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Overdose Prevention Initiative
Pills, a syringe, and a spoon with liquid drugs on a black background, text across image reads: Fentanyl

What is fentanyl?

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. It is a major contributor to fatal and nonfatal overdoses in California and the United States.

There are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl (illicit fentanyl). Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. Illicit fentanyl is distributed through illegal drug markets for its heroin-like effect.

Learn more facts about fentanyl and download the Centers for Disease Control and Prevention's (CDC) The Facts about Fentanyl (PDF) fact sheet.

Why is fentanyl dangerous?​

Fentanyl is extremely potent. It is up to 50 times stronger than heroin and 100 times stronger than morphine. Illicit fentanyl can be added to other drugs to make them cheaper, more powerful, and more addictive. Illicit fentanyl has been found in many drugs, including heroin, methamphetamine, counterfeit pills, and cocaine. Fentanyl mixed in with any drug increases the likelihood of a fatal interaction.

Fentanyl-laced drugs are extremely dangerous. It is nearly impossible to tell if drugs have been laced with fentanyl without the use of fentanyl test strips because fentanyl cannot be seen, smelled, or tasted. Testing strips are inexpensive, typically give results within 5 minutes, and can be the difference between life or death. Even if the test is negative, caution should be taken as test strips might not detect more potent fentanyl-like drugs, like carfentanil. Download CDPH's Fentanyl Testing to Prevent Overdose (PDF) fact sheet.

Naloxone is an opioid antagonist that temporarily reverses the effects of an opioid overdose. With a fentanyl overdose, two or more doses of naloxone may need to be administered.

A fatal amount of fentanyl next to a penny
A fatal amount of fentanyl next to a penny.

Illicit fentanyl is sold alone or in combination with other drugs and has been identified in counterfeit pills, mimicking pharmaceutical drugs such as oxycodone. According to the United States Drug Enforcement Administration (DEA), counterfeit pills are more lethal than ever before. The number of DEA-seized counterfeit pills with fentanyl has jumped nearly 430 percent since 2019. Lab testing finds that 2 out of every 5 counterfeit pills with fentanyl seized by the DEA contains a potentially lethal dose of fentanyl. The only safe medications are ones prescribed by a trusted medical professional and dispensed by a licensed pharmacist.

Fentanyl can be found in different forms, including pills, powder, and liquid.

Fentanyl in three different forms, including pills, powder, and liquid

Fentanyl in California

Fentanyl-related overdose deaths in California have been increasing at an unpredictable pace (PDF).

What is California doing?​

The CDPH Substance and Addiction Prevention Branch (SAPB) works with many partners throughout the state to monitor and address current trends at the statewide and local level. Working closely with local health departments, opioid safety coalitions, and other partners at the local level allows CDPH to support local prevention and intervention efforts that address the specific and unique trends and needs of California's  communities.

CDPH SAPB monitors fatal and non-fatal opioid-related overdose trends over time in California, by sex, age, race/ethnicity, and substance type. These indicators and trends are also available by geography, county, and zip code on the California Overdose Surveillance Dashboard.


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