those struggling with substance use issues find the help that they need. Jeff's work has been used in rehabs across the country as tools to help patients achieve sobriety.

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Dr. Edwin Gomez, M.D.

Edwin Gomez, M.D. joined the Legacy Healing Centers Medical Team in 2021. In addition to working at Legacy Healing Centers, Dr. Gomez operates a private practice and research here in the South Florida Area and the Florida Keys. Prior to joining Legacy Healing Center, he served as Medical Dire...