Signs of Fentanyl Overdose: What to Look For and What to Do Immediately

Fentanyl overdoses are happening at an alarming rate across the United States. Many people who experience a fentanyl overdose never intended to take it at all. In many cases, fentanyl is ingested unknowingly through counterfeit pills or fentanyl-laced substances. Because fentanyl is extremely potent and acts quickly, recognizing the signs of fentanyl overdose can mean the difference between life and death.

This guide is designed to help families, friends, and community members understand how to tell if someone is overdosing on fentanyl, what symptoms to look for, and what steps to take right away. Acting quickly can save a life. Knowing what comes next can also help reduce the risk of future emergencies and support long-term recovery.

Big Sky Treatment’s philosophy and commitment reflect a compassionate, evidence-based approach to substance use and mental health care.

Fentanyl is a powerful synthetic opioid that is 50 to 100 times stronger than morphine. According to the National Institute on Drug Abuse, fentanyl is used medically to treat severe pain, but illicit fentanyl is now widely present in the illegal drug supply. This has significantly increased the risk of accidental overdose.

Because fentanyl is so potent, even a very small amount can overwhelm the body. Overdose occurs when fentanyl suppresses the part of the brain that controls breathing. In many cases, this can happen within minutes, especially when someone does not know fentanyl is present in what they consumed.

The risk is higher today due to several factors, including:

• Fentanyl-laced pills
• Counterfeit pills and fake prescription pills
• Accidental fentanyl exposure
• Mixing fentanyl with alcohol or other drugs

The Centers for Disease Control and Prevention reports that synthetic opioids like fentanyl are now the leading cause of overdose deaths in the United States. This makes education, early recognition, and rapid response more important than ever.

Recognizing fentanyl overdose signs and symptoms early is critical. Many of these warning signals overlap with other opioid overdose signs, and they often appear suddenly and worsen rapidly. When in doubt, it is always safer to assume an overdose is happening and seek immediate help.

Physical Signs of a Fentanyl Overdose

Some of the most common fentanyl overdose symptoms include:

• Pinpoint pupils, also called constricted pupils
• Blue lips and fingernails, known as cyanosis, caused by lack of oxygen
• Cold and clammy skin
• Limp body or extreme muscle weakness
• Gurgling or choking sounds, sometimes referred to as the death rattle
• A person who is awake but unable to stay awake
• No response to shouting, shaking, or pain

These physical indicators are strong warning signs that immediate medical attention is needed.

Breathing and Oxygen-Related Fentanyl Overdose Symptoms

Breathing problems are the most dangerous aspect of a fentanyl overdose. Watch closely for:

• Shallow breathing
• Very slow breathing
• Irregular breathing
• Breathing that stops completely

This condition is known as respiratory depression, meaning the body is not getting enough oxygen. When oxygen levels drop too low, the brain and organs begin to shut down. This process is called hypoxia from opioid overdose and can lead to permanent brain injury or death if not treated quickly.

When fentanyl suppresses breathing, serious medical complications can develop rapidly. These may include:

• Loss of consciousness
• Unresponsiveness
• Brain damage caused by oxygen deprivation
• Cardiac arrest

One rare but severe complication is wooden chest syndrome. This occurs when fentanyl causes the muscles in the chest wall to become rigid, making it extremely difficult or impossible to breathe.

Families often ask, can you survive a fentanyl overdose? The answer is yes, survival is possible, especially when overdose signs are recognized early and emergency response is immediate. However, delayed treatment significantly increases the risk of fatal or long-term outcomes.

It can be difficult to tell the difference between opioid intoxication and a life-threatening overdose. Understanding the distinction is crucial for making the right decision in an emergency.

Being high may include:

• Drowsiness while still responsive
• Slowed speech
• Relaxed muscles
• Normal skin color

Overdose signs include:

• Unresponsiveness
• Slow or stopped breathing
• Blue or gray lips and fingertips
• Gurgling or choking sounds
• Cold, clammy skin

If you are unsure, always treat the situation as an overdose. Waiting can be fatal.

Knowing what to do if someone is overdosing on fentanyl can save a life.

Immediate Steps to Take

1. Call 911 or emergency services immediately
2. Try to wake the person by shouting or rubbing your knuckles firmly on their sternum
3. Administer naloxone, also known as Narcan, if available
4. Provide rescue breathing if you are trained to do so
5. Stay with the person until help arrives

The National Harm Reduction Coalition emphasizes that calling emergency services is critical, even if naloxone appears to work.

Using Naloxone During a Fentanyl Overdose

Naloxone is an opioid reversal agent that can temporarily reverse the effects of fentanyl.

Important facts to know include:

• Naloxone nasal sprays are easy to use
• Multiple doses may be needed for fentanyl overdoses
• Naloxone is safe and will not harm someone if opioids are not present
• Naloxone is available without a prescription in many states

After administering naloxone, continue rescue breathing and monitor the person closely until emergency responders arrive.

Many overdoses occur in people who never intended to use fentanyl. The FDA warns that counterfeit pills made to look like legitimate prescription medications often contain fentanyl in unpredictable and dangerous amounts.

Counterfeit pill overdose signs are often sudden and severe, particularly in people without opioid tolerance. Risk factors include:

• Fake pills sold as oxycodone, Percocet, or Xanax
• Pills purchased online or from non-medical sources
• Unknown drug potency

Using fentanyl test strips and other harm reduction strategies may reduce risk, but they are not foolproof.

Surviving an overdose is a medical emergency and a serious warning sign. People who experience one overdose are at much higher risk for another.

Recovery from a non-fatal overdose often includes:

• Medical evaluation and monitoring
• Mental health support
• Substance use treatment
• Education on overdose prevention

Many individuals benefit from structured, evidence-based care such as addiction treatment that addresses both substance use and underlying factors.

For adults who need flexible but consistent care, Big Sky Treatment offers an adult outpatient program designed to support recovery while maintaining daily responsibilities. Families concerned about younger individuals can also explore the adolescent outpatient program for age-appropriate support.

It may be time to seek professional help if:

• There have been one or more overdoses
• Fentanyl use is escalating
• Loved ones express fear or concern
• Attempts to stop using have not been successful

Overdose risk is often connected to mental health challenges such as anxiety, depression, or trauma. Integrated mental health treatment can play an important role in long-term recovery.

Big Sky Treatment also incorporates experiential approaches that help individuals build coping skills and emotional resilience. Programs like our experiential therapy program support healing beyond traditional talk therapy.

For those who need remote access to care, Big Sky Treatment provides a virtual IOP option that allows individuals to receive structured support from home.

Fentanyl overdoses are fast, dangerous, and increasingly common. However, they are not always fatal when people know the warning signs and act quickly. Learning the signs of fentanyl overdose, carrying naloxone, and understanding emergency response steps can save lives.

Education, awareness, and early intervention remain some of the most powerful tools available to protect individuals, families, and communities. If you or someone you love needs guidance or support, you can contact Big Sky Treatment to learn more about available options and next steps.

• Centers for Disease Control and Prevention. (n.d.). Understanding the opioid overdose epidemic. https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html
• Food and Drug Administration. (n.d.). Counterfeit medicine. https://www.fda.gov/drugs/buying-using-medicine-safely/counterfeit-medicine
• National Harm Reduction Coalition. (n.d.). Responding to an opioid overdose. https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/
• National Institute on Drug Abuse. (n.d.). Fentanyl drug facts. https://nida.nih.gov/research-topics/fentanyl