Legal status Effective from 1 May 2019, China officially classified all forms of fentanyl as controlled narcotics. In the UK, fentanyl is classified as a controlled Schedule II, Class A drug under the
Misuse of Drugs Act 1971. In the Netherlands, fentanyl is a List I substance of the
Opium Law. In the US, fentanyl is a Schedule II controlled substance per the
Controlled Substances Act. Distributors of Abstral are required to implement an FDA-approved
risk evaluation and mitigation strategy (REMS) program. In order to curb misuse, many health insurers have begun to require
precertification and/or quantity limits for Actiq prescriptions. In Canada, fentanyl is considered a scheduleI drug as listed in Canada's
Controlled Drugs and Substances Act. Some fentanyl precursors, such as the
piperidones (after October 2023) have been banned under its
Precursor Control Regulations, which have been in place at least since November 2016.
Recreational use Illicit use of pharmaceutical fentanyl and its analogues first appeared in the mid-1970s in the medical community and continues in the present. More than 12 different analogues of fentanyl, all unapproved and
clandestinely produced, have been identified in the U.S. drug traffic. In February 2018, the U.S. Drug Enforcement Administration indicated that illicit fentanyl analogs have no medically valid use, and thus applied a "Schedule I" classification to them. Fentanyl analogues may be hundreds of times more potent than heroin. Fentanyl is used orally, smoked, snorted, or injected. Fentanyl is sometimes sold as heroin or
oxycodone, which can lead to overdose. Many fentanyl overdoses are initially classified as heroin overdoses. Recreational use is not particularly widespread in the EU except for Tallinn, Estonia, where it has largely replaced heroin.
Estonia has the highest rate of
3-methylfentanyl overdose deaths in the EU, due to its high rate of recreational use. Another form of fentanyl that has appeared on the streets is the
Actiq lollipop formulation. The pharmacy retail price ranges from US$15 to US$50 per unit based on the strength of the lozenge, with the black market cost ranging from US$5 to US$25 in 2007, depending on the dose. The attorneys general of Connecticut and Pennsylvania have launched investigations into its diversion from the legitimate pharmaceutical market, including Cephalon's "sales and promotional practices for Provigil, Actiq and Gabitril." Even those with opiate tolerances are at high risk for overdoses. As with all opioids, the effects of fentanyl can be reversed with
naloxone, or other opiate antagonists. Naloxone is increasingly available to the public. Long-acting or sustained-release opioids may require repeat dosage. Illicitly synthesized fentanyl powder has also appeared on the United States market. Because of the extremely high strength of pure fentanyl powder, it is very difficult to dilute appropriately; often the resulting mixture may be far too strong and, therefore, very dangerous. Some heroin dealers mix fentanyl powder with heroin to increase potency or compensate for low-quality heroin. In 2006, illegally manufactured, non-pharmaceutical fentanyl, often mixed with
cocaine or
heroin, caused an outbreak of overdose deaths in the United States and
Canada. Deaths were heavily concentrated in the cities of
Dayton, Ohio;
Chicago, Illinois;
Detroit, Michigan; and
Philadelphia, Pennsylvania.
Enforcement , United States The fentanyl supply chain in Mexico consists of a vast and elusive network, potentially involving hundreds of players. U.S. and Mexican anti-narcotics officials acknowledge that the exact number is unknown. Some brokers operate as specialists within major cartels, while others act independently. However, the majority remain unknown to authorities and operate below the radar. A major challenge in disrupting this trade lies in the global chemical industry. Many of the compounds used to manufacture fentanyl have legitimate industrial applications, classifying them as dual-use chemicals. These substances are often unregulated or only lightly controlled in key countries such as the United States, Mexico, and China. This regulatory gap enables brokers to evade detection, seamlessly navigating between the legal chemical trade and the illicit drug market to acquire the necessary precursors. Several large quantities of illicitly produced fentanyl have been seized by U.S. law enforcement agencies. In November2016, the DEA uncovered an operation making counterfeit oxycodone and
Xanax from a home in
Cottonwood Heights, Utah. They found about 70,000pills in the appearance of oxycodone and more than 25,000 in the appearance of Xanax. The DEA reported that millions of pills could have been distributed from this location over the course of time. The accused owned a
tablet press and ordered fentanyl in powder form from China. A seizure of a record amount of fentanyl occurred on 2 February 2019, by
U.S. Customs and Border Protection in
Nogales, Arizona. The of fentanyl, which was estimated to be worth US$3.5M, was concealed in a compartment under a false floor of a truck transporting cucumbers. The "China White" form of fentanyl refers to any of a number of clandestinely produced analogues, especially
α-methylfentanyl (AMF). which today are classified as
Schedule I drugs in the United States. Part of the motivation for AMF is that, despite the extra difficulty from a synthetic standpoint, the resultant drug is more resistant to metabolic degradation. This results in a drug with an increased duration. In June 2013, the United States
Centers for Disease Control and Prevention (CDC) issued a health advisory to emergency departments alerting to 14 overdose deaths among intravenous drug users in Rhode Island associated with
acetylfentanyl, a synthetic opioid analog of fentanyl that has never been licensed for medical use. In a separate study conducted by the CDC, 82% of fentanyl overdose deaths involved illegally manufactured fentanyl, while only 4% were suspected to originate from a prescription. Beginning in 2015, Canada has seen several fentanyl overdoses. Authorities suspected that the drug was being imported from Asia to the western coast by organized crime groups in powder form and being pressed into pseudo-OxyContin tablets. Traces of the drug have also been found in other recreational drugs, including cocaine,
MDMA, and heroin. The drug has been implicated in the deaths of people from all walks of life—from homeless individuals to professionals—including teens and young parents. Because of the rising deaths across the country, especially in
British Columbia where 1,716deaths were reported in 2020 and 1,782 from January to October2021,
Health Canada is putting a rush on a review of the prescription-only status of
naloxone in an effort to combat overdoses of the drug. In 2018,
Global News reported allegations that
diplomatic tensions between Canada and China hindered cooperation to seize imports, with Beijing being accused of inaction. Fentanyl has been discovered for sale in illicit markets in Australia in 2017 and in New Zealand in 2018. In response, New Zealand experts called for wider availability of naloxone. In May 2019, China regulated the entire class of fentanyl-type drugs and two fentanyl precursors. Nevertheless, it remains the principal origin of fentanyl in the United States: Mexican cartels source fentanyl
precursors from Chinese suppliers such as
Yuancheng Group, which are finished in Mexico and smuggled to the United States. Following the
2022 visit by Nancy Pelosi to Taiwan, China halted cooperation with the United States on combatting drug trafficking. Bilateral talks on fentanyl later resumed in
San Francisco in 2023 when then
U.S. President Joe Biden and
CCP General Secretary Xi Jinping met. In the past several months before February 2025, China also began scheduling fentanyl precursors that are internationally banned, aligning with efforts to restrict the flow of chemicals used in fentanyl production as well as the drug itself. These actions are intended to strengthen efforts to curb drug trafficking and disrupt the supply chain more effectively. In February 2025, US president Trump imposed a 10%
tariff on Chinese imports, claiming the move as a way "to pressure China into taking action on fentanyl" but experts have expressed concern that these tariffs could reverse the progress made under the Biden administration and weaken the international cooperation necessary to combat global drug trafficking. India has also emerged as a source of fentanyl and fentanyl precursors, In 2023, a California police union director was charged with importing synthetic opioids, including fentanyl and
tapentadol disguised as
chocolate. U.S. law enforcement had been slow in their response to the fentanyl crisis, according to the Washington Post. The response by the federal government to the fentanyl crisis had also faltered, according to the press release. Overdose deaths by fentanyl and other illegally imported opioids were surging since 2019 and are presently a major cause of death in all U.S. states. According to the national archives and the
DEA, direct fentanyl shipments from China have stopped since 2022. The majority of illicit fentanyl and analogues now entering the U.S. from Mexico are final products in the form of "tablets", and adulterated heroin from previously synthesized fentanyl. From the sophistication of full
fentanyl synthesis and acute toxicity in laboratory environments, 'clandestine' labs in Mexico prefer to make an illicit dosage form from available fentanyl rather than the synthesis itself. Based on further research by investigators, fentanyl and analogues are likely synthesized in labs that have the appearance of a legal entity, or are diverted from pharmaceutical laboratories. Recent investigations and convictions of members of the
Sinaloa drug cartel by federal agencies made a clear connection between illegal arms trafficking from the U.S. to Mexico and the smuggling of fentanyl into the U.S. Mexico had repeatedly made official complaints, since illegal guns are easily purchased (for example in Arizona and as far north as Wisconsin and even Alaska) according to U.S. intelligence sources. The guns are transported onto Mexican territory through a chain of American brokers and couriers, often financed by those drug cartels that also engage in money laundering. Therefore, the lack of arms controls in the U.S. has directly contributed to the U.S. opioid overdose crisis. The
opioid epidemic in the United States is largely fueled by drugs smuggled from Mexico; approximately 98% of fentanyl entering the U.S. comes from Mexico. In January 2025, President Trump said that
tariffs on Mexico were intended to reduce the U.S. trade deficit and force the country to secure its border with the U.S. against fentanyl smuggling and
illegal immigration.
Brand names Brand names include Sublimaze, Actiq, Durogesic, Duragesic, Fentora, Matrifen, Haldid, Onsolis, Instanyl, Abstral, Lazanda and others.
Economics In the United States, the 800 mcg tablet was 6.75 times more expensive as of 2020 than the lozenge. As of 2023, the average cost for an injectable fentanyl solution (50 mcg/mL) is around
US$17 for a supply of 20 milliliters, depending on the pharmacy. In a 2020 report by the
Australian Institute of Criminology, a 100-microgram transdermal patch was valued from between
AU$75 and AU$450 on illicit markets. Furthermore, in another 2020 study, the average price per gram of non-pharmaceutical fentanyl on various
cryptomarkets was US$1,470.40 for offerings of less than five grams; the average for offers over five grams was US$139.50. In addition, on
DreamMarket furanfentanyl (Fu-F), the most common analog on said market, the average price per gram was US$243.10 for retail listings and US$26.50 per gram for wholesale listings.
Storage and disposal The fentanyl patch is one of a few medications that may be especially harmful, and in some cases fatal, with just one dose, if misused by a child. Experts have advised that any unused fentanyl patches be kept in a secure location out of children's sight and reach, such as a locked cabinet. In
British Columbia,
Canada, where there are environmental concerns about toilet flushing or garbage disposal,
pharmacists recommend that unused patches be sealed in a
child-proof container that is then returned to a
pharmacy. In the United States, where patches cannot always be returned through a medication take-back program,
flushing is recommended for fentanyl patches, because it is the fastest and surest way to remove them from the home, preventing ingestion by children, pets or others not intended to use them.
State usage as weapon US death penalty In August 2018, Nebraska became the first American state to use fentanyl to
execute a prisoner.
Carey Dean Moore, then one of the longest-serving
death row inmates in the United States, was executed at the
Nebraska State Penitentiary. Moore received a
lethal injection, administered as an
intravenous series of four drugs that included fentanyl citrate, to inhibit breathing and render the subject unconscious. The other drugs included
diazepam as a tranquilizer,
cisatracurium besylate as a muscle relaxant, and
potassium chloride to stop the heart. The use of fentanyl in execution caused concern among death penalty experts because it was part of a previously untested
drug cocktail. to rapidly incapacitate people in the
Moscow theater hostage crisis in 2002. The siege was ended, but many hostages died from the gas after their health was severely taxed during the days-long siege. The Russian Health Minister later stated that the gas was based on fentanyl, but the exact chemical agent has not been clearly identified. == Veterinary use ==