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Fentanyl Facts

Fentanyl Facts

There are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl (IMF). Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. Illicitly manufactured fentanyl (IMF) is distributed through illegal drug markets. IMF is often added to other drugs, especially opioids, because of its extreme potency, which makes drugs cheaper, more potent, more addictive, and more dangerous. This page will be focusing on illicitly manufactured fentanyl. If you have questions about pharmaceutical fentanyl talk to your pharmacist or PCP.

Illicitly manufactured fentanyl is a synthetic opioid that can be up to 50 times stronger than heroin and 100 times stronger than morphine. Because it is an illicit substance, its potency can change depending on the batch. It is a major contributor to fatal and nonfatal overdoses in the US, including Oregon.


​Illicitly manufactured fentanyl is a synthetic opioid that can be up to 50 times stronger than heroin and 100 times stronger than morphine. Because it is an illicit substance, its potency can change depending on the batch. It 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 are made to resemble other prescription opioids such as oxycodone. Fentanyl-laced drugs are extremely dangerous, and many people may be unaware that their drugs are laced with 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. Oregon is experiencing an influx of counterfeit pills that contain fentanyl. Many of these pills are made to look identical to prescription opioids and are falsely marketed as legitimate. The majority of counterfeit pills resemble oxycodone 30mg pills (M30s), but can also mimic 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 are selling counterfeit pills on social media, appealing to a younger, more opioid naïve audience that use these 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. Naloxone is an opioid antagonist that rapidly reverses the effects of an opioid overdose. With a fentanyl overdose, two or more doses of naloxone may need to be administered. Always call 911 in the event of a suspected overdose.

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Illicitly manufactured fentanyl has been prevalent in the northeastern region of the US since 2017, but it did not become prevalent in Oregon until 2019. Since then, law enforcement seizures of counterfeit pills containing fentanyl have grown dramatically in Oregon. The Oregon-Idaho High Intensity Drug Trafficking Area (HIDTA) reported seizing more than 1.3 million counterfeit pills in 2021 in Oregon, an 85% increase since 2020 and a 1,199% increase since 2019. Fentanyl is now the second leading cause of unintentional overdose in Oregon, after methamphetamine. 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. ​

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

  1. Unless a pharmacist directly hands you a prescription pill, assume it is counterfeit and contains fentanyl.
  2. Assume any pills obtained from social media, the internet, or a friend are counterfeit and contain fentanyl.
  3. If you are using pills, don’t use alone and always have naloxone on hand.
  4. Test your drugs with fentanyl test strips. Fentanyl test strips can often be accessed at local harm reduction sites. Ask your harm reduction providers how to effectively use a test strip.

An overdose is always a medical emergency. Individuals should call 911 immediately after administering naloxone. Be aware that it may take multiple doses of naloxone to reverse the 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 (pdf).

If you are actively using opioids, you can get naloxone and other harm reduction materials such as fentanyl test strips at no cost through syringe service programs. Syringe services are available to everyone that uses drugs, regardless as to whether you inject them. View a list ​of syringe and needle exchange services available in Oregon. If you are concerned you may witness an opioid overdose, naloxone can be obtained at a pharmacy or through your primary care provider.

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Fentanyl test strips (FTS) are a form of inexpensive drug testing technology that 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 may reduce their risk of overdose.

Are FTS accurate, reliable, or effective? Because access to FTS is relatively new, scientific evidence is still emerging:

  • An evaluation of FTS use in San Francisco found they promote increased fentanyl awareness and lead people to take safety precautions to prevent overdose if fentanyl is detected. ​(Source)
  • A study involving a community-based FTS distribution program in North Carolina found that 81% of those with access to FTS routinely tested their drugs before use. Those with a positive test result were five times more likely to change their drug use behavior to reduce the risk of overdose. (Source)
  • In a Rhode Island study of young adults who reported using heroin, cocaine, or illicitly obtained prescription pills, “receiving a positive [fentanyl] result was significantly associated with reportig a positive change in overdose risk behavior.” (Source)
  • A 2018 study jointly conducted by researchers at Brown University, Boston Medical Center, and Johns Hopkins University in collaboration with law enforcement agencies sought to validate the efficacy of FTS for use in detecting fentanyl in drug samples. The study found that the test strips were accurate at detecting fentanyl when it was present in samples of street drugs provided by law enforcement, and unlikely to produce false negative results. (Source)

FTS have some known limitations. They do not measure the quantity or potency of fentanyl present in a drug sample. There is also emerging evidence that FTS may produce inaccurate results with methamphetamine and that methamphatamine drug samples should be diluted in a greater amount of water (about half a cup) to produce accurrate fentanly testing results.

Fentanyl test strips may not be for everyone. FTS are most useful for individuals who use ilicit substances regulary. If an individual is opoid naiive, or taking a pill from an unknown souce, they should assume fentanyl is present in their drugs.

Vist the HIV Alliance website ​for instructions on how to use FTS.

How can people access FTS? FTS are considered an important tool to prevent drug overdose. If you are actively using opioids, you can get fentanyl test strips at no cost through syringe service programs. View a list of syringe and needle exchange services available in Oregon.

What else can people do to prevent drug overdose? For people who use drugs, FTS should be considered one “tool” in the “toolbox” of effective drug overdose prevention strategies.

Remember to also:

  • Connect with a local syringe service program. Syringe services are available to everyone that uses drugs, regardless as to whether you inject. View a list of syringe and needle exchange services available in Oregon.
  • Always have naloxone on hand and ensure that other people who are nearby know where it is and how to use it.
  • Avoid using alone and take turns using when using with other people so there is someone to administer naloxone if someone overdoses.
  • Know the symptoms of overdose and how to provide first aid. If someone overdoses, give them naloxone, call 911 immediately, and provide rescue breathing until they can breathe on their own.

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