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Q&A: What you need to know about fentanyl

Editor’s note: This story was originally published on Sept. 7, 2023 for The Dallas Morning News “Deadly Fake” series examining fentanyl’s grip on North Texas. We have updated it and are bringing it back to continue to help our community.
Here are some resources and key information on fentanyl.
Fentanyl is a highly addictive painkiller — used legally in medical settings — that has gripped a new generation looking to self-medicate or experiment with drugs. It hides in counterfeit pills that look exactly like those prescribed for pain.
Fentanyl is cheaper to manufacture, easier to traffic and more potent than other opioids, driving illicit drugmakers to use it deceptively in place of other substances. Just two milligrams of fentanyl, the equivalent of 10 to 15 grains of table salt, can be deadly, according to the Drug Enforcement Administration.
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A 2024 report from Dallas County Health and Human Services and the Recovery Resource Council state that fentanyl continues to be the dominant drug involved in overdose-related deaths. And the number of overdoses and deaths keeps rising.
Incredibly potent and easy to get, the synthetic opioid has overtaken heroin as the drug most frequently involved in overdose deaths in the United States. It is linked to more fatalities of Americans under 50 than any other cause of death, including heart disease, cancer and suicide.
In Texas, an average of five people died from the drug every day in 2022. A string of overdoses among school kids and young adults has left the state scrambling for solutions amid mounting pressure from families who have lost loved ones.
Illicit fentanyl is available in different forms, including liquid and powder. Powdered fentanyl looks just like many other drugs. It is commonly mixed with drugs like heroin, cocaine and methamphetamine and made into pills that resemble other prescription opioids. People can therefore take fentanyl without knowing. In its liquid form, illicit fentanyl can be found in nasal sprays and eye drops, and dropped onto paper or small candies.
Fentanyl can be snorted, smoked, taken orally by pill or tablet, spiked onto blotter paper or taken via patches.
Drugs may contain deadly levels of fentanyl, and you wouldn’t be able to see it, taste it or smell it. It is nearly impossible to tell if drugs have been laced with fentanyl unless you test them with fentanyl test strips. Test strips are inexpensive and typically give results within five minutes. The state of Texas considers test strips to be illegal drug paraphernalia. The Texas House voted overwhelmingly in April 2023
to decriminalize fentanyl testing strips, but the Senate declined to take action on House Bill 362 in the regular session. Gov. Greg Abbott supported decriminalizing the test strips, reversing his earlier opposition.
It may be hard to tell whether a person is high or experiencing an overdose. If you aren’t sure, the CDC urges you to treat it like an overdose and take the following steps.
1. Call 911 immediately.
2. Administer naloxone, if available. Naloxone is a medicine that can rapidly reverse an opioid overdose. Naloxone is available as a prefilled syringe (Zimhi); an autoinjector (Evzio), which is a spring-loaded syringe similar to an EpiPen; or in fast-acting nasal sprays (Narcan and Kloxxado). The U.S. Food and Drug Administration approved Narcan for over-the-counter use in March.
3. Try to keep the person awake and breathing.
4. Lay the person on their side to prevent choking.
5. Stay with the person until emergency assistance arrives.
Pharmacies: Naloxone is available at pharmacies such as CVS and Walgreens, as well as at Kroger and Walmart stores.
Vending machines: A free Narcan vending machine installed in Deep Ellum in Sept. 2024 is the first of its kind in Dallas with more slated.
MoreNarcanPlease.com: This website offers Texans a way to order Narcan online and also offers training materials, including videos, on steps to take in an overdose emergency.
Naloxoneexchange.com: This website provides instructions on administering naloxone and provides a way to buy the medication online and have it delivered to your door. The site offers brand-name Narcan nasal spray as well as generic naloxone kits with vials, a syringe and an atomizer.
No matter who you are, it couldn’t hurt to have Narcan in your first-aid kit at home, according to the Cleveland Clinic. But it’s especially important to have Narcan if:
Because of fentanyl, the way parents talk to their kids about drugs must change, experts say.
Start the conversation on drug safety early
Conversations about drug safety need to start much earlier than high school, according to experts.
Parents should talk to their kids as early as age 9 about safe medication practices, said Dr. David Atkinson, a pediatric psychiatrist and medical director of the Teen Recovery Program at Children’s Health.
“Do not take any pill that is not from mom or dad,” Atkinson said parents should tell their kids. “Don’t even take a Tylenol from a friend.”
Understand what fentanyl is and where it hides
America’s rise in overdose deaths and addictions is largely driven by fake pills containing fentanyl. These pills are pressed to look like familiar prescription medications such as Xanax, Adderall and, most commonly, Percocets, known as “blues” for their color.
Know social media’s role
It’s wrong to think that drug deals only happen on street corners or the dark web, said Stefanie Turner, the founder of Texas Against Fentanyl. Platforms like Instagram, Snapchat, TikTok, YouTube and Telegram Messenger have become easy marketplaces for illicit substances, which means adolescents are more susceptible than ever.
“My honest recommendation is to keep kids off social media as long as you possibly can,” said Turner, whose teenage son, Tucker, died after he took a fake Percocet he bought on Instagram.
When kids start using social media, parents should have login access to their phones and social media accounts, Turner said. Parents should also consider not allowing kids to have their phones in their bedrooms at night.
Recognize signs of drug use
Sometimes there are no visible signs of drug use, Turner said, but it’s important to know the red flags.
“Be observant to all behaviors,” Turner said. “And if you suspect your child is using, don’t be ashamed. This is a crippling epidemic because of the shame and silence around it. Talk about it. Get help.”
Educate yourself and your kids on naloxone
With opioid overdoses soaring around the country, experts say everyone should carry naloxone, especially people who use drugs or know someone who does.
Texas Targeted Opioid Response, a public health initiative operated by the Texas Health and Human Services Commission: txopioidresponse.org
Centers for Disease Control and Prevention: cdc.gov/stopoverdose/fentanyl
National Institute on Drug Abuse facts on naloxone: nida.nih.gov/publications/drugfacts/naloxone
North Texas Behavioral Health Authority: 24-hour crisis hotline at 1-866-260-8000 or go to ntbha.org.
SAMHSA National Helpline: Call 1-800-662-HELP (4357) or visit samhsa.gov/find-help/national-helpline for free, confidential 24/7 treatment referral and information for individuals and families facing mental health and/or substance use disorders.
Crisis Text Line: Text HOME to 741741 or visit crisistextline.org for this free, 24/7 crisis support counseling.
988 Suicide and Crisis Lifeline: Call 988 or visit 988lifeline.org to access this free support network for people in distress, as well as prevention and crisis resources for you or your loved ones. Services are confidential and available 24/7.
Mental Health Texas: Provides learning and treatment opportunities for those coping with mental health conditions and those who support them. Call, chat or text to get help now. For details, visit mentalhealthtx.org.

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