Pharmacists can address patient fears about fentanyl by distinguishing illicit from prescribed opioids and promoting safe, empathetic, evidence-based opioid use.
Nationwide opioid overdose deaths have decreased by approximately 50% from their peak in June 2023 to January 2026.1 Although this trend is encouraging, synthetic opioids, primarily illicitly manufactured fentanyl (IMF) and its analogues, remain the leading drivers of opioid mortality, accounting for an estimated 85% to 90% of opioid-related deaths in the United States.1 At the same time, stimulant-related overdoses involving cocaine and methamphetamine have doubled over the past decade, often because of cross-contamination or intentional adulteration with fentanyl.2
Michelle Krichbaum, PharmD, BCPP, is a clinical manager at Baptist Health South Florida.
Ebtesam Ahmed, PharmD, MS, BCMTMS, is a clinical professor at St John’s University College of Pharmacy, and a clinical pharmacist at Ruttenberg Cancer Center.
Kiara Parker, PharmD, is a clinical pharmacy specialist at Birmingham VA Health Care System.
Public awareness of opioid-related risks has reached unprecedented levels. Media coverage and social media, which once focused heavily on the prescription opioid crisis of the 2000s and 2010s, now emphasize the dangers of illicit fentanyl. Campaigns such as One Pill Can Kill from the Drug Enforcement Administration (DEA), and broader messaging associated with the Fentanyl Free America initiative, have reinforced the lethality of illicit fentanyl.3,4
These efforts appear to have influenced public perception. In a nationally representative survey, more than 1 in 4 Americans (26%) identified opioids and fentanyl as the nation’s leading public health threat, surpassing concerns such as firearm violence and cancer.5 Other studies similarly demonstrate that the general public perceives fentanyl as extremely dangerous, reflecting widespread awareness of its risks.6
Although these campaigns have likely contributed to declining overdose deaths and increased awareness of illicit drug use, they have also had unintended consequences. Many patients now express fear and uncertainty, not only about illicit fentanyl but also about prescribed opioid therapy. Increasingly, patients struggle to distinguish between the risks associated with illicit substances and those associated with medically supervised treatment.
This disconnect is becoming increasingly evident in pharmacy practice. Patients prescribed legitimate opioid therapies, including pharmaceutical fentanyl, may hesitate to initiate treatment,question the necessity of therapy, or even refuse prescribed medications altogether. Pharmacists are encountering more patients who associate fentanyl, and, in some cases, opioids in general, with overdose, addiction, and death, regardless of the clinical circumstances.
As one of the most accessible health care professionals, pharmacists are uniquely positioned to bridge this knowledge gap by helping patients understand risk within the appropriate clinical context while promoting the safe and effective use of opioid therapy.
A major contributor to patient anxiety is the conflation of illicit fentanyl with pharmaceutical fentanyl. Although both are potent opioids, their risk profiles differ substantially when used as intended.
Illicit fentanyl is often manufactured without quality control, variable in potency and purity, frequently mixed into counterfeit pills or other illicit substances without the user’s knowledge, and a major contributor to unpredictable overdose risk. In contrast, prescribed fentanyl is FDA-approved and manufactured under strict quality standards; is delivered through controlled dosing systems (eg, transdermal patches and transmucosal formulations); is prescribed only for carefully selected patients, typically those who are opioid tolerant and require opioids for chronic pain from malignancy or nonmalignancy; and is monitored within a structured clinical framework.
Despite these important distinctions, many patients perceive “fentanyl” as a monolithic threat. Public messaging is designed to discourage illicit drug use but rarely differentiates between dangerous street drugs and appropriately prescribed medication, inadvertently reinforcing this misunderstanding.
Pharmacists often have the final opportunity to counsel patients before opioid therapy begins or continues. In today’s practice environment, effective communication is just as important as pharmacologic knowledge.
1. Validate Concerns Without Dismissing Them
Patients’ fears are understandable and often reflect what they have seen in the news or on social media. Acknowledging these concerns helps build trust and open the door to meaningful discussion.
Examples include:
2. Clarify the Difference in Context
Patients benefit from simple, nontechnical explanations that distinguish prescribed medications from illicit fentanyl. For example: “The fentanyl you have been hearing about in the news is made illegally and used in unpredictable ways. The medication you have been prescribed is manufactured under strict quality standards, carefully dosed and monitored by your health care team.”
3. Emphasize Safety Measures
Patients often feel more comfortable when they understand the safeguards built into their treatment plan, including: careful patient selection and opioid tolerance requirements, controlled-release delivery systems, routine clinical follow-up, and prescription drug monitoring program oversight. Emphasizing these safeguards helps patients recognize that risk is actively managed throughout therapy.
4. Normalize Hesitation While Supporting Adherence
Fear may lead some patients to delay treatment, underuse medication, or discontinue therapy altogether.
Pharmacists should discuss the consequences of untreated or undertreated pain, the importance of taking medications exactly as prescribed, and the value of communicating concerns early so that therapy can be adjusted when necessary.
Heightened public awareness has also contributed to increasing stigma, not only toward individuals with substance use disorders, but also toward patients who legitimately require opioids for pain management.
Patients may:
Pharmacists can counter these effects by fostering a respectful, nonjudgmental environment. Tone, body language, and attention to patient privacy all influence trust and therapeutic relationships.
Counseling should also address common misconceptions by explaining that:
Even when opioids are prescribed appropriately, harm reduction remains an essential component of patient care.
Pharmacists should routinely:
Prescribing naloxone as a routine safety measure, similar to carrying an epinephrine autoinjector or using a seat belt, can reduce stigma and improve patient acceptance.
1. Start with empathy. “I understand why hearing the word ‘fentanyl’ can feel frightening.”
2. Clearly distinguish prescribed from illicit. Use plain language and avoid unexplained medical terminology.
3. Highlight built-in safety measures. Explain individualized dosing, monitoring, and clinical oversight.
4. Invite questions. Encourage patients to share concerns without fear of judgment.
5. Address stigma directly. Explain the difference between physical dependence and addiction.
Incorporate harm reduction. Offer naloxone and review overdose recognition and response.
7. Reinforce appropriate medication use. Stress adherence to prescribed dosing and discuss the dangers of altering dosage forms (eg, cutting fentanyl patches).
8. Provide ongoing support. Encourage patients to contact the pharmacy or health care team whenever questions or concerns arise.
Campaigns such as the DEA’s Fentanyl Free America messaging play an important role in preventing deaths related to illicit fentanyl. However, broad public messaging may inadvertently create confusion among patients receiving legitimate opioid therapy.
Pharmacists must navigate this dual responsibility by:
Achieving this balance requires more than clinical expertise. It demands empathy, effective communication, and a commitment to individualized patient education.
By proactively addressing misconceptions, correcting misinformation, and fostering open dialogue, pharmacists can help patients make informed decisions, adhere safely to therapy, and feel confident in their treatment plans.
As opioid-related mortality continues to evolve and public awareness campaigns increasingly focus on illicit fentanyl, pharmacists face a new communication challenge: helping patients distinguish between the dangers of illicit opioids and the appropriate use of prescribed opioid therapy.
Through empathetic counseling, evidence-based education, and proactive harm reduction, pharmacists can help patients navigate fear without compromising appropriate pain management. In doing so, they not only improve individual patient outcomes but also contribute to a more balanced, informed, and compassionate understanding of opioid therapy.
