Fear, Loathing, and Fentanyl Misinformation
Misleading fentanyl narratives are pervasive and cause very real harm
Nov 4, 2022, by Ryan Marino, MD – Medpage Today
“‘Think about this,’ (East Liverpool Ohio Chief of Police) Lane told ‘Inside Edition.’ ‘Nobody sees (fentanyl) on his shirt. He leaves and goes home, takes off that shirt, throws it in the wash. His mom, his wife, his girlfriend goes in the laundry, touches the shirt — boom. They drop. He goes home to his kid. ‘Daddy! Daddy!’ They hug him — Boom. They drop. His dog sniffs his shirt, it kills his dog. This could never end.'” – Washington Post
“She said her body went numb within 10 minutes after picking up the dollar. She said she could barely talk or breathe before passing out…(they) believe the dollar she picked up was laced with fentanyl.” – WSMV4
“Deputy Faiivae tested three bags found in a suspect’s car using a portable narcotics analyzer in the back of the patrol vehicle…the first two bags tested presumptive positive for fentanyl…when he stood up ‘he began to feel lightheaded and fell down’…he was administered four doses of Narcan…Deputy Faiivae’s field training officer recounted that Deputy Faiivae ‘was OD’ing the whole way to the hospital.'” – New York Times
The looming specter of fentanyl in news reports has become inescapable. But more often what is shared is misinformation rather than accurate facts.
These aren’t just isolated cases of bad reporting. It’s a societal problem. On a recent episode of the primetime CBS show, NCIS: Hawai’i, a sailor with abrasions on his feet steps in a tide pool containing a bag of fentanyl and is shown dying from a fentanyl overdose in under a minute.
I have studied fentanyl misinformation since 2017. While misinformation is problematic for obvious reasons, misinformation about drugs, like fentanyl, is harmful. The U.S. continues to break records in drug overdose death numbers year after year, from thousands of deaths per year in the early 2000s to a now consistent 100,000 plus American lives lost each year in preventable deaths. The biggest driver of these deaths is fentanyl.
Nowadays fentanyl is a boogeyman, something people fear can injure them at any time. But fentanyl is neither good nor bad, it is literally just a molecule. It is simultaneously an invaluable medical therapeutic and the primary cause of record-breaking overdose deaths. Notably, fentanyl is not a new drug; it has been FDA-approved since the 1960s and in street drugs since at least the 1970s, and it is well-studied and well-understood. The problem with the publicized information is that the people who speak the most and the loudest — and dominate reporting — appear to neither have studied nor understand fentanyl.
The “fentanyl exposure” myth has dominated headlines more than anything else: people claiming to have experienced “overdoses” from touching unknown powders that they believe to be fentanyl or from simply being in close proximity to some substance they believe to be fentanyl — even when it turns out not to be fentanyl. This was the case with the woman who picked up the dollar bill (she tested negative for fentanyl) and the Sheriff’s Deputy who collapsed after handling an open bag of powder.
We know that fentanyl does not pose a risk through accidental skin contact or proximity. It does not readily absorb through the skin, and even under the most intentional conditions cannot absorb in any rapid time frame. It also does not aerosolize or enter into the air to be inhaled or otherwise ingested. The only way fentanyl can cause overdoses is if it is injected, snorted, or otherwise ingested. Even the CDC, no stranger to communications issues, has had to recently address this myth in light of law enforcement continuing to perpetuate a dangerous and impossible narrative.
Yet the misleading reports continue — and not without consequences. They have inspired a lucrative market of scammy products from “fentanyl-proof” gloves to expensive HAZMAT responses, all of which are nonsensical and unnecessary. But this myth has far worse harms than scamming people and wasting taxpayer dollars. This myth — a scientific impossibility — has led to a reduced or delayed response to real fentanyl overdoses where time is critical and to criminal charges and incarceration for the imaginary crime of “fentanyl exposure.” These are very real harms, and this myth is the justification behind further harming a vulnerable population that is already suffering and dying at astronomical rates.
More recently, a new fentanyl myth has arisen regarding the idea of “rainbow fentanyl,” which the U.S. DEA described as “brightly-colored fentanyl” being made to “target young Americans.” The DEA did not provide any evidence to support this, and has declined to substantiate their own claim even to major media sources. It is worth noting that before the DEA director made this announcement, “rainbow fentanyl” was not even a searchable term. However, less than 90 days after this announcement there were nearly 1,400 news articles about “rainbow fentanyl” and a proposal from Congress to give the DEA almost $300 million dollars “to fight rainbow fentanyl,” something that nobody in the world of substance use and addiction had ever heard of. This is also not the only time in recent memory that the DEA has denied objective scientific facts to mischaracterize illicit fentanyl products to expand their authority.
The “rainbow fentanyl” in the DEA press release was actually illicit pills made to look like pharmaceutical oxycodone tablets, which come with added color even when made by legitimate pharmaceutical companies. Even DEA press releases going back years show nearly identical fake pills of multiple colors containing fentanyl without such concerns. Yet, this captured public attention in proximity to Halloween and became the most recent iteration of the very extensively debunked “Halloween sadism” myth. For obvious reasons, children are not ideal customers for drug dealers; yet, completely illogical reports that expensive fentanyl pills would be given out for free to unsuspecting trick-or-treaters continued.
Our society has long had strong — and strongly divided — opinions on substance use but we should all agree on objective facts. Not only are fentanyl myths pervasive, but they also cause very real harms and distract us from having more meaningful conversations, like how to truly prevent pediatric overdoses and which evidence-based public health measures can address our drug overdose problem. Clinicians and researchers like me are ignored for sensationalist narratives, while Americans continue to die entirely preventable deaths. While we assume that our leaders, and the people speaking most vocally about this topic, would not do so without having credible knowledge, profiteers, politicians, and others have been capitalizing on the moral panic around fentanyl without addressing problems meaningfully or even realistically. With record drug overdoses showing no sign of slowing, it is time to listen to experts and listen to the science instead.
Ryan Marino, MD, is a medical toxicologist, addiction medicine specialist, emergency physician, and assistant professor at Case Western Reserve University School of Medicine.