A dose of lethal fentanyl as compared to a penny


Prescription painkillers, heroin, and fentanyl can be dangerous and potentially addictive


Opioids are a class of drugs used to reduce pain. They are potentially addictive drugs that can be both legal and illicit, naturally-occurring (derived from a plant) or synthetic (man-made in a lab). They work by binding to opioid receptors in the brain to reduce pain, along with other effects. The most commonly used opioids are prescription painkillers, heroin, and fentanyl. 

    • Talk to young people about the dangers of opioids.
    • Learn to recognize the signs of addiction, drug use, and overdose.
    • Ask your health care provider about non-prescription alternatives to pain relief medications
    • Store prescription drugs where they cannot fall into the wrong hands. Keep track of medications and safely dispose of unused or expired medications at approved drug-drop-off sites.
    • Get trained in how to administer the opioid overdose reversal drug naloxone and have it readily available.


    Warning Signs 

    • Loss or increase in appetite 
    • Weight loss or weight gain 
    • Intense flu-like symptoms (nausea, vomiting, sweating, shaky hands, feet or head, large pupils) 
    • Wearing long-sleeves or hiding arms 
    • Small pupils 
    • Decreased respiratory rate 
    • Drowsiness or non-responsiveness 
    • Change in attitude and/or personality 
    • A tendency to avoid contact with family and/or friends 
    • Change in friends, hobbies, activities and/or sports 
    • Drops in grades or performance at work 
    • Isolation and secretive behavior 
    • Moodiness, irritability, nervousness, giddiness 
    • Tendency to steal 
    Advanced Warning Signs
    • Missing medications 
    • Burnt or missing spoons and/or bottle caps 
    • Syringes 
    • Small bags with powder residue 
    • Missing shoelaces and/or belts 

    Prescription Painkillers

    Prescription opioids are prescribed by a healthcare professional to treat or manage severe pain resulting from a legitimate medical condition, surgery, or injury. Prescription opioids are legal when they are prescribed to you. Because they are produced by a legitimate company, prescribed by a healthcare professional, and regulated legally, users may falsely perceive prescription opioids as perfectly safe. However, prescription opioids can have dangerous effects, are potentially addictive, and can quickly become as dangerous as illicit substances. Misuse of prescription drugs can result in overdose and death, addiction, and/or other serious medical or mental problems. Many individuals who start with prescription opioids progress to using illicit opioids like heroin or to other dangerous behaviors like mixing opioid pills with alcohol and other drugs.  

    Common prescription opioids include oxycodone (brand names: OxyContin, Percocet), hydrocodone (brand names: Norco, Vicodin), hydromorphone (brand name: Dilaudid), meperidine (brand name: Demerol), codeine, and morphine (brand names: Oramorph, MS Contin), and fentanyl (Duragesic). 

    Signs of Misuse
    • Use in higher frequency than prescribed or for reasons other than prescribed; Running out of prescriptions early or reporting lost medication supplies. 
    • Use of prescription drugs for longer than prescribed or recommended. 
    • Using prescription opioids in ways other than how they are prescribed, such as snorting, inhaling, or injecting them. 
    • Mixing prescription opioids with dangerous substances such as alcohol or benzodiazepines. 
    • Use of prescriptions that were not prescribed to you, i.e., taking a friend’s medication, stealing someone else's medications, or purchasing them on the black market. 


    Heroin is an illegal opioid. The chemical make-up of heroin is similar to many prescription opioids on the market, and it can produce effects like those of legal prescription opioids. Heroin use has increased across the U.S. among men and women, most age groups, and all income levels including groups with historically low heroin use such as young adults (ages 18-25), women, and higher-income individuals. 

    Heroin is typically found as a white or brown powder or sticky black substance. It can be injected with a syringe (intravenously) but may also be snorted, inhaled, or smoked.  When injected intravenously these effects can set in very quickly and be life-threatening. Intravenous use also increases the risk of contracting infections such as skin infections, heart infections, HIV, and viral hepatitis. Heavy use and/or use following a drug-free period, as well as mixing heroin with other substances, increase the risk of overdose and death.  

    Effects and Side Effects
    • Euphoria 
    • Nausea, vomiting, drowsiness 
    • Clouded mental function 
    • Slowed breathing and heart function 
    • Unresponsiveness, loss of consciousness 
    • Overdose death 

    Harm reduction initiatives are essential in keeping heroin and opiate users alive and safe until they are ready to take action and seek treatment. Proper syringe access & disposal, as well as overdose prevention, help address the immediate health and safety concerns faced by people who use heroin and opiates.

    Hidden Fentanyl

    Fentanyl is a synthetic opioid pain reliever that is 50-100 times more potent than heroin and more than 100 times more potent than morphine. It is approved for treating severe pain, typically advanced stage cancer pain. Illegally made/distributed fentanyl has been on the rise in many U.S. states. It's often disguised or mixed into other drugs, such as often, crystal methamphetamine, Ecstasy/MDMA, and street benzodiazepines, even without the street dealers’ or users' knowledge. 

    Drugs containing fentanyl or similar highly potent opioids (called fentanyl analogues), even in very small amounts, substantially increase the risk of overdose and death. Just three milligrams of fentanyl can be fatal, compared to 30 milligrams of heroin. 

    When made and used illicitly or recreationally, fentanyl is often: 

    • A liquid, or a white or brown powder
    • Press into a pill, often mislabeled as an actual medication such as OxyContin
    • Mixed in with other illicit drugs, including: heroin, methamphetamine and cocaine. 
    A dose of lethal fentanyl as compared to a penny
    Image above shows the dose of lethal fentanyl as compared to a penny. Image courtesy of the New York State Police Crime Laboratory.

    Overdose Death Prevention

    Opioids kill a person who is overdosing by slowing and stopping their breathing, so the key to saving their life is to get them breathing again as quickly as possible. If you suspect an opioid overdose, call 911, administer naloxone, administer rescue breathing and CPR until they wake up if you are trained to do so, and encourage the person to seek treatment for addiction. 

    Opioid overdoses are most common among those who use opioids and have been increasing recently. Drug overdose from other drugs (e.g., cocaine, methamphetamine) has also been increasing, due to their being mixed with opioids including fentanyl. Factors that increase the risk of overdose and death include a relapse in drug use following a drug-free period, mixing substances, using alone, and having other medical conditions such as respiratory or heart conditions. 

    Signs of an overdose
    • Small, constricted, 'pinpoint' eye pupils  
    • Choking or gurgling sounds 
    • Pale blue or cold skin, lips, or nails 
    • Limp body 
    • Shallow or no breathing 
    • Falling asleep, loss of consciousness 

    Naloxone is a medication that can rapidly reverse an opioid overdose from a prescription opioid, heroin, fentanyl or other drugs mixed with opioids. Naloxone nasal spray is now available in more than 2,000 pharmacies across New York State. Individuals who are at risk for an overdose and their family members and friends may acquire naloxone in these pharmacies without bringing in a prescription. They may also go to a community-based organization that dispenses naloxone kits and provides training for free. 

    New York State OASAS and the New York State Department of Health oversee training to teach New Yorkers how to administer naloxone.

    Call 911

    Naloxone is not a substitute for medical attention. The effects of naloxone will last 30-90 minutes, until emergency medical attention arrives, but could wear off, and put the person at risk of going back into an overdose. Also, overdoses are often associated with other serious medical problems that require medical attention. The New York State 911 Good Samaritan Law allows individuals witnessing or experiencing a drug or alcohol overdose to call 911 without fear of arrest or prosecution.  

    Medication-Assisted Treatment

    OASAS has worked to increase access to medication-assisted treatment for opioid use disorder. Medication options for the treatment of opioid use disorder are FDA-approved and safe to use, even for women who pregnant or nursing. These medications include methadone, buprenorphine, and long-acting naltrexone injection (brand name: Vivitrol).

    Treatment for substance use disorders is person-centered, individualized, and varies greatly. If you or someone you love is living with an opioid use disorder or other addiction, call the OASAS HOPEline, locate an out-patient treatment provider, and get an evaluation. Decide together what the best treatment option is based on the individual, their level of use, their recovery goals, and their life experiences. 


    LEARN MORE ABOUT Medication-assisted treatment