Illicit fentanyl has transformed the landscape of risk. Its extreme potency, counterfeit formulations, and volatile supply chain turn dependence into a gamble where every dose could be the last. We map how fentanyl spread from labs to street corners, why counterfeit pills exploded across North America, and how the odds shift when naloxone, test strips, and same-day medications are available. But availability is not enough—delivery systems must be designed to meet people where they are, when they need help most. Without that, every swallow, every injection, remains Russian roulette.
By Niklas S. Osterman BHPRN, MA Addiction Specialist
