Fear and Facts About Fentanyl

Although prescription opioid-involved overdoses were the major driver of the epidemic in the late 1990s and early 2000s, overdose deaths are currently being driven by illicitly manufactured fentanyl and its potent fentanyl analogues, which have contaminated the unregulated drug supply throughout the United States. Fentanyl is up to 50 times more potent than heroin and has been found in cocaine, counterfeit pills, heroin, methamphetamine, and crack cocaine.¹

Anyone who uses unregulated substances is at risk of experiencing an overdose, even those who do not identify as having an opioid use disorder (OUD), such as people who occasionally use stimulants recreationally. Last year alone, the DEA seized more than 20 million counterfeit pills (e.g., alprazolam, amphetamine/dextroamphetamine, oxycodone) that look just like the real thing, even to a pharmacist.

In addition, approximately 40% of the counterfeit tablets confiscated by the DEA contained enough fentanyl to be deadly to a person who is opioid naïve.² It is unfortunately common for adolescents and young adults to share stimulant medications used to treat attention-deficit hyperactivity disorder (ADHD). Those accepting tablets from someone else are putting their lives at risk, as they cannot verify that they are authentic and not contaminated with fentanyl.

Fear of fentanyl is warranted and people should take protective measures, including only taking prescription products furnished to them by a provider and licensed pharmacy, never using any unregulated substances alone, and always having naloxone available to reverse the effects of an opioid-involved breathing emergency. However, fear from misinformation, including fentanyl in Halloween candy or that touching fentanyl leads to overdose, does more harm than good and may deter someone from helping a person who is experiencing a breathing emergency.

While it is true that counterfeit tablets may be brightly colored, they are also expensive, and other adult party drugs have been colorful or even shaped like cartoon characters for decades, such as ecstasy. If some psychopath was intentionally planning to harm children on Halloween with laced candy, fentanyl would not necessarily have been the weapon of choice.

The unfounded panic is reminiscent of the 1970s and 80s myth of strangers handing out cyanide poisoned candy or placing razorblades in apples.³ Of course, we all want to keep our children safe and it is prudent to take reasonable measures to protect them.

Although fentanyl is potent and often deadly, it is not passively absorbed into the bloodstream. People who use drugs cannot rub fentanyl powder onto their skin to get high, nor can they sit in a room and passively inhale air exposed to fentanyl.

People must smoke, snort, swallow, or inject street drugs recreationally. According to the American College of Medical Toxicology, it would take 200 minutes of fentanyl inhalation at the highest airborne concentrations to absorb a therapeutic dose.⁴

Certainly, industrial workers who routinely manufacture pharmaceutical fentanyl should not do so unprotected, but there is no reason to think fentanyl would be aerosolized under usual and customary circumstances, including during an overdose rescue. It is important to remember that opioids cause respiratory depression in an overdose; the breathing rate slows down, which over time leads to a loss of consciousness.

First responders who have reported negative effects from passive exposure to fentanyl often exhibit symptoms of a panic attack, rapid heart rate, sweating, and enlarged pupils, which are the opposite of opioid overdose symptoms.⁵

The best way to help protect our communities from the impact of the overdose epidemic is to spread accurate information about opioids and recreational drugs, dispel myths, support recovery housing, provide low barrier naloxone to anyone willing to carry it, and expand access to evidence-based treatments, such as methadone or buprenorphine, for managing opioid addiction.

About the Author

Anita N. Jacobson, PharmD, clinical professor, URI College of Pharmacy.

References

1. Facts about fentanyl. DEA. Accessed October 28, 2022. https://www.dea.gov/resources/facts-about-fentanyl
2. One pill can kill initiative. DEA. Accessed October 28, 2022. https://www.dea.gov/sites/default/files/2022-03/20220208-DEA_OPCK%20Overview%20and%20Key%20Results.pdf
3. Rainbow fentanyl passed out on Halloween? Why experts say that’s absolutely ludicrous. USA Today. Accessed October 28, 2002. https://www.usatoday.com/story/news/nation/2022/10/26/rainbow-fentanyl-halloween-candy/10554817002/
4. Moss MJ, Warrick BJ, Nelson LS, et al. ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders. J Med Toxicol. 2017;13(4):347-351. doi:10.1007/s13181-017-0628-2
5. Herman PA, Brenner DS, Dandorf S, Kemp S, Kroll B, Trebach J, Hsieh YH, Stolbach AI. Media Reports of Unintentional Opioid Exposure of Public Safety First Responders in North America. J Med Toxicol. 2020 Apr;16(2):112-115. doi: 10.1007/s13181-020-00762-y. Epub 2020 Feb 24. PMID: 32096007; PMCID: PMC7099103.