Harm reduction

Harm Reduction & Overdose Prevention: Fentanyl

Fentanyl is a potent synthetic opioid that is much stronger than heroin and morphine.

What is Fentanyl?

Fentanyl is a potent synthetic opioid that is much stronger than heroin and morphine.

Opioids are respiratory depressants. They slow your breathing and heart rate down. Heroin, morphine, oxy, vicodin, and fentanyl are all examples of opiates.

Fentanyl is a white granular or crystalline powder. Its color can vary. It can be white, gray, green, lavender, pink, blue, or yellow.

Safer Use and Overdose Risk

Most people smoke or inject fentanyl.


  • Injecting has the highest risk of overdose. When you inject, use new equipment each time and choose a needle gauge and length that is best for the location where you are injecting.


  • Smoking is a bit safer but you still can overdose from smoking fentanyl. Take breaks in between hits so you can see how you are feeling.
  • If you are sharing bubbles/pipes make sure you mark your pipes in some way, like with a sharpie or nail polish. Keep one pipe for fentanyl and one for meth. This way you can avoid someone thinking it’s meth, when it’s really fentanyl and overdosing because they do not have a tolerance for opioids.

Strengths of fentanyl can change batch to batch. Just because it’s the same color as what you may have bought before doesn’t mean that it’s the same strength this time.

Color does not necessarily have anything to do with strength.

Start with a little. You can always do more after you see how you are feeling.

Our drug supply is unregulated and inconsistent:

Pills bought on the street, like Xanax, can contain fentanyl. Fentanyl test strips can be reliably used for testing pills, cocaine, and heroin when used correctly.

Pills, Pressed pills, “pressies”

Pressed pills consist of powdered drugs and binders that are pressed in a pill press and stamped to mimic pharmaceutical pills, like Xanax or M30’s.

Blue pills stamped M30’s (“Blues”) can be pressed fentanyl pills and not oxycodone.

Pills that are sold as Xanax can also be pressed fentanyl pills.

The way fentanyl is sold differs region to region. People can find pressed fentanyl pills called “Blues” (stamped M30’s) in Portland Oregon, for example, and folx purchase it knowing it is fentanyl. In San Francisco, we mostly have fentanyl powders sold as fentanyl, and it comes in various colors.

If you are using other drugs besides fentanyl you can test your drugs to see if they contain fentanyl. Test strips are available at many harm reduction centers such as syringe exchanges and drug users’ unions. Some harm reduction centers also offer more in depth drug checking services.

What increases your OD risk?

Mixing substances:

Mixing opiates with benzodiazepines, like xanax and klonopin, or with other opioids (heroin,oxy), and with alcohol all can increase your risk of overdose. Overall, mixing depressants with other depressants can increase risk.

Change in tolerance:

If you were recently in jail or treatment or took a break from using, your tolerance may have gone down. Go slow – start with a little and see how you feel, you can always do more later.

Using Alone:

  • Use with others when you can.
  • Look out for each other and respond with Narcan if someone ODs.
  • If you are using with others don’t all smoke or inject at the same time. Take turns so you can keep an eye on each other and decrease the risk of all ODing at the same time if you have a very strong batch.

Getting high alone safety tips:

Do a test shot or smoke a small amount first. If you are injecting, release the tourniquet after you register and inject slowly – this way you can see how it hits you.

If you have a phone:

Text a trusted friend and make an OD prevention plan. This could look like letting them know where you are and that you’re about to get high, make a plan to text them back in 5 mins and let them know what you would like them to do if you do not respond, including calling 911. If you are indoors, leave the door unlocked.

Get high while on the phone with someone and make a plan before you get high. You can also use a hotline for support. The Never Use Alone hotline is 800-484-3731.

Fentanyl myths and facts:

  • You cannot get high or overdose by touching fentanyl!
  • Fentanyl needs to get into your bloodstream or through your mucus membranes for you to feel the effects and get high. This is done by injecting, smoking, or snorting fentanyl. The powder cannot be absorbed through your skin. (Fentanyl patches from a doctor are different from fentanyl powder and have been made in a way that allows for absorption through your skin.)

Be ready to respond to overdose

  • Use with friends or with other people, so someone is there to help should you overdose
  • Naloxone will work on all opioids, fentanyl is an opioid. Stock up on naloxone (Narcan), and be prepared to use it if someone with you overdoses.
  • If mixing benzodiazepines and opioids, remember Narcan ONLY works on opiates.
  • Know the signs of overdose, and be prepared to respond. If you’re using with other people, stagger your use so that someone is always alert enough to take action if someone overdoses.
  • Naloxone works to reverse fentanyl overdoses. Do not believe widespread myths about fentanyl, including the idea that it is “naloxone-resistant.”
    After administering Naloxone perform rescue breathing so oxygenated blood is making its way to the brain. Naloxone can take 2-3 minutes to work. If at that point they have not responded, administer another dose.