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Fentanyl

Fentanyl

Fentanyl is a strong synthetic opioid that relieves pain. Legal, pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. Legally made fentanyl can be diverted through theft, fraudulent prescriptions, and illicit distribution. Fentanyl is also illegally manufactured. Illicitly manufactured fentanyl (IMF) is distributed in powder or tablet (pill) form through illegal drug markets. IMF is often added to other drugs, because of its extreme potency. This makes drugs cheaper, more potent, more addictive, and more dangerous.

This page focuses on illicitly manufactured fentanyl. If you have questions about a fentanyl prescription that you received from a healthcare provider, talk to your pharmacist, primary care provider or visit the OHA Prescription Opioids webpage for more information.

The Oregon Health Authority presents this information with the acknowledgement that this data represents individuals whose loss of life has had an enormous impact on their families and communities.

Illicitly manufactured fentanyl (IMF) is a synthetic opioid that can be up to 50 times stronger than heroin and 100 times stronger than morphine. The potency and contents of illicit drugs, including IMF, is always changing. This makes it impossible for someone to know the strength or the mixture of substances in their drug product. Oregon is experiencing an influx of powdered fentanyl and fentanyl in the form of counterfeit pills. IMF is a major contributor to fatal and nonfatal overdoses in the US, including Oregon.

Powdered fentanyl looks just like many other drugs that come in powder form. In Oregon, we have seen white and colored powdered fentanyl. It is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that resemble other prescription opioids such as oxycodone. Illicitly manufactured fentanyl has not been found in cannabis (also known as marijuana or weed), but its presence in cocaine, heroin, methamphetamine, and counterfeit pills has significantly increased.

Drugs mixed with fentanyl are extremely dangerous, and many people may be unaware that their drugs contain fentanyl. It is nearly impossible to tell if drugs have been laced with fentanyl without the use of fentanyl test strips because fentanyl cannot be seen, smelled, or tasted.

Counterfeit pills containing fentanyl are made to look identical to prescription medication and are falsely marketed to people in the community as legitimate. Most counterfeit pills resemble oxycodone 30mg pills (M30s), but they can also look like hydrocodone, alprazolam (Xanax), Adderall, and other medications. These are photos of counterfeit pills collected from a drug seizure in Oregon. 

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Counterfeit pills are extremely dangerous because people purchasing them may think they are purchasing legitimate prescription medications. However, these fake pills may contain lethal amounts of fentanyl.

Distributors in the US sell counterfeit pills on social media, appealing to a younger, more opioid naïve audience that use social media apps. Opioid naïve individuals are at high risk of accidental overdose because they do not have a tolerance for opioids, may not have access to naloxone, and may not know how to decrease overdose risk.

Fentanyl mixed with drugs or alcohol increases the likelihood of a fatal overdose. Refer to OHA's Polysubstance webpage for more information on polysubstance use and overdose prevention.

Being prepared to respond to a fentanyl-involved overdose means having naloxone. Naloxone is an opioid overdose reversal medication that rapidly reverses the effects of opioids and can reverse an opioid overdose. Always call 911 in the event of a suspected overdose. Refer to the “Reduce Your Risk of Overdose" section below for more information.​

Since 2020, fatal overdoses involving illicitly manufactured fentanyl have significantly risen throughout Oregon. The number of unintentional overdose deaths related to illicitly manufactured fentanyl nearly quadrupled between 2020 and 2022, increasing from 223 to 843 overdose fatalities. (Data source: CDC SUDORS Dashboard: Fatal Drug Overdose Data). In 2022, illicitly manufactured fentanyl contributed to 65.5% of all overdose deaths in Oregon, making it the most prevalent illicit drug involved in overdose fatalities.1

The emergence of illicitly manufactured fentanyl has created a shift in the populations in Oregon impacted by substance use disorder and overdose. Communities with higher poverty rates and economic hardships, Native American/Native Alaskan communities, and non-Hispanic Black communities are disproportionately impacted by substance use disorder and overdose. These disparities are closely related to the systemic racism and centuries-long inequities these communities have historically experienced. There is an urgent need to dedicate attention and resources to closing the harmful gaps of racial inequities surrounding overdoses in Oregon. The Oregon Health Authority is committed to implementing community-driven solutions centered in equity to address Oregon's overdose crisis. Refer to the population-specific fact sheets below for more information:

The availability of fentanyl in Oregon has also caused the rise in overdose fatalities. Illicitly manufactured fentanyl has been prevalent in the northeastern region of the US since 2010s, but it did not become prevalent in Oregon until 2019. Since then, law enforcement seizures of illicitly manufactured fentanyl have grown dramatically in Oregon. Oregon law enforcement officials seized over 3 million counterfeit pills containing fentanyl and 176.8 kilograms (about 389.78 lbs.) of powder fentanyl in 2023. Nearly all these drug seizures occurred along the I-5 corridor within Oregon counties designated as high-intensity drug trafficking areas (HIDTA).

Refer to this report from the Oregon-Idaho HIDTA Program for more information on illicit drug use and trafficking trends in Oregon: Oregon-Idaho HIDTA Performance Management Process 2024.

Title: Illicitly Manufactured Fentanyl (IMF) Seized by Oregon HIDTA Designated Enforcement Initiatives, 2019-2023

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1. It is important to note that the CDC State Unintentional Drug Overdose Reporting System (SUDORS) data resource has up to a one-year lag between data collection and reporting as the data are processed and analyzed for quality. This webpage provides data through 2022, which is the most recent data available to share data insights and trends.

Fentanyl mixed (adulterated) with xylazine has been declared an emerging drug threat by the White House's Office of National Drug Control Policy.

Xylazine is a powerful non-opioid sedative used in veterinary medicine. Xylazine is not approeved or safe for human use in any amounts. When fentanyl or other opioids are mixd with xylazine, the effects on breathing can be life-threatening. Xylazine use can lead to unresponsiveness, forgetfulness or memory loss, dangerously low blood pressure, slowed heart rate, and reduced breathing. Xylazine can also cause wounds and may lead to life-threatening infections that can cause conditions like endocarditis and sepsis.

Many illicit drugs are mixed with multiple substances. Xylazine may be mixed in with other illicit drugs for several reasons, including increasing drug weight or adding an effect. People who use drugs may not be aware of the presence of xylazine in their drug product.

Xylazine is being incorporated into the illicit drug supply and is now geographically spread throughout the United States. Routine testing for xylazine by the Oregon State Medical Examiner began in 2020. Since then, xylazine has been found in a small but increasing amount of overdose deaths in Oregon. So far, all overdose deaths in Oregon where xylazine was present also involved fentanyl.

Refer to OHA's Xylazine webpage for more information about fentanyl adulterated with xylazine.

Refer to OHA's Polysubstance web​page for more information on polysubstance use and overdose prevention.

There is no safe way to consume illicitly manufactured fentanyl (IMF). Smoking IMF is not safer than injecting, snorting, or ingesting IMF. Smoking is now the primary route of use among drug overdose deaths in Oregon. Smoking IMF can intensify drug effects and increase overdose risk. Furthermore, people who use drugs by smoking as opposed to injecting may not use traditional syringe services where harm reduction messages and supplies are provided. Individuals who consume IMF should take harm reduction measures such as using clean smoking equipment or syringes, avoid using alone and ensure that naloxone is readily available in the case of an overdose.

Refer to this report for additional information: Routes of Drug Use Among Overdose Deaths – United States, 2020-2022 (link)

Oregon Health Authority recommends the following strategies to prevent accidental overdose:

  1. Unless a pharmacist or your healthcare provider directly hands you a prescription pill, assume it is counterfeit and contains fentanyl and other substances, including xylazine.
  2. Assume any pills from friends, social media, or the internet are counterfeit and contain fentanyl and other substances, including xylazine.
  3. When using substances, start low and go slow, checking the strength and the effects of the substance.
  4. Never use alone.
  5. Always carry naloxone with you.
  6. When using substances, have naloxone where it can be seen in case of overdose so that someone can use the naloxone on you.
  7. Store prescription medications and illicit substances in a locked cabinet or container, out of reach of children, pets, and unauthorized individuals.
  8. Test all the substances you are planning to use with fentanyl and xylazine test strips. You may be able to get drug testing strips at local syringe service or harm reduction program sites. Ask syringe service and harm reduction service providers how to correctly use fentanyl and xylazine drug testing strips.

 
Fentanyl test strips (FTS) are a useful and effective harm reduction tool to prevent an overdose. When used correctly, fentanyl test strips can identify the most common types of fentanyl in illicit drugs and pills. However, testing may not be 100% accurate, and you should assume that any illicit substance contains fentanyl. To learn more about how to use fentanyl test strip visit the CDC Fentanyl Test Strips Resource Guide.

Recognizing & Responding to an Opioid Overdose

When a person survives an overdose, it's because someone was present, recognized that the person was overdosing, and responded to help them.

People who use drugs and people who may witness an overdose should learn what an overdose looks like, carry naloxone, and know how to give naloxone to a person to reverse an opioid overdose. As fentanyl becomes more common in Oregon's drug supply, it is increasingly important to know how to identify and respond to overdoses.

Signs of an opioid overdose:

  • Difficult or unable to wake up
  • Slow or no breathing
  • Bluish or pale lips and fingernails
  • Pale or clammy skin
  • Abnormal snoring or breathing sounds
  • Vomiting or foaming at the mouth

If someone is unconscious or has any of these signs, administer naloxone and call 911 immediately. Refer to the Save Lives Oregon "Reverse Opioid Overdose with Naloxone Nasal Spray" guide for the six steps to reverse an opioid overdose.

An overdose is always a medical emergency. Call 911 immediately after administering naloxone. Be aware that it may take more than one dose of naloxone to reverse an opioid overdose.

Oregon's Good Samaritan law protects the caller and the person who has overdosed against possession and paraphernalia charges, or parole/probation violations based on information provided to emergency responders. Read the Good Samaritan law.

Syringe service programs provide support, information, naloxone, and other harm reduction supplies to people who use drugs, including people who take pills, smoke, inject, and more. There are many syringe service programs in Oregon. Please contact your local public health authority to learn more about services nearest to you.

If you are concerned you may witness an opioid overdose, you can get naloxone over the counter at most pharmacies in Oregon. If you are prescribed an opioid medication to treat pain, you can ask for a co-prescription of naloxone.

There is a growing concern about accidental or secondary exposure to illicitly manufactured fentanyl (IMF) and its potential to cause an overdose. Examples of accidental fentanyl exposure may include:

  • Exposure to secondhand smoke from someone smoking fentanyl in a public place
  • Exposure to fentanyl residue in a public place or on a piece of mail

Accidental exposure to secondhand fentanyl smoke, fentanyl powder, or fentanyl residue is highly unlikely to cause an overdose. Accidental fentanyl ingestion, which occurs when someone consumes a drug unknowingly containing fentanyl, is much more common and significantly more dangerous.

To date there is no evidence of community members or first responders experiencing an overdose from accidental or secondhand fentanyl exposure. First responders have different guidelines for preventing and responding to fentanyl exposure. For more information, please refer to the “Resources" section at the bottom of this page.

If you witness someone who might be experiencing an overdose, it is safe to help them. It is safe to touch them, administer naloxone, and provide rescue breathing or chest compressions.

Touching Fentanyl

You cannot overdose by touching fentanyl powder or counterfeit pills containing fentanyl. Fentanyl is not easily absorbed through the skin and there are no confirmed cases of this type of overdose scenario.

The only known way fentanyl can be absorbed through your skin is if you use a specially designed fentanyl patch that has been prescribed to you by a healthcare provider. But even then, it takes hours of contact for the fentanyl patch to take effect.

In the case that you accidentally touch fentanyl, do not panic, as accidental skin contact is highly unlikely to cause harm. Avoid touching your face and wash the affected area with soap and water immediately. Do not use alcohol-based hand sanitizers. Remove and wash any contaminated clothing separately. If you feel unwell or have concerns, seek medical attention right away.

If there are large amounts of fentanyl-containing pills or powder present, call 911. To clean up a small number of pills or powder, wear nitrile gloves, an N95 mask, and eye protection. Clean hard surfaces with a damp cloth. Vacuum carpet and fabric surfaces with a HEPA-filtered vacuum.

 

Breathing in Secondhand Fentanyl Smoke

There have been no clinically confirmed overdoses from people who accidentally inhaled secondhand fentanyl smoke. "Secondhand fentanyl smoke" refers to smoke produced by burning fentanyl pills or powder, or from the exhalation of someone who has smoked fentanyl. Even if you can smell smoke, the risk from being in or near exhaled fentanyl smoke is extremely low.

To clean an area where fentanyl has been smoked, open windows or run a fan to air out the space. Clean surfaces with a damp cloth. Wear nitrile gloves and an N95 mask for protection.

Breathing in Secondhand Fentanyl Smoke

Fentanyl powder does not easily become airborne, and the powder from the drug does not linger in the air. To be at risk for overdose from fentanyl powder, there would have to be large amounts of powder suspended in the air for a prolonged time. Such an event is highly unlikely.

If there is a large amount of fentanyl powder present, call 911. To clean up a small amount of fentanyl powder, wear nitrile gloves, an N95 mask, and eye protection. Clean hard surfaces with a damp cloth. Vacuum carpet and fabric surfaces with a HEPA-filtered vacuum.

If you or someone you care about is struggling with substance use, please reach out for help. Speak with a healthcare provider or visit the links below for support and treatment resources. You are not alone.

If you have additional questions about illicitly manufactured fentanyl or counterfeit pills, please contact the Injury & Violence Prevention Program at IVPP.General@odhsoha.oregon.gov​.