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Fentanyl Facts

Fentanyl Facts

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, fradulent 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 added to other drugs, especially opioids, 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 or primary care provider.

​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. 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. 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.

Oregon is experiencing an influx of fentanyl in the form of counterfeit pills. Many of these pills are made to look identical to prescription opioids 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. Naloxone is a medication that rapidly reverses the effects of opioids and can reverse 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 amount of seized fentanyl in Oregon's high intensity drug trafficking areas (HIDTA) increased from 690 dosage units (counterfeit pills) in 2018 to more than 2 million in 2022. Fentanyl has now surpassed methamphetamine as the most frequent drug involved in overdose deaths in Oregon.

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. ​

​Xylaxine is a powerful non-opioid sedative used in veterinary medicine. Xylazine is not approved or safe for human use in any amounts. When fentanyl or other opioids are mixed with xylazine, the effects on breathing can be life-threatening.

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. There are limitations to xylazine and fentanyl drug checking strips because illicit drugs are not evenly mixed. This means that fentanyl and/or xylazine may still be present in a drug product, even when a portion of the product tested with drug checking strips does not react. This is why it's best to assume that all drugs not prescribed and handed to you by a pharmacist are mixed with fentanyl, xylazine, or other drugs.

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

Effects of Xylazine

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. These wounds have been reported from injecting, smoking, and snorting xylazine, and they can develop quickly. Multiple wounds may form at the same time. Xylazine wounds can take a long time to heal and require prolonged medical care.

People using xylazine can develop a dependence and may be at risk of withdrawal. Withdrawal symptoms can include anxiety, irritability, restlessness, rapid heart rate, and high blood pressure. Xylazine withdrawal can become a critical medical event requiring hospitalization. Clinicians should be prepared to manage both xylazine and opioid withdrawal symptoms for individuals admitted for care.

Since xylazine is not an opioid, naloxone and other opioid antagonists do not reverse xylazine's effect on breathing in the event of an overdose. Xylazine mixed with fentanyl or other opioids can increase the chances for fatal overdose because both drugs slow and stop breathing.

The Food & Drug Administration issued a letter to healthcare professionals (link) in November 2022 to provide clinical information about the risks of xylazine exposure in humans, possible withdrawal symptoms, and considerations for medical care.

Xylazine in Oregon

Xylazine is being incorporated into the illicit drug supply and is now geographically spread throughout the United States. Xylazine has frequently been found mixed with opioids (including fentanyl) and stimulants (including methamphetamine and cocaine).

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. In 2020, there were two overdose deaths where xylazine was identified in the toxicology report, followed by nine in 2021 and nine (so far) in 2022. Oregon's 2022 date is preliminary and may change. The Oregon Health Authority expects to see a significant increase in xylazine-involved overdose deaths in 2023 once the data are finalized. So far, all overdose deaths in Oregon where xylazine was present also involved fentanyl.

Responding to Xylazine Overdoses

Naloxone should be given in response to any suspected drug overdose. Naloxone will not reverse the effects of xylazine, but it does help reverse the effects of opioids such as fentanyl. Naloxone should still be given because xylazine is often used with fentanyl. Naloxone will not cause harm if opioids are not involved in an overdose. It is important to call 911 for additional medical treatment, especially since the effects of xylazine may continue after naloxone is given.

Rescue breaths are critical for people who have used xylazine because it causes breathing to slow down. Harm reduction experts also recommend rolling the person who has overdosed onto their side with their top knee bent, in the recovery position.

If you call police or 911 to get help for someone having a drug overdose, Oregon's Good Samaritan law protects you and the person who has overdosed from being arrested or prosecuted for drug-related charges or parole/probation violations based on information provided to emergency responders. Read the Good Samaritan law (pdf).

Learn more about responding to suspected drug overdoses on OHA's Naloxone Rescue for Opioid Overdose webpage (link).


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

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. 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.

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 xylazine 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 (pdf) for the six steps to reverse an opioid overdose.

An overdose is always a medical emergency. Individuals should 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 (pdf).

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 (link) to learn more about services nearest to you.

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

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

Oregon-Specific Resources

National Resources