We all want ourselves, our loved ones, and communities to be safe and healthy. It’s normal to feel scared when you hear about fentanyl and the growing overdose crisis. Unfortunately, so much of the information on fentanyl promotes fear and criminalization instead of helping people. To address our collective safety and well-being—and save lives—information on fentanyl must be factual so people can make safer choices. Our responses to people who use drugs must be rooted in public health.
There is growing public acceptance of the fact that drug use is a public health issue, not a criminal one. Unfortunately, some elected officials and members of law enforcement continue to call for draconian criminal policies and have spread misinformation to drive up support for policies that hurt people instead of helping them.
Fentanyl is a synthetic opioid painkiller. It is currently legal to treat patients with severe pain, often after surgery, and is commonly used for pain management under the supervision of a doctor.
Medical fentanyl is made in a regulated laboratory with oversight and is packaged with accurate labeling. A doctor knows exactly what they are getting and can prescribe the dosage needed for the intended therapeutic effect. Many chronic pain and cancer patients safely use fentanyl for pain relief because it effectively reduces the effects of unrelenting, intolerable pain.
However, when people talk about fentanyl in relation to the overdose crisis, they are often referring to illicitly manufactured fentanyl (it was made in an underground laboratory) that has been mixed into the heroin and counterfeit pill supply or has replaced heroin altogether in some drug markets. Illicit fentanyl is made with no oversight, is not labeled, and people do not know what/how much they are getting, or it may be mixed in without them realizing it. Unfortunately, criminalizing fentanyl does not make it disappear from our communities. Instead, it creates perverse incentives for manufacturers to continue manufacturing illicit fentanyl in this way.
Criminalization creates illicit drug markets to meet drug demand- increasing demand for heroin and more heroin seizures from law enforcement is why manufacturers began to produce illicit fentanyl. Fentanyl has become an entrenched part of drug supplies now, and because there are parts of the country where heroin is no longer available, there is no reason for producers to stop making it. Illicit fentanyl is typically produced industrially in an underground lab and is not derived from the opium plant, making it significantly easier, faster, and cheaper to produce than heroin.
Tougher penalties create perverse incentives for manufacturers. Underground chemists have found new ways of evading enhanced penalties by modifying the structure of a substance to create something that is similar to fentanyl, yet chemically distinct. This has led to more potent forms of fentanyl that are more likely to cause overdose deaths. Further criminalization of fentanyl also drives people who use drugs away from health services and encourages them to engage in riskier drug-taking activity to avoid detection and prosecution.
Unfortunately, many myths exist about fentanyl that lead to policies that hurt people instead of helping them. Overdose is skyrocketing. It’s time to focus on the facts and endorse science-based public health strategies, such as overdose prevention centers, expanded access to Naloxone, and ensuring people are housed and fed, all of which have the power to save lives. Read on for more facts about fentanyl, as well as ways you can help people and communities dealing with this public health challenge.
You can reverse a fentanyl or other opioid overdose. And we need better access to these medications in communities.
Naloxone (also known by the brand name Narcan®) is an FDA-approved medication that works to reverse an opioid overdose, including fentanyl overdose, by restoring breath to unconscious overdose victims. Naloxone is not psychoactive, has no potential for misuse, and side effects are rare. Click here to read more about Naloxone.
There has been a political push to get naloxone in the hands of law enforcement and paramedics, but the first people on the scene of an overdose are often other people who use drugs, peers, or loved ones. This is why it’s important to prioritize community-based naloxone distribution, in addition to equipping professional first responders.
Unfortunately, very few states provide dedicated budget lines to support the cost of naloxone or staffing for community-based opioid overdose prevention programs, which means they are not able to serve nearly as many people as need naloxone. Virtually no jails or prisons provide naloxone upon release, even though risk of a fatal overdose is nearly 130% greater in the two weeks after release compared to the general population.
It is possible to overdose with fentanyl, heroin, and other opiate drugs whether someone is snorting, injecting, or taking them in pill form. The risk of overdose increases drastically if combined with alcohol and other “downers.” Here are some signs to look out for if you think someone has overdosed:
Here is what Dr. Ryan Marino, MD Medical Toxicologist, Addiction Medicine Specialist and Emergency Physician Assistant Professor at Case Western Reserve University School of Medicine has to say:
“It is not possible to overdose on fentanyl or fentanyl analogues through accidental skin contact or from close proximity alone. Fentanyl and fentanyl analogues do not readily cross the skin barrier and do not aerosolize well. The only way to overdose on these substances is from injecting, snorting, or otherwise ingesting them, or in the case of the fentanyl patch, from mixing with an absorbable solvent and applying very large quantities for very long durations of time.
“Misinformation not only hinders appropriate responses to people who use drugs and resuscitations of people experiencing true overdose, but also worsens the stigma faced by people with substance use disorders and has been used to increase criminalization of this already vulnerable group.”
Unfortunately, law enforcement and others have often spread misinformation about fentanyl to build support for increased policing and criminalization, instead of the supportive responses that help people be healthier and safer.
Fentanyl is destroyed by flames and deteriorates in heating processes. When smoking marijuana in flower form (i.e., via pipe, paper, lighting on fire and inhaling smoke), any hypothetical fentanyl contamination would be destroyed by the flame and the fentanyl would not be active. If a marijuana edible, like a gummy or brownie, contained fentanyl then the fentanyl would partially degrade in the heating and baking process, and would erode. Sensationalized stories about widespread fentanyl-contaminated marijuana are overblown. Again, these stories are often perpetuated by police and media—in fact, reports are often later debunked or corrected.
Marijuana is the most widely used illegal drug in the country. If this were a real phenomenon, we would see far more deaths across the country.
Now that you know the facts and the importance of a public health response to fentanyl, share this article on social media, email it to your friends, spread the world. And if you are not already a member of Drug Policy Alliance, join now.