Fentanyl is a synthetic opioid that is around 100 times more potent than morphine, making it a dangerous substance of abuse. [1] In 2023, over 70,000 Americans had a fatal overdose of a synthetic opioid, the majority of which was fentanyl. [2] This article will unpack further the visible signs of the fentanyl epidemic in the United States.
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What is the fentanyl fold, and what does it look like?
The fentanyl fold (also called the fent fold or fenty lean) describes the unique look that can be caused by regular fentanyl use. The individual is often bent over at the waist, head bowed, slumped forward, and in a rigid position; a look that can be quite startling when first seen. The individual may remain stuck in this position for several hours, leading to difficulty breathing and poor circulation. This sight has become more common in recent years, with the opioid crisis in the United States.
There are also several other opioid-induced postures. For example, ‘The Nod’ (or nodding out) occurs when the individual is falling in and out of consciousness, often causing the head to tilt forward and backward, with eyes closing or rolling back. But what exactly causes these unique postures?
The science: Why does the fentanyl fold happen?
Due to fentanyl’s high potency and unique structure, which causes rapid absorption in the brain, adverse effects can occur quickly and severely. [3][4] The Blood-Brain Barrier (BBB) has a unique lipid composition that helps protect the brain from many harmful substances. [5] However, fentanyl is highly lipophilic, meaning it readily crosses the BBB, leading to harmful effects on the user.
One of these effects is increased muscle rigidity, particularly of the trunk muscles, affecting posture, mobility, and breathing, contributing to the fentanyl fold. [3] Another is reduced breathing rate, which can make the individual feel lightheaded, which can contribute to them slumping over in the fentanyl fold. Fentanyl also causes depression of the central nervous system, causing sedation and reduced consciousness, which can lead to ‘the nod’.
Polysubstance risk
People who use fentanyl often combine it with other substances, either intentionally or by accident. Some people intentionally take other drugs, such as methamphetamine, in combination with fentanyl to help combat its sedating effects; whereas unintentional consumption of other substances can happen if the fentanyl has been adulterated. [6] However, taking multiple different drugs together increases the risk of serious health effects and death. [6]
Stigma and social media portrayal
Illicit drug use has a large stigma attached to it, which often acts as a barrier for the individual to get the treatment they need. [7] This stigma can come in many forms, often combining negative public attitudes, wider policies, and the individual’s negative mental health impact.
Social media content, particularly viral videos on TikTok portraying streets full of people in the fentanyl fold, only helps to exacerbate this stigma by dehumanizing the individuals involved and subjecting them to online abuse.
Health risks of the fentanyl fold and recognizing danger signs
The main health risk of the fentanyl fold is related to breathing. Opioid use causes the breathing to be slowed regardless, but by adding in this unnatural posture and restriction of the chest muscles, the breathing can be further restricted. Reduced consciousness is also a danger, as the individual becomes less aware of their surroundings, leading to an increased risk of accidents, such as crossing the road with oncoming traffic.
The danger signs of opioid overdose include:
- Reduced consciousness
- Slowed breathing
- Blue lips or fingertips
- Cold skin
- Limb weakness
- Tiny pupils
- Snoring noises
If someone has one or more of these signs, urgent attention is needed to prevent serious health impacts.
Bystander response: What to do if you see someone in a fentanyl fold
It can be upsetting and scary if you see someone in a fentanyl fold. If you feel safe and able to offer help, you should follow the following steps:
- Check for danger. Ensure that by approaching the person, you will not be putting yourself in danger. Think about who else is around, traffic, exposed needles etc.
- Get help. If there is anyone else with you or nearby, shout to them and ask them to help you.
- Check responsiveness. Once you have approached the individual, if they are not alert, try speaking to them. If they do not respond to your raised voice, try exerting a small amount of pain, like squeezing the top of their shoulder.
- Check breathing/circulation. If the breathing appears slow or they have other signs of reduced oxygen circulation, like cold peripheries or blue lips/fingertips, further treatment is needed.
- Call 911 for an ambulance. If the individual is in a fentanyl fold or with signs of reduced consciousness/breathing, they need naloxone to help reverse these effects.
- Stay with them until emergency services arrive, keeping them in a safe place.
Supporting recovery and reducing harm
If you or someone you know is suffering from an opioid addiction, please know that you’re not alone and there is a lot of support out there to help with addiction recovery. It’s important to have a good support group around you, including family, friends, and medical professionals. Here at Recovered, we can assist in finding your local treatment centers and have lots of resources to help support your addiction recovery journey.
It’s also good to know what harm reduction strategies are in your local area, such as needle exchange programs and drug testing centers. These strategies can help to reduce harm while still using substances, and more information on these can be found here.
Final thoughts
The fentanyl fold has sadly become a more common sight on the streets in recent years due to its high potency and availability. The fentanyl fold can put the individual at risk of several serious health impacts, and even death. If you or someone you know is struggling with fentanyl addiction, please reach out to a medical professional to start the recovery journey.
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