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Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. It has a rapid onset and its effects generally last less than two hours. Medically, fentanyl is used by injection, nasal spray, skin patch, or absorbed through the cheek (transmucosal) as a lozenge or tablet.

Common side effecs include vomiting, constipation, sedation, confusion, hallucinations, and injuries related to poor coordination. Serious side effects may include decreased breathing (respiratory depression), serotonin syndrome, low blood pressure, addiction, or coma. Fentanyl works primarily by activating μ-opioid receptors. It is around 100 times stronger than morphine, and some analogs such as carfentanil are around 10,000 times stronger.

Brand names include Sublimaze, Actiq, Durogesic, Duragesic, Fentora, Matrifen, Haldid, Onsolis, Instanyl, Abstral, Lazanda, and others.

According to the Guardian in an article published in December 2018 by Mark Townsend major dark web drug suppliers have started to voluntarily ban the synthetic opioid fentanyl because it is too dangerous, the National Crime Agency has said. They are “delisting” the high-strength painkiller, effectively classifying it alongside mass-casualty firearms and explosives as commodities that are considered too high-risk to trade. Fentanyl can be up to 100 times stronger than heroin and can easily cause accidental overdoses, particularly when mixed with heroin. Medical examiners concluded that musician Prince died on April 21, 2016, from an accidental fentanyl overdose. Fentanyl was among many substances identified in counterfeit pills recovered from his home, especially some that were mislabeled as Watson 385, a combination of hydrocodone and paracetamol. American rapper Lil Peep also died of an accidental fentanyl overdose on November 15, 2017. On January 19, 2018, the medical examiner-coroner for the county of Los Angeles said Tom Petty died from an accidental drug overdose as a result of mixing medications that included fentanyl, acetyl fentanyl, and despropionyl fentanyl (among others). He was reportedly treating "many serious ailments" that included a broken hip. Additionally, in 2018, American rapper Mac Miller died from an accidental overdose of fentanyl, cocaine, and alcohol.

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