Key Takeaways
- A lethal dose of fentanyl is approximately two milligrams, roughly the weight of a few grains of salt.
- Fentanyl is found in counterfeit pills designed to look like prescription medications, as well as in heroin, cocaine, and methamphetamine.
- Naloxone (Narcan) can reverse a fentanyl overdose but may require multiple doses due to fentanyl's extreme potency.
- Fentanyl test strips allow individuals to check substances for fentanyl contamination before use.
- Treatment for fentanyl addiction follows the same evidence-based model as other opioid use disorders, with medication-assisted treatment as the standard of care.
What Is Fentanyl and Why Is It So Dangerous?
Fentanyl is a synthetic opioid that was originally developed for managing severe pain in clinical settings, particularly for cancer patients and surgical procedures. It is 50 to 100 times more potent than morphine and 50 times more potent than heroin. When used under medical supervision with precise dosing, pharmaceutical fentanyl serves a legitimate medical purpose.
The crisis in San Bernardino County and across the nation is driven by illicitly manufactured fentanyl produced in clandestine laboratories, primarily in Mexico using precursor chemicals sourced from China. This illicit fentanyl is cheap to produce, enormously profitable, and extraordinarily deadly due to the challenge of achieving consistent dosing in non-pharmaceutical manufacturing.
A lethal dose of fentanyl is approximately two milligrams for a non-tolerant individual, a quantity so small it is barely visible to the naked eye. This extreme potency means that even minor variations in mixing and distribution can result in some pills or portions of a drug supply containing lethal concentrations while others contain sub-lethal amounts, creating a deadly lottery for anyone using illicit substances.
No pill purchased outside a licensed pharmacy is safe. Counterfeit pills made to look identical to pharmaceutical medications like oxycodone, Xanax, and Adderall frequently contain lethal doses of fentanyl. If it did not come from a pharmacy, assume it contains fentanyl.
How Fentanyl Enters the Drug Supply
Fentanyl contamination of the drug supply is not limited to opioid markets. In San Bernardino County, fentanyl has been detected in counterfeit pharmaceutical pills, heroin, cocaine, methamphetamine, and substances sold as MDMA. This cross-contamination means that individuals who do not consider themselves opioid users may unknowingly consume fentanyl.
Counterfeit pills represent one of the most insidious delivery methods. These pills are pressed using pill molds that produce tablets virtually indistinguishable from genuine pharmaceuticals. Labels like "M30" that imitate pharmaceutical oxycodone are among the most common, but counterfeit Xanax, Adderall, and other medications have also been identified in the Inland Empire.
The unpredictable distribution of fentanyl within a batch of counterfeit pills is particularly dangerous. Testing has shown that fentanyl concentration can vary dramatically from pill to pill within the same batch, meaning that an individual who has used pills from the same source before without incident can still encounter a lethal dose.
Recognizing Fentanyl Overdose
Recognizing the signs of an opioid overdose quickly can save a life. Fentanyl overdoses can progress rapidly from normal function to respiratory arrest, sometimes within minutes of ingestion. Family members, friends, and community members should know the signs and be prepared to act immediately.
The primary signs of a fentanyl overdose include extremely small, pinpoint pupils, loss of consciousness or unresponsiveness, slow, shallow, or stopped breathing, bluish discoloration of the lips and fingertips, choking or gurgling sounds, and a limp, heavy body. If you observe any combination of these signs after suspected substance use, assume overdose and act immediately.
The immediate response to a suspected overdose should follow the steps: call 911, administer naloxone if available, position the person on their side to prevent aspiration, perform rescue breathing if trained, and stay with the person until emergency responders arrive. California's Good Samaritan law protects individuals who call 911 during an overdose from prosecution for minor drug offenses.
- 1Call 911 immediately and report a suspected overdose
- 2Administer naloxone (Narcan) nasally or intramuscularly if available
- 3Place the person on their side in the recovery position
- 4Perform rescue breathing if trained and if the person is not breathing
- 5Administer a second dose of naloxone after 2 to 3 minutes if no improvement
- 6Stay with the person until emergency medical services arrive
Naloxone Access in San Bernardino County
Naloxone, marketed as Narcan in its nasal spray formulation, is the primary tool for reversing opioid overdoses. It is available without a prescription at pharmacies throughout San Bernardino County and is distributed free of charge by community organizations and county health programs.
The San Bernardino County Department of Public Health and various community organizations conduct naloxone distribution events throughout the Inland Empire. These events provide free naloxone kits along with training on recognizing overdose and administering the medication. Training typically takes less than 15 minutes.
Naloxone has no potential for abuse, is safe even if administered to someone who is not experiencing an opioid overdose, and has minimal side effects. There is no medical or legal risk to carrying and administering naloxone. Every household that may encounter opioid use should keep naloxone accessible.
Fentanyl Test Strips
Fentanyl test strips are inexpensive, easy-to-use tools that detect the presence of fentanyl and many fentanyl analogs in a drug supply. While they do not quantify the amount of fentanyl present, a positive result alerts the individual that fentanyl contamination exists and that using the substance carries extreme risk.
Test strips are available through harm reduction organizations in San Bernardino County and can be purchased online for approximately one to two dollars each. To use a strip, a small amount of the substance is dissolved in water, and the strip is dipped into the solution. Results appear within two to five minutes.
Public health experts emphasize that fentanyl test strips are not a guarantee of safety but rather an additional harm reduction tool. A negative result does not mean a substance is safe, as test strips may not detect all fentanyl analogs, and substances can contain other dangerous adulterants.
If you or someone you know uses any illicit substance, fentanyl test strips can provide a critical layer of protection. Harm reduction saves lives by meeting people where they are while encouraging pathways to treatment.
Treatment for Fentanyl Addiction
Addiction to fentanyl responds to the same evidence-based treatment approaches used for other opioid use disorders, though the extreme potency of fentanyl may require modified detox protocols and longer stabilization periods. Medication-assisted treatment with buprenorphine or methadone, combined with behavioral therapy, represents the standard of care.
Medical detox from fentanyl can be more challenging than detox from heroin or prescription opioids due to fentanyl's lipophilic properties, which cause it to accumulate in body fat and produce prolonged withdrawal. Experienced medical teams adjust detox protocols accordingly, and facilities like Trust SoCal have developed specialized protocols for fentanyl-dependent individuals.
If you or a loved one is using fentanyl or any substance that may contain fentanyl, treatment is available. Call Trust SoCal at (949) 280-8360 for a confidential assessment. The admissions team is experienced in helping Inland Empire families navigate the fentanyl crisis and can coordinate rapid admission for individuals at immediate risk.
Madeline Villarreal, Counselor
Counselor
