If a pill, powder or crystal didn’t come from a pharmacy with your loved one’s name on the label, assume it could contain fentanyl. Nobody can see, smell or taste it, and half of the fake pills tested in 2024 held a potentially deadly dose.3 You can’t control the drug supply, but a few steps at home make a mistake less likely to be fatal.
U.S. overdose deaths fell for a third straight year in 2025, to an estimated 69,973, but opioids were still involved in about 44,564 of them.14 Illegally made fentanyl is added to other drugs to make them cheaper and stronger, and many people don’t know their drugs contain it.12 If someone is unresponsive right now, call 911 and follow our step-by-step guide to giving naloxone.
Why is fentanyl so much more dangerous than other drugs?
Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine, so a small mistake in amount can stop someone’s breathing.2 About 2 milligrams, enough to fit on the tip of a pencil, can be deadly.3 The amount also varies from pill to pill, so “I took one last week and was fine” says nothing about the next one.3
How can you tell if a pill is fake?
Usually you can’t. Counterfeit pills are made by the millions each year to look like OxyContin, Percocet, Xanax or Adderall.3 Besides fentanyl, some contain illegal benzodiazepines or other drugs.4
Ordering online doesn’t get around this. In October 2024 the CDC warned that illegal online pharmacies were shipping counterfeit pills that frequently contained fentanyl and methamphetamine. Medicine should come from a licensed clinician and a licensed pharmacy, nowhere else.15
What is xylazine, medetomidine or carfentanil?
Xylazine (“tranq”)
Xylazine is a sedative that isn’t approved for people and is often mixed with fentanyl. It can cause heavy sedation, trouble breathing, dangerously low blood pressure, a slow heart rate, severe withdrawal, and wounds that can become infected and, if untreated, lead to amputation.6 In 2022 it turned up in about 23% of the fentanyl powder and 7% of the fentanyl pills the DEA seized.6
Medetomidine (“rhino tranq”)
Medetomidine is a dog sedative, more potent and longer-acting than xylazine, and in April 2026 the CDC warned it is increasingly found in the illegal fentanyl supply.7 It can cause deep, often prolonged sedation and a very slow heart rate.78 People who stop after regular use can go through a severe withdrawal that may need emergency or intensive care.7 If your loved one uses street fentanyl and wants to stop, read why some withdrawals need a hospital before they try.
Carfentanil and nitazenes
Carfentanil is about 100 times stronger than fentanyl. Deaths with it detected rose roughly sevenfold, from 29 in the first half of 2023 to at least 238 in the first half of 2024, in 37 states.9 Nitazenes are a separate group of lab-made opioids. Some are far stronger than fentanyl, and an overdose may take more than one dose of naloxone.10
When is overdose risk highest?
A return to use after a break is one of the most dangerous moments. Tolerance drops during time without opioids, so the old amount can be fatal. The weeks after release from jail or prison, or after leaving treatment, are especially risky.11
Mixing is the other big danger: opioids combined with alcohol, benzodiazepines such as Xanax or Valium, or other medicines can be fatal.12 Using alone means no one is there to help, and a new source or a different-looking pill means nobody knows the dose or purity.6
Stimulants aren’t a safe exception. About 79% of cocaine-involved overdose deaths from 2021 to mid-2024 also involved opioids, and most meth deaths did too.5 Fentanyl can be mixed into cocaine,2 so “they only use cocaine” isn’t a reason to skip the precautions below.
Do fentanyl test strips work?
They help, with limits. Strips are inexpensive and usually give a result within 5 minutes.1 They can give false negatives, may miss carfentanil and some other fentanyl-like drugs,17 and don’t detect xylazine or medetomidine, which need their own strips.67 A negative result doesn’t mean a drug is safe, so treat testing as a backup to naloxone.
What can families do right now?
Start with naloxone. The nasal spray has been sold without a prescription since 2023.17 It won’t hurt someone who hasn’t taken opioids, and the CDC urges families and caregivers to carry it.13
Your family's fentanyl safety plan
- Today
- This week
- Before a high-risk moment
Medication is one of the strongest protections there is. Buprenorphine and methadone help people cut back on illegal opioids, stay in treatment longer and lower their risk of overdose.16 Here’s how to ask about them.
How you bring all this up matters. A few swaps that keep the door open:
What to say instead
“Do you want to die? You’re going to overdose.”
“I’ve read that most street pills are fake now. I’m scared, and I want you safe.”
“I’m not keeping Narcan here. That’s enabling.”
“Naloxone is in the kitchen drawer. I hope no one ever needs it.”
“If you use again, don’t bother coming home.”
“If you ever use, please don’t do it alone. And if you want help, I’ll drive you that day.”
If they won’t consider treatment yet, see what you can still do when they refuse help.
Frequently asked questions
Is this the same fentanyl doctors prescribe?
Fentanyl is also a prescription drug for severe pain, but the overdose crisis is driven by illegally made fentanyl, not the medicine a pharmacy dispenses.1
How do I find out what's in the drug supply near me?
Ask your local or state health department. Many publish drug-supply alerts, and the CDC posts national ones, such as its April 2026 medetomidine warning.7
Should I take away their drugs or search their room?
That’s your call. If you find pills or powder, don’t taste them, and wash your hands after handling them. Read how to bring up getting help calmly before you talk to them.
Sources
- CDC — Fentanyl (June 2025). cdc.gov/overdose-prevention/about/fentanyl.html — accessed Oct 2026
- CDC, Stop Overdose — Fentanyl Facts (April 2, 2024). cdc.gov/stop-overdose/caring/fentanyl-facts.html — accessed Oct 2026
- CDC, Free Mind campaign — Get the facts on fake pills and the dangers hiding inside (fact sheet, 2025). cdc.gov/free-mind/media/pdfs/Free-Mind-Fake-Pills-Fact-Sheet_YOUTH_508… — accessed Oct 2026
- CDC — Preventing Opioid Overdose (June 9, 2025). cdc.gov/overdose-prevention/prevention/index.html — accessed Oct 2026
- CDC, Morbidity and Mortality Weekly Report — Drug Overdose Deaths Involving Stimulants — United States, January 2018–June 2024 (August 28, 2025). cdc.gov/mmwr/volumes/74/wr/mm7432a1.htm — accessed Oct 2026
- CDC — What You Should Know About Xylazine (May 16, 2024). cdc.gov/overdose-prevention/about/what-you-should-know-about-xylazine.… — accessed Oct 2026
- CDC Health Alert Network — Medetomidine in the U.S. Illegal Fentanyl Supply Increasing Risk for Overdose and Severe Withdrawal Syndrome, HAN-00527 (April 2, 2026). cdc.gov/han/php/notices/han00527.html — accessed Oct 2026
- CDC, Morbidity and Mortality Weekly Report — Overdoses Involving Medetomidine Mixed with Opioids — Chicago, Illinois, May 2024 (2025). cdc.gov/mmwr/volumes/74/wr/mm7415a1.htm — accessed Oct 2026
- CDC, Morbidity and Mortality Weekly Report — Detection of Illegally Manufactured Fentanyls and Carfentanil in Drug Overdose Deaths — United States, 2021–2024 (December 2024). cdc.gov/mmwr/volumes/73/wr/mm7348a2.htm — accessed Oct 2026
- CDC, Morbidity and Mortality Weekly Report — Notes from the Field: Nitazene-Related Deaths — Tennessee, 2019–2021 (September 2022). cdc.gov/mmwr/volumes/71/wr/mm7137a5.htm — accessed Oct 2026
- CDC — Evidence-Based Strategies for Preventing Opioid Overdose: What's Working in the United States (2018). cdc.gov/overdose-resources/pdf/2018-evidence-based-strategies_508.pdf — accessed Oct 2026
- SAMHSA — Opioid Overdose Prevention and Reversal (updated December 2025). samhsa.gov/substance-use/treatment/overdose-prevention — accessed Oct 2026
- CDC — Fact Sheet: Family and Caregivers, How and When to Use Naloxone for an Opioid Overdose (April 2024). cdc.gov/overdose-prevention/media/pdfs/2024/04/Naloxone-Fact-Sheet_Fam… — accessed Oct 2026
- CDC National Center for Health Statistics — U.S. Overdose Deaths Decrease for Third Consecutive Year in 2025 (May 13, 2026). cdc.gov/nchs/pressroom/releases/20260513.html — accessed Oct 2026
- CDC — Potential public health risk among individuals ordering counterfeit prescription medications from online pharmacies (October 2, 2024). cdc.gov/media/releases/2024/s1002-counterfit-prescription-online-pharm… — accessed Oct 2026
- CDC — Treatment of Substance Use Disorders (April 25, 2024). cdc.gov/overdose-prevention/treatment/index.html — accessed Oct 2026
- FDA — FDA Approves First Over-the-Counter Naloxone Nasal Spray (March 2023). fda.gov/news-events/press-announcements/fda-approves-first-over-counte… — accessed Oct 2026