Fentanyl shuts down the brain’s alertness and breathing centers at the same time. The brain drifts toward sleep, briefly wakes, then slips again. That cycle causes the head to drop and pop back up, what we call the nod. It’s not sleep. It’s central nervous system and respiratory suppression. The danger: nodding can quietly turn into slowed breathing, low oxygen, unconsciousness, and overdose, especially when doses stack or tolerance changes. Bottom line: If you see the nod, the brain is already

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