Fentanyl deaths and overdoses are spiking. A Swedish expert explains why.


[7 min read]

In this article: 

  • Medical grade fentanyl is an effective drug used to treat the extreme pain that comes with certain medical conditions. 

  • Illegally made fentanyl is flooding the street drug supply and driving an epidemic of overdose and drug-related deaths.

  • Learning the signs of overdose, which include shallow breathing, loss of consciousness, very small pupils and a faint heartbeat, could help you save a life.   

Fentanyl and other opioids are driving the most severe drug crisis in United States history. The National Center for Health Statistics reports that more than 1,500 people die every week from taking some kind of opioid, making them the nation’s leading cause of overdose death. More recently, illegally made fentanyl has saturated the street drug supply, where the drug is often disguised as a prescription medication containing lethal amounts of fentanyl. COVID-19 exacerbated the growing opioid crisis; people were using new and more powerful unfamiliar drugs and often using alone. In 2023, Department of Homeland Security Secretary Alejandro Mayorkas called fentanyl overdoses “the single greatest threat we face as a country.” May 9 marks National Fentanyl Awareness Day. To learn more, we spoke to John Delfeld, a behavioral health expert at Swedish, who explained the dangers of fentanyl and how to get help for addiction. 
“No one sets out to be addicted to drugs. When we look beyond the addiction, we see these are actual people with complex lives, facing daily struggles compounded by the effects of drug use; they have hopes and dreams for their lives that often include a life without addiction,” says John. “Stigma around addiction shames and isolates the people that need our compassion and help. Everyone can make an impact on someone else’s life. Treatment is available. Recovery is possible.” 

What is fentanyl? Why is it so dangerous? 

Medical grade fentanyl is a powerful and effective medication that is prescribed by physicians to treat the extreme pain that often accompanies serious medical conditions such as cancer. Fentanyl is up to 50 times stronger than heroin, and 100 times stronger than methadone. 
Illicitly manufactured fentanyl is made without regulation or quality controls, and often combined with other drugs such as cocaine, methamphetamine, and heroin. Some people use it recreationally. Others are unaware they are using it because it’s often sold as a fake prescription drugs that are made to look like Xanax or other opioids, making it  impossible to determine the potency of each pill. The equivalent of a couple of grains of sand of fentanyl can be lethal.  

What does the Fentanyl crisis look like locally and nationally? 

Fentanyl is potent and extremely addictive. It's driving high rates of addiction, accidental overdose and preventable death. Overdose involving fentanyl is now the number one cause of death for Americans under 50. 
People can become addicted to opioids including fentanyl in different ways. Sometimes people start using opioids for pain relief following surgery or a significant accident, only to find themselves unable to stop using the medication or using more than prescribed. Others start with recreational use. Still others may use opioids or other substances to cope with trauma they’ve experienced, or a drug might be used by one person to gain control over another. No matter how someone starts using, people often increase their use due to heightened tolerance. 
Due to its potency, smaller amounts of the drug can be smuggled and distributed, making it more difficult for law enforcement to find and confiscate the drug supply and easier for users to get trapped in a cycle of addiction and dependence. It’s important to remember that addiction is a medical disorder where brain chemistry is altered by a substance over time, influencing a person's behavior, motivation, and decision-making process. 
"No one sets out to be addicted to drugs. When we look beyond the addiction, we see these are actual people with complex lives, facing daily struggles compounded by the effects of drug use; they have hopes and dreams for their lives that often include a life without addiction."

Naloxone was recently approved by the U.S Food and Drug Administration (FDA) for over-the-counter sales. What should we know? 

Naloxone (which is also known by the brand name Narcan) is used following an accidental overdose to reverse the effects of an opioid. Naloxone, which we encourage everyone to carry and know how to use, is a medication that blocks the effects of other opioids, including fentanyl. It can quickly restore breathing for the person who has experienced an overdose. The easiest way to administer naloxone is via nasal spray. It doesn't have any effects on someone who isn't using opioids at the time and is safe for people of all ages. Even in situations where medical grade fentanyl is prescribed, others in their family including children can experience an accidental exposure and overdose. So having naloxone on hand is an important safety consideration for anyone using opioids for any reason. 
Currently in Washington there is a standing prescription for naloxone, meaning that it's available to anyone from any pharmacy upon request. You can also have naloxone delivered by mail. In March, the FDA approved  naloxone for over-the-counter sale, which is expected to begin by fall of 2023. Visit this website for information about the drug.
If you see signs of opioid overdose, which include unconscious and not responding to loud noises or physical touch, very small pupils, slow or shallow breathing, vomiting, faint heartbeat, pale skin, purple lips and fingernails and limp arms and legs, call 911 and then use naloxone. Naloxone is effective for 30-90 minutes, so in some cases people may need a second dose. Everyone who is given naloxone should be taken or escorted to the nearest emergency department for appropriate medical care.  

How can I help a family member or loved one who is struggling with addiction? 

Anyone can develop a problem with substances. Addiction not only impacts their life but the lives of their family, friends, and co-workers. It's important to adopt a supportive, compassionate perspective on addiction that acknowledges the way in which substance dependence affects brain chemistry. 
Addiction is not a lack of willpower or a moral failure. Approaches to addressing addiction by using shame, threats, coercion, or punishment are not usually effective and can damage relationships between people suffering from addiction and the people who love them. It is best to take an approach of compassion, understanding, and support. Asking the individual “how can I help you” or “what do you need right now” often makes the biggest difference. 
Encouraging and supporting professional, evidence-based treatment is necessary to effectively treat opioid addiction. Unrealistic expectations that someone addicted to opioids should simply make different decisions without treatment and support can wind up frustrating and discouraging everyone involved. Furthermore, forcing someone into treatment before they are ready to make a change is often unhelpful. Returning to use is not uncommon, so working to move past incidents of relapse and helping to reconnect them back to treatment and support can also be helpful. A harm reduction approach is also an option. Harm reduction implements ideas and tools (such as naloxone) intended to keep people with addiction alive and as healthy as possible until recovery is possible. To find evaluation and treatment for substance use disorder, talk with your primary care physician, or call the Washington Recovery Helpline at 1-866-789-1511.
Don't forget about support for yourself, too! Finding peer support from other families facing addiction and/or talking with a counselor will help you care for yourself and be there for the person you love who is suffering from addiction. Determining the right balance of supporting the person you love who is addicted to opioids on the one hand and protecting yourself, other family members and your finances/assets on the other hand is different for everyone, but you may need help establishing and maintaining those boundaries. 

How is fentanyl addiction treated? 

Getting treatment and having a support system is vital to someone in recovery from opioid addiction. Recovery is a lifelong journey and can look different for everyone. Stigma and bias are a huge factor in someone accessing help, so we should treat people with kindness. 
Typically, someone recovering from opioid use disorder would have their treatment overseen by a physician. Treatment might include medications for opioid use disorder which can be important for medically treating addiction by addressing the changes in brain chemistry caused by addiction. They often see a counselor and/or attend treatment groups to support healthy ways of coping and learning skills to make healthy changes in their life. Some people support their recovery by attending 12 step or SMART recovery groups. 
While addiction may be the most visible and concerning thing affecting someone, drug use might be related to mental health issues and/or traumatic experiences someone has gone through. They may need to address these issues in professional treatment for them to remain in recovery. Anyone experiencing a mental health crisis can call the National Suicide and Crisis Lifeline at 988 for help.

Learn more and find a provider

If you or someone you know needs help with addiction treatment, providers in our Addiction Recovery program are ready to help.  
Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction, and follow up as needed. If you need to find a provider, you can use our provider directory.

Related resources 


This information is not intended as a substitute for professional medical care. Always follow your health care professional’s instructions.


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About the Author

Whether it's stress, anxiety, dementia, addiction or any number of life events that impede our ability to function, mental health is a topic that impacts nearly everyone. The Swedish Behavioral Health Team is committed to offering every-day tips and clinical advice to help you and your loved ones navigate mental health conditions.

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