Fentanyl—the synthetic opioid that was responsible for up to 40 percent of the deaths by drug overdose in 2017—is routinely described as 50 times stronger than heroin. Government health officials and law enforcement have warned that it is so deadly that even touching it is enough to cause an overdose.
Over the past several months there have been a number of news stories which appear to back up the warning. In Ohio last month, for example, corrections officials announced 28 people (23 guards, four nurses and one inmate) at the Ross Correctional Institution in Chillicothe had fallen ill after exposure to a substance believed to be fentanyl. Pennsylvania corrections authorities were investigating similar incidents.
Fentanyl is far stronger than heroin or prescription opioids—such as Vicodin, OxyContin, and Percocet, which so often lead to heroin and fentanyl abuse or a stint at a rehab for opiate addiction—but is it really so deadly that a contact high can kill you?
If you remember earlier exaggerations of the toxicity and addictiveness of other drugs such as crack cocaine, or the ease of transmission for diseases such as AIDS and HIV, you know that even well-meaning people can get it wrong and that parties with an interest in fear-mongering can deliberately mislead.
(For example, during the “War of the Currents,” Thomas Edison tried to discourage people from adopting AC electricity over his own far less efficient DC electricity by using AC to electrocute animals, as if to say, “See how dangerous AC is?”)
As bad as fentanyl is, it also has become a scapegoat. Whenever there is a rash of drug overdoses, fentanyl is suspected. In just July and August:
- Dozens of users of the synthetic marijuana drug K2 overdosed in a New Haven park. Authorities said it might have been laced with fentanyl since administering the opioid antagonist Narcan (which most authorities say has no effect on K2 overdoses) seemed to reverse the ODs. (Later analysis found no evidence of fentanyl.)
- Prisons in Ohio and Pennsylvania (see above) were on lock-down in late August for drug overdoses that may have affected non-users, too, perhaps by skin contact. (One prison attributed it to exposure to a fine white powder later determined to be heroin mixed with fentanyl; the cause of the other overdoses is still unknown.)
- The U.S. government released a seven-minute video and guidelines detailing safety precautions for law enforcement on the proper handling of fentanyl encountered in the course of their jobs, involving gloves, protective eyewear, and respiratory masks.
Fentanyl is deadly, especially when you don’t know that you are taking it.
Musicians Prince and Tom Petty likely didn’t know what they were taking. Drug dealers often substitute it for other, less powerful opioids, because it is cheaper and because it is easier to smuggle a significant quantity, even through the US mail. However, its potency also makes it difficult for drug dealers to measure properly, so a fatal overdose is far more likely.
There have been reports of K-9 unit dogs that have overdosed just from stepping on fentanyl as well as getting it on their noses and mouths, maybe in their eyes. Special canine first aid kits have been created; Narcan works with dogs, too.
Adding to the danger: police officers haven’t been trained in how to tell if a dog is overdosing. Each dog reacts differently to fentanyl, depending on its personality, temperament, and metabolism. Some become more excited, some become lethargic.
And because they have 20 times the tolerance for opioids as humans, if they do have a reaction, there’s a lot of fentanyl around.
Even so, there’s little evidence that fentanyl is quite that deadly. Junkies and addicts don’t get high by touching fentanyl or heroin because skin is not a good conduit for drugs to enter the bloodstream. (unless you apply an alcohol-based hand sanitizer that can facilitate skin absorption; it took a lot of work to create a transdermal patch for fentanyl that worked.)
Some people in the field dispute this and suggest researchers are using medical-grade fentanyl, which is harder to absorb than the street-quality fentanyl encountered by law enforcement.
Also arguing against the toxicity of touching fentanyl is the dearth of evidence. Fentanyl is used by medical doctors and veterinarians (it’s one of the World Health Organization’s essential medicines), but as a group, they haven’t reported a slew of accidental overdoses. Large numbers of OD deaths of drug dealers while preparing fentanyl for sale or distribution haven’t manifested either.
That doesn’t make fentanyl safe, just safer than its reputation.
The risk to law enforcement, human and canine, is not so much with getting fentanyl on their hands but rather where we put our hands afterward—the nose, mouth, and eyes—as well as accidentally breathing in or swallowing loose fentanyl specks in the air.
Researchers have determined that we touch our faces every two to five minutes, which gives bacteria and germs access to our eyes, nose, and mouth, all gateways to our insides where we are most vulnerable. These are also places where fentanyl can enter our bloodstream and make us high or potentially overdose.
According to Jeremy Faust, an instructor at Harvard Medical School and an emergency room physician, he has never seen or heard of an OD by skin contact alone with documented evidence such a blood or urine test.
In the absence of evidence, exaggerating the lethality of fentanyl will make first responders overly cautious, less likely or less willing to come into contact with people overdosing.
Whatever they said earlier, the Centers for Disease Control and Prevention, The American College of Medical Toxicology and the American Academy of Clinical Toxicology all now agree that for emergency first responders, the risk of overdosing merely from attending to someone who has taken fentanyl is “extremely low.”
The Drug Enforcement Agency and the White House also agree now that “brief occupational skin exposures to fentanyl and its other potent opioid analogs pose no clinical threat to anyone.”
Not that there’s no risk, but it lies in breathing in fentanyl, accidentally getting it in your mouth–not touching it.
In July 2018, a PhD in neuroscience and pharmacology shot video of a former opioid user touching a large quantity of verified fentanyl to show it had no immediate ill effects.
But while there’s no proof of the opposite, scare stories carry weight with the general public, even among first responders. The so-called “nocebo” effect can make people feel ill without cause like the placebo effect makes you feel good without cause.
In the early days of AIDS, people worried you could catch the sexually transmitted disease from patients by shaking their hands. The media, always looking for a sensational story, ran with it.
Fentanyl is deadly for its users—by the number of overdoses, half-again as deadly as prescription opioids and twice as deadly as heroin—but with reasonable precautions, it should be safe for law enforcement and EMS to do their jobs without unreasonable fear.
In related news, the Associated Press reports on the newest tool in the fight against opioid overdoses: an inexpensive test strip that can help heroin users detect fentanyl.
Stephen Bitsoli, a Michigan-based freelancer, writes about addiction, politics and related matters for several blogs. He welcomes readers’ comments.