Fentanyl: Signs of overdose and how to respond

What is fentanyl? 

Fentanyl is a potent synthetic opioid commonly used in medicine for strong pain relief. It can be up to 100 times stronger than morphine and other prescription opioids, and its effects happen quickly. 

There are similar chemical compounds such as carfentanyl and acetylfentanyl (known as fentanyl analogues). These can be even stronger in small amounts and may carry an even higher risk of overdose. 

Illegally produced fentanyl is more common in North America than in parts of the world such as Europe or Australia, where non-medical fentanyl use generally comes from diverted pharmaceutical supplies. 

Signs of a fentanyl overdose 

Like all opioids, fentanyl attaches to receptors in the brain to block pain signals and slow the central nervous system. Opioids can cause relaxation and euphoria, but too much – especially when combined with other depressant drugs – can slow breathing to dangerous levels and stop the natural urge to breathe. This can lead to brain damage or death. 

Signs of overdose can include: 

• Not responding / cannot be woken 

• Limp body and cold or clammy skin 

• Irregular, shallow, or slow breathing (less than 12 breaths per minute) 

• Snoring or gurgling sounds (can appear like deep sleep) 

• Blue / pale or grey / ashen lips or fingertips 

• Possible vomiting 

How to respond to a fentanyl overdose 

Sometimes it can take hours for an opioid overdose to become fatal. Even if a person appears to be sleeping, they may be in danger. Immediate action could save a life. 

Check for vital signs: 

• A – Alert: Not responding to voice, touch, or pain 

• B – Breathing: Noisy, shallow, slow, stopped or unusual snoring/gurgling sounds 

• C – Colour: Blue or pale lips and fingertips (lighter skin) or grey/ashy colour (darker skin) 

If you see any of these signs, act immediately. 

Before you act: Check for danger (sharp objects, chemicals, traffic, etc.). 

Try to get a response by calling their name, squeezing their shoulder firmly or rubbing knuckles firmly across the sternum (chest bone). 

• If the person is not responding but is breathing: Place them in the recovery position. Ensure their airway is open and monitor vital signs. 

• If the person is not breathing: Use naloxone (Narcan®) if available and/or start rescue breathing. 

Call an ambulance, stay on the line and follow instructions. 

Using naloxone (Narcan)  

1. Assemble the naloxone according to packet instructions. 
2. Give the smallest dose possible and record the time. Keep the packaging to give to paramedics. 
3. Wait 2–4 minutes and stay with the person. 
4. If they have not started breathing, give another dose of naloxone and/or start rescue breathing (2 breaths every 5 seconds). 
5. If breathing returns, place the person in the recovery position and monitor closely until help arrives. 

Important: Naloxone will only temporarily reverse an opioid overdose and does not reverse other drugs. The person may stop breathing again when naloxone wears off, so never leave them alone. 

Rescue breathing (if you do not have naloxone) 

• Roll the person onto their back, supporting their head. 

• Tilt their head back to open the airway (one hand on forehead, one under the chin). 

• Clear the airway if blocked. 

• Pinch the nose and create a mouth-to-mouth seal. 

• Give 2 quick breaths every 5 seconds, checking for a rise in the chest after each breath. 

Continue until: 

• The person starts breathing on their own 

• An ambulance arrives 

• Someone else is able to take over 

What NOT to do 

• Do NOT allow a person to “sleep it off” (they may stop breathing). 

• Do NOT leave the person alone. 

• Do NOT give other medicines, drugs, food or drink. 

• Do NOT try to induce vomiting, put them in a bath/shower or slap them to wake them.