Opioids and Fentanyl

Opioids are effective pain-relievers that can cause euphoria and lead to addiction, whether they are legally or illegally produced. During an opioid overdose, a person may stop breathing and their heart may stop beating as their central nervous system shuts down.  

• Prescription Opioids: To relieve pain, doctors may prescribe their patients opioids like oxycodone (OxyContin®), morphine, and even fentanyl for severe pain. When prescription opioids are distributed directly by legitimate medical professionals, their purity and strength as labeled can be trusted.
• Illicit Opioids: Illicit opioids include heroin and any other opioids that are produced outside of a legitimate pharmaceutical laboratory. Opioids that are made illegally are far more dangerous than prescription opioids because people using them cannot verify their purity or strength.
• Fentanyl: Synthetic opioids like fentanyl are the leading driver of the overdose epidemic. Because they are extremely powerful, just a tiny amount of fentanyl (or variations of fentanyl called analogues) can be lethal. Fentanyl is often mixed into drugs without the knowledge of the people using them. 

Why is fentanyl so dangerous?

Since fentanyl is so much stronger than other opioids, only a very small amount can be deadly. Because it is cheap and widely available, it is often added to other drugs such as heroin or even stimulants like cocaine and methamphetamine. While some people may purposefully use fentanyl for various reasons, often people who use drugs are not aware that fentanyl is in the substances they are using. 

What forms does fentanyl come in?

Illicitly-made fentanyl is sold through illicit drug markets in different forms, such as powder and liquid. Fentanyl is also often found in counterfeit pressed pills made to look like oxycodone (M30s), Xanax, and other prescription pills. These counterfeit pills may contain a lethal amount of fentanyl and can be nearly impossible to distinguish from legitimate prescription pills that were prescribed by a trusted medical professional and dispensed by a licensed pharmacist. 

Xylazine

Xylazine, also called “Tranq” or “Tranq Dope,” is increasingly found as a common adulterant in fentanyl. Xylazine is a long-acting sedative, but it is not an opioid.  Although xylazine does not respond directly to naloxone because it is not an opioid, the opioids that xylazine is combined with will respond to naloxone. In the event of a suspected overdose, administer naloxone every time, no matter what. Visit Xylazine and Novel Substances to learn more. A comprehensive overview of Xylazine can be found in Xylazine in Minnesota (PDF). 

Prevention resources

Naloxone

Fentanyl and its many variations are not “naloxone resistant.” They are opioids and will respond to naloxone if someone is overdosing. When it appears that someone who is overdosing is not responding to naloxone it may be because:

• the naloxone needs more time to take effect (wait 2-3 minutes before administering more naloxone)
• they need more than one dose of naloxone (wait 2-3 minutes between doses)
• the naloxone was administered after the person had been without oxygen for too long.

It is important to remember that the goal of administering naloxone is to get the person breathing, not to wake them up. 

To access naloxone, visit these sites:

• Naloxone Finder - Know the Dangers
• Naloxone Prescribing and Dispensing

Fentanyl test strips

Fentanyl test strips (FTS) are a form of drug testing technology which can detect the presence of fentanyl in drug samples prior to use. FTS are a reliable common-sense means of providing people at risk of fentanyl exposure with more information that can decrease risk of overdose. As of July 2021, FTS are no longer within the legal definition of “drug paraphernalia” in Minnesota and are thus legal to possess, carry, and distribute.

For more information on fentanyl test strips, visit:

• Fentanyl Test Strips for PWUD (PDF)
• Fentanyl Test Strips. | Steve Rummler HOPE Network

To access fentanyl test strips, contact:

• Fentanyl Test Strips. | Steve Rummler HOPE Network
• North Point Health and Wellness Syringe Service Provider

For more data on fentanyl and its impacts on overdoses in Minnesota, visit the MDH Drug Overdose Dashboard.