Fentanyl Overdose Primer for First Responders, Nurses

Fentanyl overdose
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There are eight deadly forms, and EMS1 has the details on what first responders and nurses need to know about fentanyl overdose.

Fentanyl was the subject of major scrutiny in the mid-2000s when it was linked to a slew of overdose deaths across the United States. Unfortunately, the crisis still continues today. The DEA reported a rise in fentanyl overdose deaths from 550 in 2013 to more than 2000 in 2014 and 2015.

The drug, which is 50 to 100 times more potent than morphine, is not detected in standard narcotic toxicology screens. It can also be hard to identify in the field, as fentanyl in its powder form is often cut with heroin and cocaine. For first responders, knowing the signs of a fentanyl overdose is imperative. As an opioid, fentanyl affects the part of the brain that controls breathing. Failure to recognize an overdose can lead to respiratory failure, respiratory arrest or death.

Five Medical Forms 

  1. Lozenge
  2. Oral tablet
  3. Oral spray
  4. IV
  5. Patch

All five forms of prescribed fentanyl are used illegally. Because the patch is known to contain large doses of fentanyl even after a three-day use, users can extract the drug and ingest it in other forms.

In medical applications, patients hold a tablet or lozenge under their tongue or in their cheek. The drug is then absorbed through the mucous membrane. Oral sprays are absorbed in the same manner. When using the patch, patients absorb the drug through their skin. Depending on whether the drug is absorbed through the skin, the mouth, or injected, the half-life of fentanyl varies.

Three Illegal Forms 

  1. Spiked blotter paper
  2. Manufactured tablets
  3. Powder

Usually, abusers of the drug get fentanyl from illegal manufacturers. Often, heroin abusers seek out fentanyl as a substitute to alleviate the side effects of heroin withdrawal. Heroin or cocaine users may also take fentanyl without knowing, as heroin or cocaine manufacturers will substitute fentanyl powder to reduce costs and increase potency. Illegal manufacturers may also use the powder to create tablets that are meant to mimic other opioids.

On the street, fentanyl lozenges are often referred to as ‘lollipops.’ These fentanyl lollipops have been illegally obtained and are often found at the end of a small stick. Street names for fentanyl include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.

The Side Effects

Common side effects of fentanyl include nausea, vomiting, itching, difficulty breathing, drowsiness, and unconsciousness. These side effects are also associated with heroin use. If heroin use is suspected, be on the lookout for signs that fentanyl may be involved. Patients may be unaware that they’ve taken fentanyl since the effects are very similar.

If a patient has used fentanyl via patch, it’s important to note that the drug may take some time to reach its peak concentration. So, while a patient may present only mild side effects, you should still be alert to a potential overdose.

Fentanyl Overdose Signs

Fentanyl is an opioid, so the signs of a fentanyl overdose are like those of a heroin overdose. The user may have bluish nails or lips in addition to difficulty breathing, remaining conscious, or speaking. Unlike other opioids, fentanyl has relatively little effect on heart function.

Naloxone is used to reverse overdose symptoms for opioids. Fentanyl overdoses are no exception to this method. However, because fentanyl is so potent, overdosed patients often need multiple applications of Naloxone.

Dosage Estimating

For first responders, estimating even an approximate dosage is difficult. As mentioned, fentanyl is often laced with other drugs and will contain other impurities. However, knowing the dosages used in medical applications may provide a useful perspective.

Fentanyl lozenges, or ‘lollipops’ come in six different doses measured in micrograms (mcg). Those are 200, 400, 600, 800, 1200, and 1600 mcg doses. The half-life of lozenges varies but can be up to 12 hours.

Patches are applied for three days at a time, with three different doses measured in micrograms per hour (mcg/hr). Those are 25, 50 or 100 mcg/hr. Similar to lozenges, the half-life of patches varies but is generally around 17 hours.

Fentanyl taken via injection has a significantly lower half-life of around 3.7 hours. However, estimating dosage via injection from illegal means is very difficult.

It’s worth noting that even in medical applications, fentanyl is only prescribed to patients who have taken opioids before. Fentanyl is so potent that patients need to have a tolerance of opioids for it to be safely prescribed.

Whether fentanyl has been used legally or illegally, first responders should always look for the signs of a potential overdose when a patient is unresponsive.

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