On the street they're called "green monsters" and they're responsible for hundreds of deaths across the country recently, including four in Newfoundland and Labrador so far this year.
In June, outreach worker Tree Walsh said she had reason to believe that drug dealers were packaging fentanyl — a drug 100 times stronger than morphine — and making it look like less-potent oxycodone pills to sell to intravenous drug users in this province.
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A CBC request to the Department of Health and Community Services confirmed the talk on the street.
According to the department, this year there have been seven deaths in this province involving opioids. Fentanyl was identified as the cause or contributing factor in four of those deaths.
"I think it signals a crisis," said Walsh. "We know that it is happening right across the country."
Walsh is calling for potentially life-saving changes when it comes to training front line workers.
She said health workers should all be trained in administering naloxone, a drug that reverses the effects of narcotic drugs and can stop an overdose if administered in time.
In an interview with CBC's St. John's Morning Show, Health Minister Steve Kent said he and his provincial counterparts are lobbying Health Canada to lift the prescription requirement for naloxone.
Meanwhile, Walsh is calling on the provincial government to react to these deaths as seriously as it did a decade ago when OxyContin exploded on the scene.
Following a series of overdoses at the time, government created the OxyContin task force.
Kent said the government is taking the matter seriously.
"I can tell you first and foremost, I'm extremely concerned about fentanyl abuse," he said.
Highlighting his concern are the recent statistics.
Kent said that from 1997 to 2013, fentanyl was linked to just five deaths in this province. This year it's taken less than eight months to claim four lives.
"This is an issue that we have to work together to solve," said Kent.
"I just want to make sure that immediately people start to truly understand the dangers associated with fentanyl … they're at a real high risk for overdose and that needs to be of concern to all of us."