LEARN ABOUT ALL THINGS FENTANYL SAFETY WITH USER FRIENDLY: OVERDOSE PREVENTION, FENTANYL TESTING, NALOXONE, ANALOGUES, AND MORE
User Friendly Guides are the most concise, thorough, and reliable sources of drug safety and harm reduction information on the web. Our guides contain information that is relevant to anyone and everyone, and they are particularly useful for ravers, clubbers, and festival-goers looking to “augment” their experience with any sort of mind expanding substance.
Our guides are filled with useful, actionable information that is based on the latest scientific and academic research. Like the good school children we are, we cite all our sources so you can crosscheck all of the information in these guides and make the most informed decision for your mind, body, and psyche.
SUMMARY (READ THIS IF YOU’RE SHORT ON TIME)
Fentanyl is an extremely strong synthetic opioid that is being laced into the supplies of recreational party drugs such as cocaine and MDMA.
Fentanyl overdose is the #1 cause of death for Americans ages 18 - 45 in the United States. Over 70,000 Americans died in both 2021 and 2022 due to synthetic opioids, primarily fentanyl.
Illicit fentanyl has been found in nearly all types of recreational substances, including cocaine, adderall, methamphetamine, ketamine, and MDMA, which is why it is more important than ever to test any and all drug substances.
Dealers lace recreational substances with fentanyl to make their supplies cheaper, more powerful, and more addictive.
The most noticeable signs of a fentanyl overdose are slow or irregular breathing, slowing of circulation, cold, clammy or discolored skin, and falling asleep or losing consciousness.
Fentanyl test strips are the best products currently available to test for fentanyl contamination in recreational substances. They are easy to use and accurate.
Naloxone is an opioid overdose reversal medication that is highly effective at preventing overdose deaths.
You can dramatically increase your drug safety by always using drugs in the presence of friends you trust and by starting low and going slow.
TABLE OF CONTENTS
WHAT HELL IS FENTANYL?
You’ve probably been hearing all about fentanyl from your friends or on the timeline. Or maybe you haven't and you wandered across this guide out of pure luck.
Either way, you’ve come to the right place. We believe that everyone (and we mean everyone) should know about fentanyl: ravers and clubbers, moms and dads, freaks and geeks, and everyone in between.
Overdose deaths are at an all time high in the United States, so it's more important than ever to get informed on drug safety.
Fentanyl is a potent synthetic opioid that is significantly stronger than heroin and morphine. In fact, it's 50 times stronger than heroin and 100 times stronger than morphine. Wow…..
For anyone who isn’t already convinced that fentanyl is no joke and should be avoided at all costs, listen to this: a lethal dose of fentanyl is only a few milligrams, which is smaller in area than the period at the end of this sentence.
So yeah, fentanyl is no joke. If you or anyone you know consumes recreational drugs, it is crucial that you take every step to protect yourself against fentanyl consumption.
THE USER FRIENDLY DISCLAIMER
If you know anything about the team at User Friendly, then you know we are all for people having fun in a safe and educated way.
We are incredibly fortunate to be alive in the age of the rave, when people of all varieties can enjoy concerts, festivals, clubs and more, and to (somewhat) freely experiment with mind altering, consciousness expanding, experience shattering substances if they so choose.
That being said, any and all such substances can be dangerous when the people doing them are not educated on their effects, dosages, and potential risks.
Which is the whole reason that User Friendly exists. So you can have ridiculously easy (and free) access to all of the information and harm reduction practices you need. So no more people die when they are just trying to have fun (or expand their consciousness).
To have fun safer.
Now, onto the guide.
WHAT IS FENTANYL? WHAT IS THE DIFFERENCE BETWEEN MEDICAL FENTANYL AND STREET FENTANYL?
There are two types of fentanyl out there: medical fentanyl and street or illicit fentanyl. Medical-grade fentanyl is a common post-surgery pain killer and has other uses in a hospital setting, as well.
A brief history of fentanyl: "fentanyl was first developed in 1960 by Paul Janssen as a potent opioid anesthetic and analgesic. At the time, fentanyl was the fastest-acting opioid discovered to date and more powerful than morphine (50–100 times) and heroin (30–50 times). Transdermal, intravenous, and transbuccal fentanyl administration and several other drugs with chemical structures that are similar to fentanyl have been developed, approved, and used for surgical anesthesia and the management of severe cancer pain and perioperative pain, eventually becoming the most often used synthetic opioid in clinical practice." (Source 1)
Illicit fentanyl however, is illegally produced and sold on the black market, often as a cutting agent or contaminant in other more mainstream substances.
So if doctors are out here giving it to their patients, it must not be that bad, right? Think again: trained medical professionals administer fentanyl in micrograms, while most recreational drugs in which fentanyl is present contain milligrams of fentanyl.
All this means is that recreational drugs containing fentanyl have hundreds to thousands of times as much fentanyl than your doctor might give you after surgery. And given how strong fentanyl is, it's no wonder that it has become the leading cause of death for Americans ages 18 - 45 in the United States.
HOW MANY PEOPLE ARE DYING FROM FENTANYL?
The number of fentanyl deaths in the United States has skyrocketed in the past decade.
In 2012, more than 1500 people died due to fentanyl overdose.
In 2020, 48000 people died due to fentanyl overdose. That's a 3200% increase. (Source 2)
It gets worse… in 2021, deaths involving synthetic opioids (primarily fentanyl) continued to rise to over 70,000 and around 75,000 in 2022. Nearly two thirds of all overdose deaths in the US can be traced back to synthetic opioids. (Source 3)
Although the fentanyl crisis has been less lethal outside the United States, deaths are still occuring at record numbers.
The bottom line: wherever you are, within or outside of the United States, you should be testing your drugs every single time you consume.
FENTANYL OVERDOSE OF FENTANYL POISONING
User Friendly is the greatest ally to substance users around the world (hence the name). Whatever substances you are consuming does not matter to us. We’re just here to make sure you do it safely.
Which is why we want to take a moment to make a special distinction: although we commonly refer to fentanyl-related deaths as overdoses, it’s super important for everyone in the harm reduction and drug safety space to understand that these deaths are poisonings. The vast majority of fentanyl-related deaths are due to unintentional fentanyl consumption. Very few individuals purposefully consume fentanyl and have developed the tolerance necessary to do so. Most people that consume fentanyl do so when trying to consume other substances that they don’t know have been laced with fentanyl without their knowledge or permission.
For this reason, the term fentanyl poisoning is more accurate in describing the nefarious and harmful infusion of fentanyl into the supply of other substances such as ketamine, MDMA, and cocaine.
WHAT KIND OF SUBSTANCES CAN BE LACED WITH FENTANYL?
Plenty of our friends in the User Friendly Club are super concerned about fentanyl, but lots of people don’t think that they could ever come in contact with or consume it.
“I’m more of a party drug kind of person, I don’t ever touch opioids.”
“I get my drugs from a reliable source, I know there is no fent in it.”
“I’ve been using substances for years and never had a close call, I’m pretty sure I'm gonna be okay.”
You probably hear stuff like this all the time. Maybe these statements even sound like something you might say.
We’re here to tell you that these attitudes toward substance use aren’t going to cut it anymore. The rapidly growing fentanyl supply is making its way into ALL kinds of recreational substances, and it is causing all of us to have to change our substance use habits and practices to maintain safe and fun experiences for all of us.
Don’t be that person who doesn’t use safe practices and ruins the party for everyone else.
Here’s a cold hard fact: fentanyl has been found in a huge variety of drug substances, from cocaine to MDMA to counterfeit prescription pills.
Fentanyl can be found in both powder and liquid forms, mixed into pills, pressed into counterfeit tablets, or absorbed onto blotter paper, making it difficult to detect and easily mixed into the entire spectrum of substances.
Everything from adderall to LSD can contain fentanyl. Which means that you need to be testing any recreational substance that you consume.
Not convinced yet. Well, here's the real kicker: when fentanyl is mixed into other drugs, especially stimulants such as cocaine or MDMA, it becomes even more dangerous.
Straight from the research: “When fentanyl is used to adulterate other drugs (heroin, prescription opioids, psychostimulants), it increases their lethality. In the case of psychostimulants, this occurs not only due to the synergistic effects on the cardiopulmonary system, but also because stimulant users, who have no tolerance to opioids, are at very high risk of overdosing when ingesting fentanyl.” (Source 2)
The unfortunate reality is that the fentanyl epidemic has made many other less dangerous substances far more dangerous. For example, according to the National Institute on Drug Abuse, over two thirds of stimulant overdoses (such as an overdose on cocaine) in 2021 occurred in combination with synthetic opioid, primarily fentanyl. (Source 3)
WHY IS FENTANYL BEING LACED WITH OTHER SUBSTANCES LIKE COCAINE, MDMA, AND KETAMINE?
So, we’ve now proven to you that fentanyl has literally flooded the international drug supply and is now the most prevalent cause of death for young, healthy Americans and people across the world.
You’re probably still wondering though… why the hell are dealers lacing their drugs with fentanyl and killing their customers?
As you probably know, dealers can be quite smart and savvy businessmen. But they aren’t always great chemists. Dealers lace other drugs, such as cocaine and MDMA, with fentanyl for three reasons.
To make it cheaper
Too make it stronger
Too make it more addictive
Although most drug dealers aren’t trying to kill their customers, they put lethal doses of fentanyl into their products to build repeat customers and to get you coming back for more.
Fentanyl is very cheap to produce, and it can make a batch of a weak substance much more powerful for the user with just a small amount of fentanyl
Maybe you trust your dealer. Maybe they are a personal friend or you’ve been going to them for years now and they've never done you wrong.
Yeah, that's not quite a good enough reason to take their word for it.
Most dealers are part of a large organization and the substances you are buying come from far and wide. The person you are buying from probably didn’t make, grow, press, or even test whatever substance you intend to consume. Even if your dealer is a personal friend, they likely don't know if the substance you are purchasing contains fentnayl or other cutting agents.
So don’t trust them. Just don’t. Always test everything.
And as always, don’t just take our word for it: “Analysis of a sampling of 1 million unique patients’ urine drug test (UDT) specimens showed that positivity rates for fentanyl have increased by 1850% among cocaine positive UDT results and increased by 798% among methamphetamine-positive UDT results between January 2013 and September 2018. This mixture may lead to the increases in cocaine-related and methamphetamine-related overdoses.” (Source 1)
Fentanyl is now so common in the drug supply that many users have already consumed it without ever knowing they had done so. Had a bad trip, roll, or other drug-induced experience that just felt … off? You may have unintentionally consumed fentanyl.
Straight from the research: "Many people who have survived fentanyl overdose appear to be unaware that they ever took the drug. Surveys from 17 harm reduction sites … revealed that the prevalence of fentanyl use was 29% (70/242; based on urine drug screen), 73% of whom report that they did not knowingly use fentanyl." (Source 1)
This is all just further proof that fentanyl has fully saturated the drug supply, and that it's easier than ever to unintentionally consume fentanyl.
WHAT ABOUT FENTANYL-LACED WEED? CAN MY POT HAVE FENTANYL IN IT?
This is a tricky question, and the jury is still out on whether weed supplies, ranging from vape pens to good ol’ flower, can be laced with fentanyl.
Police in New York state have issued a warning about weed that contains fentanyl, mostly in reference to synthetic marijuana, also known as spiced K2 (source 7).
The truth is that it’s possible that marijuana bought from street dealers could contain fentanyl. Very few cases have been reported (source 8). You can practice safe marijuana use by purchasing your weed from dispensaries.
WHAT HAPPENS WHEN YOU INGEST FENTANYL? HOW CAN I RECOGNIZE THE SIGNS OF FENTANYL OVERDOSE?
Picture this: you’re at the festival in a crowd of thousands of fellow ravers, punks, or metalheads, choose your fancy. Everyone is having a great time, the music is killing and vibes are immaculate.
Suddenly, you aren’t feeling it. The world around you is moving in strange ways, the music is not quite hitting the way it was just a second ago, and you aren’t so sure the pills you took a few hours ago were the right combination for this moment in the history of the universe.
The question is, “What the hell did I take to make me feel this way?” and maybe more importantly “do I need to call an ambulance right here, right now?”
We’ve all been here before, so we know how anxiety-inducing moments like these can be. Which is why it's so important to know the signs of an overdose far before a situation like this ever occurs so you can see it in yourself or in others.
Straight from the research: "Fentanyl binds to mu/μ opioid receptors (MOR), which mediate the analgesic and the rewarding effects of opioid drugs, such as morphine and heroin, as well as their respiratory depressing actions. However, fentanyl is much more potent at activating MOR‐associated signaling than morphine (80‐100 fold) or heroin (30‐50 fold), and its higher lipophilicity leads to higher and faster brain uptake than for those other drugs. These properties underlie fentanyl’s high potency as an analgesic and its rapid actions, which are beneficial for the treatment of breakthrough pain or other severe pain conditions. However, they are also responsible for its powerful rewarding effects, which can rapidly result in physical dependence and in addiction, and for its severe and abrupt inhibition of respiration, which increases the risk for overdose." (Source 2)
In other words: like other opioids, fentanyl results in overdoses largely due to its respiratory depressant effects, meaning that it stops a victim's breathing.
Easy to recognize signs of overdose include:
very small pupils
slow or shallow breathing
an inability to speak
limp arms and legs
purple lips and fingernails
WHAT ABOUT FENTANYL ANALOGS AND RAINBOW FENTANYL
Fentanyl analogs are substances with a similar chemical structure to fentanyl and mimics the pharmacological effects of fentanyl.
"Fentanyl, fentanyl analogs and other novel synthetic opioids are all full agonists of varying potencies at the μ-opioid receptor, leading to typical clinical effects of miosis and respiratory and central nervous system depression." (Source 4)
Several common fentanyl analogs are acetylfentanyl, butyrfentanyl, carfentanil, alfentanil, sufentanil, and remifentanil.
It's most important to know that fentanyl analogs are just as deadly as fentanyl and need to be avoided at all costs.
Rainbow fentanyl, however, is not a fentanyl analog, its a term used to refer to brightly colored pills containing fentanyl that have flooded the black market.
Lots has been made about this rainbow fentanyl, and whether this is a deliberate attempt to target children with candy-like fentanyl pills. Frankly, the crew at User Friendly doesn’t know, and we’re not here to fight that battle. It’s messy and political, two things User Friendly is not ;)
What’s far more important is that you test all substances you intend to consume. Whether it’s rainbow colored or not.
HOW TO USE FENTANYL TEST STRIPS
Here at User Friendly our mission is to make harm-reduction resources accessible, but we also want to make sure you are using our testing gear correctly. Read on to find out how to actually use fentanyl test strips correctly for higher accuracy and to prevent wasting any strips. These testing instructions are adapted from both instructions from the CDC and the NYC Department of Health, so they are reliable and accurate.
However, fentanyl test strips differ by brand and you should defer to the instructions that come with whatever test strips you have. If the test you have didn’t come with instructions, you can count on the steps listed below!
BUT FIRST: WHERE SHOULD I TEST MY DRUGS
User friendly fam, take our word for it: it is always easier to test your substances in the safety and comfort of your own home. Why? So you can take your time, redo the test as many times as you need, conduct the testing in a safe and spacious environment, and thoroughly do every step in the process in order to maximize correct results. It is ALWAYS safer to test in a more controlled environment.
Testing at a venue, club, bar, or festival is a last option! These establishments are by no means ideal locations to do drug testing, and many venues may not allow it due to local laws.
If you do have to test substances in public, try to find a well lit location away from the party, music, and people so you can test in a controlled fashion.
Now, onto the steps:
There are two ways to approach fentanyl test with strips. Method #1, in which you test all of your drugs, is the ideal method as it avoids the CHOCOLATE CHIP COOKIE DILEMMA, which we discuss below. Still, both of these methods are much better than not testing your substances at all!
Option #1: Dissolve all of your substance that you intend to consume (an entire baggie of cocaine, an MDMA pill) into water. This is the preferred and more accurate method of fentanyl testing as it will assess the entirety of your substance.
- When to use this method: If you are okay with DRINKING your substance or snorting it through a clean nasal spray device.
Option #2: Put a small amount (at least 10mg) of your drugs aside in a clean, dry container.
For reference, think of 10 mg as about the size of ol Abe Lincoln’s hair on a penny or an eraser on the end of a No. 2 pencil.
We recommend fully breaking down the substance if it's in pill or crystalline form so that you can get an even sample of the entire substance. If you don’t want to do this, break the pill or crystal in half and take the 10 mg from the center.
Step 1: Add water to the container and mix with your substance until it is fully dissolved within the water.
Please note: For most drugs, you need ½ teaspoon of water. If you are testing methamphetamines or other stimulants, use 2 full teaspoons (see our note below on how important it is to use the proper amount of water for these tests!!!).
For Method 1, use enough water to dissolve the entire substance. More water (within reason) will not make the test strips any less effective. See our note below on using enough water when testing fentanyl test strips. Here’s an easy rule: add 1 teaspoon of water for every 10 mg of substance you are testing.
Step 2: Dissolve the substance in the water until few or no chunks or solid particles remain in the solution.
Step 3: Place the wavy end of the test strip down in the water and let it absorb for about 15 seconds.
Step 4: Take the strip out of the water and place it on a flat surface for 2 to 5 minutes. The amount of time it takes for results to show varies, so be patient and allow the test strips to do its thing.
Step 5: Read the results.
Positive results: A single pink, red, or colored line on the left-hand side indicates that fentanyl or a fentanyl analog has been detected in your drugs. If you receive a positive result, it is crucial that you discard the entire batch. Using it could kill you, regardless of whether you have consumed fentanyl in the past, or have already consumed some of the substance you just tested. Throw it away in a safe location where you’re sure no children or pets will come across it.
Negative results: Two pink, red or colored lines indicate that fentanyl or a fentanyl analog has not been detected in your drugs. Remember that no test is 100% accurate and your drugs may still contain fentanyl or fentanyl analogs even if you receive a negative result. You should still take caution as FTS might not detect more potent fentanyl-like drugs, like carfentanil, and fentanyl might not be everywhere in your drugs and your test might miss it. For this reason, we recommend testing the substance multiple times using different samples.
Invalid results: A single pink, red or colored line on the right-hand side or no lines at all, indicates an invalid test. If you get an invalid result, test your drugs again using a new strip. Invalid results are not a valid reason to consume the substances you are testing. If you get invalid results but don’t have any more testing materials, do not consume the substance. Wait until you can test again with another strip.
It is absolutely critical that you use enough water when testing your substances with fentanyl test strips. In a recent study done on fentanyl test strips, researchers found that adulterants, cutting agents, and stimulants substances such as methamphetamine and MDMA can cause false positives when the sample is not diluted with a significant amount of water. To avoid this, try using around 10 milliliters of water (two teaspoons). While this might sound counterintuitive, fentanyl test strips are highly sensitive to fentanyl and its analogs and adding greater amounts of water will dilute the adulterants more, allowing the strip to get a better reading of the fentanyl presence. (source 5)
Fentanyl test strips are highly effective, ranging between 96 - 100% accuracy. However, that pesky little 4% is a huge cause for concern. Check out the section below on the ‘Chocolate Chip Cookie Effect’ to learn why you should test your substances multiple times.
Here's the bottom line about fentanyl test strips: they’re an amazing life-saving tool that we highly recommend.
So please use them.
WHAT SHOULD I DO IF I GET A POSITIVE TEST RESULT FOR FENTANYL?
Receiving a positive result for fentanyl contamination in your drugs can be jarring, we get it. The important thing is that you immediately dispose of that substance in a safe and responsible way. We recommend wrapping the whole batch of whatever you tested and disposing of it in a garbage container where you know it will be absolutely not be consumed. If you have pets or young children, be absolutely sure that you don’t dispose of it somewhere where they might find it.
It’s to remember that drug safety doesn’t stop with a negative result for fentanyl. Drug safety is a continuous process and lifestyle that all those who choose to indulge in the mind expanding, experience altering effects of recreational substances. If you came to this guide for instructions on how to use fentanyl test strips, we urge you to read and learn about the full spectrum of drug safety and harm reduction practices as it relates to fentanyl.
TESTING ONCE ISN’T ENOUGH: THE CHOCOLATE CHIP COOKIE DILEMMA
Remember when we told you that incredibly small (but still incredibly lethal) amounts of fentanyl are being laced into recreational substances? Remember when we also reported that the accuracy of fentanyl test strips sits somewhere between 96% and 100%, and inaccuracies largely occur due to cutting agents and other adulterants.
This problem can be boiled down to what scientists and harm reduction experts call the chocolate chip cookie effect, which refers to the uneven distribution of fentanyl in recreational drug substances.
Basically, your baggie or pill might have fentanyl in it, but not spread evenly throughout the entire substance.
For this reason, we highly recommend that users test any substance multiple times.
Because fentanyl test strips are so cheap, and because of the lethality of fentanyl, we believe it is well worth it to use multiple test strips for any given occasion to ensure maximum safety and remove any chance of fentanyl overdose.
ARE FENTANYL TEST STRIPS LEGAL WHERE I'M AT?
While the lovely members of the User Friendly Club are now aware of how important and lifesaving fentanyl test strips are, the rest of the world is still catching up :(
Unfortunately, some US states still classify fentanyl test strips as drug paraphernalia, designating them as illegal. While attitudes and laws are changing across the United States, and drug paraphernalia laws are somewhat loosely enforced in some areas, it is still important to take caution and to be informed of your state's drug laws.
The split of US states that allow testing materials is 50-50, but each state has specific laws and statutes that delineate the specifics of what is and isn’t paraphernalia and testing materials. In general, states take one of three positions on drug testing materials:
Some states allow only testing materials that can test for the presence of fentanyl
Some states allow for all substances testing materials that can test any substance for purity and/or composition
Some states do not allow for drug testing materials whatsoever (although some exceptions are made under Good Samaritan laws that allow for exemption of individuals who are using testing materials for fatal overdose prevention causes.)
User Friendly has taken the dirty work out of determining whether drug safety materials are legal where you are at. We’ve summarized the laws state-by-state here.
WHAT IS NARCAN? HOW TO REVERSE OVERDOSE WITH NARCAN OR NALOXONE
Naloxone, also commonly known by its trade name, Narcan, is a medication that can reverse the effects of an opioid overdose, including fentanyl. Naloxone can be administered intravenously, but you are more likely to come across it in the form of nasal spray.
Here’s how it works: naloxone is an opioid antagonist, meaning that it attaches to the same receptors that opioids do. By promptly injecting naloxone through an overdosed individuals nostrils, you can reverse the effects of an opioid overdose for thirty to ninety minutes.
Special Alert to the User Friendly Club: we highly recommend that anyone and everyone get their hands on some Naloxone, regardless of what brand you’re using. You can obtain naloxone from harm reduction organizations, local pharmacies, or through prescription, if available. Earlier this year, the FDA approved Narcan for over the counter sale, and we are stoked to see it hit the shelves in the coming months. For now, it's easiest to find it for free at local harm reduction organizations.
Naloxone is a highly effective harm reduction tool. “A review of emergency medical services data from Massachusetts found that when given naloxone, 93.5% of people survived their overdose. The research looked at more than 12,000 dosages administered between July 1, 2013 and December 31, 2015. A year after their overdose, 84.3% of those who had been given the reversal drug were still alive.” (source 6)
Together, fentanyl test strips and Naloxone are a lifesaving duo that can dramatically reduce the risk of death from fentanyl overdose, one by preventing fentanyl consumption and the other by reversing overdoses. We believe that all members of the User Friendly Club should be equipped with both test strips and narcan whenever they go into a situation where drug use is occurring.
Like testing strips, having Naloxone is one thing, but knowing how to use it properly is another. Read our User Friendly steps for administeri