Fentanyl is a major contributor to fatal overdoses in California and the United States. In 2022, 59% (nearly 6,500) of drug-related overdose deaths in California included fentanyl.

There are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl* (illicit fentanyl). Doctors prescribe pharmaceutical fentanyl to treat severe pain. Illicit fentanyl is distributed through illegal drug markets and is often mixed into other drugs. Fentanyl can be found in the form of a pill, powder, or liquid. Brightly colored “rainbow” fentanyl can come in pill form, powder, and blocks that look like sidewalk chalk or candy. Rainbow fentanyl, like all forms of fentanyl, is extremely potent and dangerous. See CDPH’s Alert on Rainbow Fentanyl. 

*An illicit drug refers to drugs that are illegal (e.g., heroin, cocaine, etc.) or pills not obtained from a pharmacy or doctor (e.g. counterfeit opioids, counterfeit Xanax, counterfeit Adderall, etc.)

 

Image caption: Fentanyl in the form of a pill, powder, and liquid.

 

How to Save a Life​​​: Naloxone

Naloxone is a life-saving medication that can  reverse an opioid overdose. Naloxone comes in the form of an easy-to-use nasal spray and can be purchased from pharmacies online and in-person or obtained for free at a community-based organization (find one near you using the free naloxone finder map). It is an opioid antagonist, so it is safe to give to someone even if they are not experiencing an opioid overdose. If someone is still unconscious after administering naloxone, wait 2-3 minutes before administering another dose (one naloxone container is a single dose).

Fentanyl Test ​Strips

Fentanyl test strips (FTS) test drugs for the presence of fentanyl. They are a helpful tool for preventing overdose since fentanyl cannot be seen, smelled, or tasted when mixed into another drug. FTS are accurate and reliable, inexpensive ($1 each), typically give results within 5 minutes, and can be the difference between life or death.** When testing a substance, make sure to thoroughly mix the drug prior to testing to account for the chocolate chip cookie effect. ​

Image caption: Visual example of the “chocolate chip cookie effect” when testing a drug for fentanyl. Image source: CDC

**Even if the test is negative, caution should be taken, as (a) false-positives can occur if high concentrations of certain nonopioid drugs are not properly diluted, (b) test strips may not detect other fentanyl-like drugs, like carfentanil, and (c) the portion of drug tested may not contain the same concentration of fentanyl as the rest of the sample. ​

FTS vendors include:  

• BTNX
• Dance Safe
• North America Syringe Exchange Network (NASEN) Buyers Club  

Free or low-cost FTS are available to individuals at California’​s syringe services programs (SSPs) through the California Harm Reduction Supplies Clearinghouse.
More info on FTS:

•  Fentanyl Testing to Prevent Overdose (PDF)
•  Fentanyl and Fentanyl Test Strips FAQs (PDF)

What​ is CDPH doing?

The CDPH Substance and Addiction Prevention Branch (SAPB) works with many partners throughout the state to monitor and address trends at the statewide and local level. CDPH works closely with local health departments and multi-sector partners to support local prevention and intervention efforts that address the specific and unique trends and needs of California’s communities.

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

In August 2024, SAPB launched a statewide public education campaign called Facts Fight Fentanyl to raise awareness of life-saving naloxone and the prevalence and dangers of fentanyl. SAPB also provides other tools and resources for organizations to utilize to spread awareness of fentanyl dangers and overdose prevention strategies within their networks:

• Facts Fight Fentanyl Toolkit
• Fentanyl & Opioid Overdose Prevention Toolkit

The CDPH Office of AIDS (OA) funds harm reduction programs throughout the state that offer syringe services, naloxone, FTS, and other supplies and services to support the health of people who use drugs. The OA Harm Reduction Unit also provides technical assistance to local health jurisdictions and other local partners to add harm reduction services into health departments, clinics, hospitals, and community-based organizations. ​

Publications

• Responding to a Fentanyl Overdose: What California First Responders Need to Know (PDF)

Sources

• CDC: The Facts about Fentanyl (PDF)
• National Harm Reduction Coalition: Fentanyl
• California Overdose Surveillance Dashboard
• Syringe Services Programs in California​

For questions, please contact us at opi@cdph​​.ca.gov.​​​​​​​​