What Is Fentanyl?
Fentanyl is a powerful synthetic opioid originally developed for medical use under carefully controlled conditions.
Illicit fentanyl is different.
The fentanyl driving today’s crisis is unregulated, unpredictable, and often hidden. It is frequently mixed into other substances without a person’s knowledge or consent — including counterfeit pills and non-opioid drugs.
This difference matters.
Illicit Fentanyl vs. Medical Fentanyl
Medical fentanyl is a medication with legitimate medical uses when prescribed, dosed, and administered by healthcare professionals in controlled settings.
This is NOT the same fentanyl
driving the current crisis.
Medical fentanyl:
• Prescribed and administered in controlled medical settings
• Dosage is known and monitored
Illicit fentanyl:
• Manufactured and distributed illegally
• Potency varies widely
• Often mixed into other substances without warning
• Cannot be reliably seen, smelled, or tasted
Illicit fentanyl is an unregulated, unpredictable synthetic opioid found in the illegal drug supply.
It is responsible for the majority of fentanyl-related deaths today.
The current crisis is driven by illicit fentanyl contamination, not legitimate medical care.
This difference matters.
Many people harmed by illicit fentanyl did not ignore danger.
They noticed something was wrong — but lacked the language, information, or support to understand what was happening in time.
That gap between exposure and understanding is where prevention can save lives.
Where Illicit Fentanyl Is Being Found
Illicit fentanyl has been found in:
• Counterfeit prescription pills (such as pills sold as oxycodone, Percocet, or Xanax)
• Cocaine
• Methamphetamine
• Heroin
• Other substances where fentanyl was not expected
Many people affected did not intend to use opioids or fentanyl at all.
A Public Safety Issue —
Not Just an Addiction Issue
Fentanyl exposure does not require:
• A substance use disorder
• Regular drug use
• Identifying as a “drug user”
People at risk include:
• First-time or infrequent users
• People taking pills they believed were legitimate prescriptions
• Teens and young adults
• People with and without substance use disorder
• Families and children exposed accidentally
Hidden fentanyl is a public safety crisis.
Why Language Matters
Many deaths are labeled “overdoses,” but for many families, this does not reflect reality.
An overdose typically implies taking too much of a known substance.
Fentanyl poisoning reflects exposure to a toxic substance that was unknown, unexpected, or misrepresented.
Naming this distinction matters — for prevention, policy, medical response, and family support.
Many of these deaths are better understood as fentanyl poisoning — exposure to an unknown, unexpected, or misrepresented substance — rather than overdose from a known drug.
When Something Doesn’t Feel Right
Many people who are later harmed by hidden fentanyl noticed early warning signs- but did not yet have the language or information to understand what was happening.
These warning signs include:
Saying a pill or substance “didn’t feel right”
Sudden changes in mood after taking something
New or worsening depression or anxiety
Inability to sleep
Physical discomfort that doesn’t make sense
Expressing fear, confusion, suicidal thoughts, or concern about a substance
Some people experience intense withdrawal-like symptoms after a single exposure, especially when fentanyl was unexpected. Without language or testing, this can be mistaken for sudden mental health crisis.
When someone voices concern, that moment matters.
Listening can save a life.
Social Responses Can Increase or Reduce Risk
Sometimes, when someone shares concern about a substance, the response they receive unintentionally increases danger.
This can look like:
Minimizing the concern
Normalizing symptoms
Encouraging continued use
Treating distress as “just mental health” without asking why it suddenly appeared
This is not always malicious.
But it can delay care and silence warning signs.
How to Advocate for Each Other
If someone you care about says:
“Something feels wrong”
“I feel unlike myself”
This doesn’t feel right”
Talks about not wanting to live or being disconnected from themselves
Take it seriously.
You do not need certainty to prioritize safety.
Exposure does not always look like immediate collapse.
Possible warning signs may include:
• Sudden or severe depression
• Confusion or disorientation
• Inability to sleep
• Leg cramps or body pain
• Extreme anxiety or fear
• Feeling “not right” after taking a pill or substance
If someone experiences unexpected symptoms after taking a substance — even once — it is important to seek medical care and advocate clearly for fentanyl testing.
About Drug Testing & Hospitals
Standard drug panels have not always included fentanyl unless specifically ordered.
This gap has led to missed diagnoses, confusion, and delayed care.
We believe fentanyl testing should be:
• Routinely available
• Clearly explained
• Nonjudgmental
• Focused on safety, not punishment
Lack of testing is not a personal failure — it is a systems issue.
About Fentanyl Test Strips
Fentanyl test strips can be one harm reduction tool, but they have limitations.
Important facts:
• Test strips were originally validated as urine tests
• Testing drugs directly may not detect uneven distribution (“chocolate chip cookie effect”)
• A negative test does not guarantee safety
• Complete testing would require fully dissolving the substance
Many people do not know they need to test — because they do not believe they are at risk.
Education must reach everyone.
Test strips are one tool- not a guarantee.
Education and access must work together.
Testing for Possible Exposure
Fentanyl test strips were originally validated for urine testing.
In some situations, urine testing may help confirm fentanyl exposure after symptoms begin, support medical advocacy, and guide people to seek immediate care when something feels wrong.
A positive test does not explain timing or dose — but it can provide critical information when symptoms are confusing or dismissed.
Testing does not replace medical evaluation. It is one tool to support understanding and safety.
Naloxone (Narcan)
Saves Lives
Naloxone reverses opioid poisoning and is safe to carry.
We encourage:
• Every household to carry naloxone
• Friends, families, and communities to learn the signs of opioid poisoning
• Removing stigma around carrying or using naloxone
You do not need to identify as someone who uses drugs to carry naloxone.
If You Think Someone Has Been Exposed
• Call emergency services immediately
• Administer naloxone if available
• Stay until help arrives
• Advocate clearly and calmly
Asking for help is an act of care — not a confession.
What to Say / What Not to Say
Helpful response
“I’m glad you told me.”
“Let’s slow down and make sure you’re safe.”
“Hidden fentanyl is common — this could matter.”
“We don’t have to figure this out alone.”
Responses that can increase risk
“You’re overthinking it.”
“That happens to everyone.”
“It’s probably just anxiety.”
“You’ll be fine.”
Your response can create safety — or silence.
Our Commitment
Never Alone Nick exists to:
• Name hidden fentanyl exposure honestly
• Support families left without language or recognition
• Expand harm reduction to include everyone
• Reduce preventable loss through education, compassion, and truth
Closing the gap between and exposure and understanding-throughlanguage, testing, and compassionate response- is central to Nick’s Law and to preventing future loss.
You are not alone.
And this did not happen because you failed.