The Trump administration announced on Thursday that it would suspend recently imposed tariffs on Mexico and Canada for about a month. The tariffs were intended to thwart the flow of fentanyl into the United States and dampen life-threatening overdoses tied to the drug.
The news has thrust fentanyl, a drug that’s been at the forefront of the opioid epidemic, into the spotlight and resurfaced questions about its dangers.
More than 107,000 people died from drug overdoses in 2023, and nearly 70 percent of those deaths were caused by fentanyl and other opioids, according to the Drug Enforcement Administration.
Provisional C.D.C. data through September of last year indicate that deaths caused by fentanyl have been falling for months. Yet many people know someone who has died because of fentanyl, said Dr. Daniel Colby, medical director of the emergency medicine department at the University of California, Davis. “And I think that’s causing a lot of concern.”
What is fentanyl?
Fentanyl is a synthetic opioid, which means it’s created in a laboratory with chemicals, said Dr. David Fiellin, the director of the Yale Program in Addiction Medicine.
The drug, which is approved by the Food and Drug Administration for pharmaceutical use, is offered to relieve pain, Dr. Colby said. It could be given to someone who visits the E.R. after breaking a bone, for instance, or while a patient undergoes an invasive surgery, he said.
Pharmaceutical fentanyl is incredibly strong, so doses are carefully measured by doctors. It can be given several ways including injected into veins, absorbed through skin using a patch or sprayed under the tongue, Dr. Fiellin said.
Illegal fentanyl can also be injected, and it’s often sold as a white powder that is snorted, smoked or packed into a pill, Dr. Fiellin said. And while there’s no chemical difference between pharmaceutical fentanyl and the drug that’s sold illicitly, Dr. Fiellin said, illegal fentanyl isn’t measured or distributed carefully and is often combined with other drugs.
You don’t know what you’re getting when fentanyl is “being sold in a bag on a street,” Dr. Colby said.
How does it work?
The brain and the spinal cord have opioid receptors that help regulate pain, Dr. Fiellin said. When fentanyl enters the bloodstream, it binds to those receptors and reduces how much pain the brain perceives, said Dr. Caroline Freiermuth, an associate professor of emergency medicine at the University of Cincinnati.
The drug also “hijacks” the brain’s reward system by triggering the release of dopamine and mimicking substances like endorphins, which our body produces to make us feel good, Dr. Fiellin said. This can create a “high,” or a feeling of euphoria, associated with using many opioids, Dr. Freiermuth said.
Why is it so dangerous?
In short, fentanyl can be unsafe because it’s extremely potent. It’s considered about “50 times stronger than heroin” and “100 times stronger than morphine,” according to the C.D.C. That makes it easy for someone to overdose without medical supervision, experts said.
The drug is also frequently disguised as or mixed with other substances, Dr. Colby said. This means many people don’t know that they’re ingesting it. In 2023, about 46 percent of overdose deaths involved opioids combined with stimulant drugs including cocaine and methamphetamine, according to the C.D.C.
Using fentanyl can cause confusion, dizziness, nausea and vomiting, according to the D.E.A. It can also cause constipation, sleepiness and a deadly side effect called respiratory depression, which is when your natural drive to breathe is reduced and breathing becomes slow and shallow, Dr. Fiellin said. You can lose consciousness, stop breathing altogether and die as a result, Dr. Colby added. And it’s only possible to experience these side effects if fentanyl enters your system, he said. You won’t feel anything or run the risk of overdosing if you’re just near the substance.
Those who survive an overdose can sometimes experience permanent brain damage if they were deprived of oxygen for too long, Dr. Fiellin said. They may also develop kidney failure, nerve damage and pneumonia, among other issues.
But it’s important to remember that fentanyl is safe to use in medical settings, Dr. Colby said, where a doctor can ensure you’re taking a safe dose.
“There’s nothing wrong or immoral or evil about the medicine itself,” Dr. Colby said.
Why are fentanyl deaths falling?
Experts have largely credited the overdose-reversing medicine naloxone, known as Narcan, with reducing deaths caused by opioids.
The F.D.A. approved naloxone as a prescription medication decades ago, but access increased exponentially in 2023, when the agency approved an over-the-counter nasal spray version of the medicine. And prescription medications to treat opioid use disorder — namely buprenorphine and methadone — save lives too, Dr. Colby said.
Fentanyl test strips, which identify whether another drug contains the opioid, are available over the counter and may also play a role, Dr. Fiellin said. But they’re not foolproof, Dr. Freiermuth added, and they’re not legal in every state.
The best way to avoid overdosing is to never use fentanyl without a doctor’s guidance. “Any use of fentanyl outside a prescription is potentially fatal,” Dr. Freiermuth said.
