Fentanyl Myths and Facts
How you communicate about fentanyl could be harmful than helpful
Myths are often created from a lack of information and can have a “grain of truth”, which can make them more believable. The misinformation coupled with fear can have a number of consequences.
Fentanyl is one of the most frequently used intraoperative analgesics across the world. Its popularity stems from its minimal cardiovascular effects, lack of increases in plasma histamine, rapid onset of action, relatively short half-life, and low cost resulting from its ease to synthesize and produce.
Not only does the public hysteria around fentanyl overdose jeopardize its clinical use, but is used to justify the continuation of failed drug prohibition efforts that further exasperate the overdose crisis.
MYTH: FENTANYL LACED CANNABIS
In the case of cannabis flower, smoking involves loading the material into a pipe or roll paper, lighting it on fire, and inhaling the smoke. Burning fentanyl with flame destroys it, so even if someone smoked cannabis contaminated with fentanyl, the fentanyl would not be active in the smoke.
In the case of vaping cannabis, fentanyl’s boiling point is 466°C, or about 871°F. The hottest temperature settings on cannabis vape pens are 210-220°C (or 410-428°F).
MYTH: YOU CAN OVERDOSE FROM TOUCHING FENTANYL (or something that has fentanyl on it)
Someone can not easily overdose by touching something that has fentanyl on it. However, you do need to make sure the opioid does not get into your mouth, nose, or eyes because then it can be dangerous.
Fentanyl cannot penetrate the skin on its own. It needs moisture. That’s why, in clinical care, patients are given fentanyl patches to aid in absorption and relieve pain.
The American College of Medical Toxicology recently issued a position paper concluding that, based on what’s been publicly released, none of the recent incidents involving first responders is consistent with opioid toxicity
Sarah Sottile, a Ph.D. in neuroscience and pharmacology alongside Chad Sabora, a former opioid user, intentionally touching a visible quantity of verifiably genuine fentanyl
MYTH: FENTANYL TEST STRIPS DON’T WORK
Fentanyl test strips are one tool to have in a harm reduction toolbox, and using them is one way to get a person thinking about safer drug use. However, not all strips are the same, and user error and false positives can occur with the test strips.
Known false positive reactions:
BTNX Rapid Response strips - Diphenhydramine (Benadryl), Improper dilutions with Substituted Amphetamines (most notably MDMA and Methamphetamine), and with improper dilutions containing too much Ketamine.
DanceSafe WHPM strips - Diphenhydramine (Benadryl)
People must test all of the drugs they are using to be sure that fentanyl is not present in another part of the batch. Ingesting a liquid solution like a nasal spray is a recommended method for being able to dilute all of the substance for testing and still use it.
Fentanyl test strips can only test for the presence of fentanyl and some analogs and can vary by brand and lot-to-lot.
BTNX Rapid Response strips have revealed lot-to-lot variability that negatively impacts their drug checking performance. Some lots are up to ten times less sensitive to fentanyl and its analogs, which may result in false negatives when using recommended drug checking dilutions. Others are much more sensitive to false positives.
Lesser prevalent analogs like Cyclopropyl Fentanyl have been found to cause fatal overdose (the latest publicly recorded case of Cyclopropyl Fentanyl adulteration was tested Oct 25, 2018 on drugsdata.org), but have not been tested to be detected by the BTNX Rapid Response and DanceSafe WHPM fentanyl strips. Analogs such as Carfentanil and Furanyl Fentanyl can be detected, but not at or below 1000ng/ml with the DanceSafe WHPM strips. None will test for the presence of potent opioids like Isotonitazene and other non-fentanyl related analogs.
MYTH: FENTANYL (or an analog) IS RESISTANT TO NALOXONE
Fentanyl itself is not resistant to naloxone, but fentanyl can cause other unique complications, which can lead to death
Fentanyl will respond to naloxone if someone is overdosing, because it is an opioid.
High doses of the synthetic opioid fentanyl cause rapid and sustained vocal cord closure (VCC) leading to airway obstruction that prevents overdose victims from breathing. This airway effect is not caused by morphine-derived opiates (e.g. heroin), is distinct from respiratory depression, resistant to naloxone, and can be lethal.
Fentanyl can induce chest wall rigidity, or wooden chest syndrome (WCS). Fentanyl induced skeletal muscle rigidity can cause ventilator failure.
MYTH: KLOXXADO OR HIGH-DOSED NALOXONE IS IDEAL FOR RESPONDING TO OVERDOSE
Studies have shown that there has been an increase in attempted reversals using two or more doses between 2013-2016. First responders and law enforcement stacking doses leads to poor data.
According to the manufacturer, less than half of all overdoses actually require 2 or more doses. (Someone can begin overdosing again after the first dose(s) of naloxone wears off.)
Giving a person more naloxone than needed can put them into withdrawal and make them less likely to use naloxone or call for help if a person is overdosing.
Side effects of overdose reversal include precipitated withdrawal and confusion. Are you waking someone up in a safe environment
MYTH: “FENTANYL IS IN EVERYTHING”
According to the International Journal of Drug Policy, many people who inject drugs are unknowingly using fentanyl, which may increase their risk for overdose and potentially their tolerance to fentanyl if it is used over time.
Current data and trends point to the threat of fentanyl being primarily contained to illicit opioids, pharmaceutical drugs (like oxycodone or benzodiazapines), methampetamine, and intermittently, cocaine, in the Americas.
The majority of reports of fentanyl being found in substances such as cannabis, MDMA, and Ketamine seem to have very few documented cases, as long ago as 2018. The root source of many of these claims trace back to DEA and/or law enforcement misinformation/stigma, or entities seeking profit from the perceived crisis.
Fentanyl Misinformation Resource List
Resources
Can someone overdose by touching something with fentanyl on it?
Are people really falling ill from touching fentanyl? In most cases, scientists say no
List of fentanyl analogues (not a complete list)
Wooden Chest Syndrome: A Case Report of Fentanyl-Induced Chest Wall Rigidity
Hikma announces US FDA approval of KLOXXADO TM (naloxone hydrochloride) nasal spray 8mg
More Than 80% of People Who Inject Drugs Test Positive for Fentanyl—But Only 18% Intend to Take It
Fentanyl Facts and Fiction: A Safety Guide for First Responders