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Fentanyl is also used as a recreational drug, and this use has led to thousands of overdose deaths each year in recent years. Deaths have also resulted from improper medical use. Fentanyl has a relatively wide therapeutic index (270) which makes it a very safe surgical anesthetic when monitored carefully; however, its extreme potency requires careful measurements of highly diluted fentanyl in solution; attempting to accurately measure a dose of pure fentanyl powder is impractical without advanced scientific equipment as an effective dose and a lethal dose of fentanyl powder placed next to each other would be difficult or impossible to differentiate with the naked eye

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