Why does fentanyl make you look like a zombie?

If you've ever watched the news about the fentanyl crisis in New York, you might have wondered if you were watching an episode of The Walking Dead by mistake, images filled with people hunched forward, almost suspended in the air like zombies mid-stride.

Keep calm, my friend, this isn't the casting of a B-movie horror film: these are real people under the influence of fentanyl, that powerful drug we talked about in a previous article about why it's so dangerous.

Jokes aside, these typical fentanyl postures, although they can also occur with other drugs or combinations of several, have become a visual symbol of this current opioid addiction crisis because of how strange and disturbing they are.

The positions of fentanyl

These unlikely postures have been popularly associated with fentanyl use, although they are not exclusive to this substance. Seeing someone hunched over like this makes it hard to know for sure what drug they took, as it could be fentanyl or another depressant, or even a combination of several drugs. Often, it's a mixture of both, with illegally manufactured fentanyl mixed with other sedatives such as xylazine (the famous veterinary tranquilizer nicknamed the zombie drug). These substances cause extreme sedation, and their combination can produce extremely serious effects.

What happens to the body? Basically, the person is semiconscious and heavily sedated. Opioids like fentanyl slow down the central nervous system, causing the individual to become lethargic and drowsy, with a slower pulse and breathing. Xylazine, on the other hand, further enhances this tranquilizing effect. The result is that the user "nods off" while standing: they begin to fall asleep even while awake, partially losing muscle tone.

However, the main reason they adopt these peculiar postures, instead of falling completely to the ground, is that these drugs provoke a dual reaction in the muscles, since while certain muscle groups remain completely relaxed (causing that flaccid and hanging appearance), other muscle groups enter a state of involuntary rigidity.

This creates a kind of precarious balance, allowing people to remain standing, even though they seem suspended in the air like true urban zombies. Pharmacology in action, sadly visible right on the street.

Opioids such as fentanyl depress the central nervous system, reducing overall muscle tone. However, in some groups (especially deep postural muscles), paradoxical rigidity can occur, thought to be mediated by a disinhibition of motor neurons in the spinal cord and brainstem. In medicine, this is known as "opioid-induced muscle rigidity", an effect described primarily with high doses of fentanyl and its analogues.

Muscle groups that tend to become rigid

• Paravertebral and back extensors: These muscles are often rigid, keeping the trunk relatively “supported” even when the person is deeply sedated.
• Leg extensors (quadriceps and glutes): may present a certain degree of spasm or hypertonia, helping to prevent the person from completely collapsing.
• Jaw and neck muscles: Some opioids, especially at high doses, produce neck stiffness (similar to what is seen with “wooden chest syndrome,” a chest stiffness induced by potent opioids).

Muscle groups that tend to become more lax

• Cervical and trunk flexors: they relax, causing the typical “hanging head” posture and the body to bend forward.
• Arms and hands: The muscles of the upper extremities lose tone, which is why the arms hang inertly.
• Facial muscles: droop, giving the appearance of a “sleepy face” or expressionlessness.

Are these postures avoidable?

Looking at it this way, the million-dollar question: Can those poses be avoided while under the influence of fentanyl? The only surefire way is to avoid misusing fentanyl or opioids. It sounds obvious, but it's true: such a potent opioid inevitably causes extreme drowsiness. That said, there are harm reduction measures to avoid ending up backed into a corner (or worse):

• Don't use alone standing in public: If someone is going to use (which we advise against, but let's be realistic), it's less dangerous for them to be sitting or lying down in a safe place. For example, in places with supervised consumption programs, people can remain seated or monitored, reducing the risk of falling or hurting themselves if they fall asleep. Of course, ideally, they shouldn't use at all, but a controlled environment at least prevents them from ending up as human statues on the street.
• Be careful with dosage and purity: With fentanyl, there's no margin for error. Even a tiny bit more can cause extreme sedation. Furthermore, on the street, it's often adulterated with xylazine or other substances , making the effect more unpredictable. Therefore, there's no "safe" way to dose yourself. But it helps to be aware that mixing it with other depressants is a recipe for disaster : for example, avoiding combining fentanyl with benzodiazepines decreases the likelihood of such profound sedation. Any combination of substances that enhance central nervous system depression (alcohol, painkillers, etc.) increases the risk of unconsciousness or an overdose.
• Have company and an emergency plan: These positions are a precursor to a possible overdose . If someone is still half-standing but extremely dazed, they could lose consciousness at any moment. Therefore, opioids should never be consumed alone. A sober companion who can recognize an overdose and take action (call emergency services and administer naloxone ) can save a life. In places like the US, they even distribute free naloxone (Narcan) kits to users and their loved ones, precisely to prevent a "bad trip" from ending tragically.

What to do if you've overdone it with fentanyl?

Let's imagine that, despite all the warnings, someone has "crossed the line" with fentanyl and is entering that dangerously semi-conscious state. Here, scolding isn't the way to go; acting quickly is essential. Here are the key steps:

• Seek medical help immediately: Call emergency services (112 in Spain, 911 in the US, or another number depending on the country) as soon as you suspect someone is suffering an opioid overdose. If the person is unconscious, breathing very slowly, or unresponsive, these are clear warning signs.
• Administer naloxone (Narcan) if available: Naloxone is an opioid antagonist medication that quickly reverses an overdose . It usually comes in an easy-to-use nasal spray. Narcan is now sold over-the-counter in pharmacies in the United States due to the scale of the crisis. It can restore normal breathing in 2–3 minutes by blocking the effects of fentanyl on the brain. It’s literally a lifesaver in spray form. If you have a kit on hand, don’t hesitate: administer a dose of naloxone immediately (spray it into the victim’s nose). Note: Naloxone has no negative effects if the person was not on opioids, so it’s best to use it as a precaution even if you’re not 100% sure of the cause. In cases of strong fentanyl, multiple doses may be necessary because it’s a very potent drug.
• Keep the person awake and monitored: If they are still semi-conscious, speak loudly and try to stimulate them so they don't fall completely asleep . Place them in a lateral safety position (on their side) to prevent suffocation if they vomit, and never leave them alone. Supervise them until the ambulance arrives.
• Don't hesitate or wait: Every second counts. Fentanyl can depress breathing to the point of arrest in a matter of minutes. Many deaths occur because no one reacted in time.

Finally, if you've used fentanyl yourself and notice that you're "overdoing it" (extreme dizziness, difficulty staying conscious), get help immediately. Call yourself or tell someone close to you what's happening. Don't be afraid to seek medical help. Many states have laws that protect callers who report an overdose. Remember: the priority is survival. There will be time to seek help for addiction, but first, we must prevent that zombie-like state from turning into a tragedy.

Reflection on the fentanyl crisis and its damage to society

The scenes of people doubled over as zombies are just the tip of the iceberg of the fentanyl crisis. Behind every viral video lies a painful reality: thousands of lives on the brink of death due to a substance 50 times more potent than heroin. In the United States, it is estimated that nearly 200 people die every day from fentanyl overdoses. A chilling rate, equivalent to a plane full of passengers crashing every 24 hours. Two-thirds of the more than 100,000 overdose deaths recorded in 2021 were attributed to synthetic opioids like fentanyl. And the problem is not limited to the US: this “opioid pandemic” is spreading across the world, from North America to Europe.

The social impact is devastating. Entire communities suffer the loss of young people, parents, friends, and neighbors. Health and social services systems are overwhelmed responding to emergencies and treating addictions and their aftereffects. The streets of some iconic cities, such as Los Angeles, Philadelphia, and New York, display the stark image of people living a nightmare in broad daylight, hunched under bridges or on sidewalks. Behind every "zombie" is a human being whose life has been taken hostage by addiction. Many of them also face poverty and mental illness, creating a vicious cycle that is difficult to break.

The presence of fentanyl adulterated with xylazine further exacerbates the situation. It not only intensifies these unconscious positions, but also causes horrific injuries to the body (sores that can lead to amputations) and does not respond to naloxone in terms of respiratory depression. According to the DEA, approximately 66% of recent overdose deaths in the US involve this lethal combination of fentanyl and xylazine. It's a perfect storm of drugs that is taking lives at an alarming rate.

What can we learn from all this? First, these strange postures aren't at all "funny" at heart, but rather visible symptoms of a public health emergency. They are a wake-up call to action: with more education, more prevention, and more treatment. Second, empathy and information are our best weapons. Instead of simply viralizing morbid images, it's important to understand the science behind them and spread the word about how to help. Third, a comprehensive and multidisciplinary approach is needed to treat and eradicate these addictions and save the people trapped in them.

The fentanyl crisis challenges us as a society not to look the other way. It's easy to feel repulsed by the sight of someone in a "zombie pose," but the stakes are high. Every individual hunched over on the sidewalk is a life that could still be restored with the right help. Recognizing the humanity behind these postures is the first step. The second step is demanding and supporting smart, evidence-based policies to address the epidemic: better addiction treatment programs, access to mental health care, control of drug distribution, international cooperation to curb the production of illicit fentanyl, and so on.

Hopefully, in the future, these gruesome scenes will disappear from our streets and remain only as a reminder of a crisis that has been overcome. That would be the happiest final image we could imagine.

References

• Rubio, I. (2023, 28 de noviembre). “Estos son los zombies de la vida real”: qué efecto tienen el fentanilo y otras drogas en la postura corporal. Factchequeado.

• N+ (2024, 5 de diciembre). Crisis por Fentanilo: Los efectos que provoca la “droga zombie” en consumidores del mundo. N+ Internacional.

• Belchi, A. (2023, 18 de abril). Fentanilo, el opioide que mata a 200 personas cada día en Estados Unidos. Voz de América.

• Associated Press (2022, 28 de noviembre). Fentanyl’s scourge plainly visible on streets of Los Angeles. AP News.

• Colby, D. (2023, 8 de agosto). Estos son los mitos sobre el fentanilo (UC Davis Health). (Entrevista en UC Davis Health).