You can potentially tell if someone is on fentanyl by looking for physical, mental, and behavioral signs of use and addiction.
Physical Signs of Fentanyl Use
If you see the following physical signs of use, the person might be on fentanyl:[1,2]
- Pinpoint pupils (the iris drastically constricts as a result of fentanyl’s effects on the central nervous system
- Excessive drowsiness
- Coordination issues
- Repeatedly nodding off when they should be awake
- Slowed breathing because fentanyl causes respiratory depression
- Skin that is pale and cool to the touch
- Bluish-colored lips and discolored fingertips
- Slurred speech
- Drooling
- Struggling to walk in a straight line or sit up straight
- Notable levels of euphoria and extreme lethargy
- Slowed movements, delayed reactions, and impaired coordination
Mental Signs of Fentanyl Use
Mental signs of fentanyl use include the following:[1,3]
- States of altered consciousness and disorientation
- Appearing confused or unresponsive to stimuli
- Significantly impaired cognitive functioning
- Poor decision-making ability
- Short-term memory problems
- Difficulties with focus and attentiveness
Because fentanyl has such a sedating effect, a user may appear detached and inappropriately relaxed with respect to their surrounding environment and context. They don’t engage in a socially expected manner. There might also be a sudden disinterest in hobbies and relationships, both as a result of being under fentanyl’s effects and because having access to more fentanyl takes precedence in their life.[3]
Behavioral Signs of Fentanyl Use
Behavioral signs of fentanyl use include the following:[3,4]
- Withdrawal from social engagements and relationships
- Neglecting professional or academic responsibilities
- Become secretive
- Shifting routines, usually a result of changing their habits and lifestyle around acquiring and using fentanyl or other opioids
- Sleep issues
- Changes in social circles
- Periods of isolation
- Issues with over money since their income or savings will become diverted to purchasing fentanyl
- Decline in appearance or their personal hygiene, as the sensation of being on fentanyl becomes more important than their self-image
Common Questions or Statements Made When on Fentanyl
If someone is on fentanyl, they may try to hide their use. However, since fentanyl is such a potent opioid, this can be virtually impossible over time.[5]
Common questions or statements when made on fentanyl will stem from the various physical, mental, and behavioral effects of the drug. Here are some examples:
Statements About Perception & Understanding
A person who is under the influence of fentanyl is likely to lose conversational threads, and they will ask people around them to repeat themselves (or they might make repetitive statements themselves, unaware of what they had just said or heard). There might be a dull perception of environmental contexts, such as not understanding what’s going on around them or continually asking for clarification of what’s happening.[6]
Statements About Money Problems
Asking for money, often with vague or evasive reasons, is a common request from people who are trying to hide a fentanyl or opioid abuse habit. They may hyper-focus on acquiring more fentanyl (or changing other things in life to better focus on fentanyl).
Talking About Pain
They could frame the need for fentanyl in terms of physical dependence, perhaps by alluding to ambiguous experiences of pain or nausea, but refusing to go into more detail. They may refuse to go to hospital or accept any other form of help except more fentanyl.
Questions About Time
Questions regarding the perception of time are common due to the altered state of consciousness that people experience when they take fentanyl. Someone on fentanyl may make repeated comments on how time seems to be passing slower or express disbelief at the natural passage of time.
Statements of Denial
They may withdraw from friends and family because (as they might say) their loved ones don’t understand their need for more opioids. A very common statement that someone misusing fentanyl might make is that they have no opioid addiction at all, even when all evidence points to the contrary.
FAQs About Fentanyl Use
These are some of the most common questions we hear about fentanyl use:
The physical signs of fentanyl use include pinpoint pupils, drowsiness, slowed breathing, nodding off, pale and cold skin, and intense relaxation.
Mental signs of fentanyl use include altered consciousness, confusion, extreme sedation, slowed cognition, and poor decision-making abilities.
Behavioral signs of fentanyl use include social withdrawal, neglecting responsibilities, secretive behaviors, and withdrawal from family and friends.
Someone on fentanyl might ask questions or make statements regarding the passage of time or the reality of the surrounding environment. They may repeat themselves or ask you to repeat yourself. They may talk about money problems and other life issues, but they’ll often deny these are related to any kind of drug abuse.
While fentanyl is often laced into other street drugs, like heroin or cocaine, without a user’s knowledge in an effort to increase the potency of drugs, some people do seek out fentanyl. The drug is known for its intense effects. Because of its strength, fatal overdose is common.[7]
- Fentanyl. United States Drug Enforcement Administration. Published October 2022. Accessed January 25, 2024.
- Fentanyl Facts. Centers for Disease Control and Prevention. Published September 2023. Accessed January 25, 2024.
- Opioid use disorder. American Psychiatric Association. Published December 2022. Accessed January 25, 2024.
- Fentanyl DrugFacts. National Institute on Drug Abuse. Published June 1, 2021 Accessed January 25, 2024.
- The Fentanyl Story. Stanley TH. The Journal of Pain. 2014;15(12):1215-1226.
- Opioid Use Disorders in Adolescents—Updates in Assessment and Management. Yule AM, Lyons RM, Wilens TE. Current Pediatrics Reports. 2018;6(2):99-106.
- Fentanyl: CDC’s response to the opioid overdose epidemic. Centers for Disease Control and Prevention. Published 2021. Accessed January 25, 2024.
