Perpetuating A Fentanyl Hysteria

When belief is more important than facts

Illegal Drugs

Fentanyl, a synthetic opioid, is a major component of the current overdose epidemic in the US. Depending on the formulation it can be from 50-100 times stronger than morphine. If ingested it can quickly suppress respiratory function and, without intervention via Narcan or other rapid treatment, rapidly lead to death. The key word in that sentence is ingested (i.e. entering the body). And the reason that I am calling that out is there is a secondary epidemic related to fentanyl–a hysteria that it is so deadly that simply touching it is enough to cause an overdose and death. Chances are, if you have heard about this danger, the source of this misinformation is most likely from some form of law enforcement, aided and abetted by various media outlets.

For at least the past half-decade, police and sheriff’s offices have been the primary source of misinformation about fentanyl. Search on the topic and you’ll find stories of officers and deputies who came in contact with mysterious white substances and immediately fell to the ground. The problem with these accounts is that testing has proven time and time again that simply dermal contact with or even inhaling trace amounts of fentanyl cannot cause an OD:

“We have a lot of scientific evidence and a good knowledge of chemical laws and the way that these drugs work that says this is impossible,” Ryan Marino, medical director for toxicology and addiction at University Hospitals in Cleveland, said in an NBC News interview.

“You can’t just touch fentanyl and overdose,” Marino said. “It doesn’t just get into the air and make people overdose.”

https://www.ems1.com/opioids/articles/toxicologist-you-cant-just-touch-fentanyl-and-overdose-qCP7P9puLCouxYbr/

Additionally, when these cases have been reviewed, the symptoms these people had–including shortness of breath, hot flashes, lightheadedness, and nausea–are not symptoms of acute fentanyl poisoning. Those are, however, signs of panic, anxiety, or other acute somatic crisis. These are real medical issues, but are not overdoses and most likely would not result in death.

The reason for the panic attacks? Law enforcement training has for years stressed, and in many places continues to stress, how deadly fentanyl exposure is and how you can OD from simply touching or breathing in (versus snorting) airborne fentanyl. If the idea that idea takes hold and you encounter the substance, then the body is primed to react in certain ways (especially if you are predisposed to anxiety or other disorders).[1]

This misinformation campaign is something that public health officials and law enforcement reformers have been fighting for years. Unfortunately, that fight is not helped by irresponsible media outlets continuing to spread this hysteria. This leads us to Fox New’s recent national amplification of this bullshit. Yesterday Fox and Friends interviewed a woman who claims to have OD’s on fentanyl by picking up a dollar bill that was laced with it:

A Kentucky mother who was hospitalized after picking up a dollar spoke out Thursday as officials warn against the dangers of fentanyl-laced bills amid a surge of overdose deaths. …

“I felt this feeling over my body that it really started at my shoulders and started going down,” Renee told co-host Carley Shimkus. “And it really became not necessarily hard to breathe because I was gasping for air, but hard to breathe because it was almost taking over my body, as in relaxing me so much I didn’t necessarily care to breathe.” 

https://www.foxnews.com/media/kentucky-mom-believes-poisoned-fentanyl-laced-dollar-bill-taking-body

Again, what she describes are the symptoms of a somatic incident. The short story does note that:

Despite the couple’s suspicions, Nashville police said the bill was not laced with fentanyl, shortly before destroying the money. […]

Renee also said the doctors told her they are unable to test for synthetic opioids in order to confirm or rule out her suspicions about the potentially-laced bill.  

“My hospital records also show that I was not tested for fentanyl,” Renee said. “They did a six or ten-panel drug screen which came back negative.”

However, nowhere in the article does it state that it is physically impossible to OD on fentanyl (even if it had been on the bill) through touch. Likewise, there is no discussion about the psychosomatic issues around fentanyl misinformation. They also don’t mention that the woman’s husband was a former law enforcement professional.[1] Further Fox decided to air the segment even though her account had previously been called into question by multiple media and medical sources.

This may seem like a little issue, but it has major ramifications. Sharp-eyed readers might have seen the broader context of this story: “officials warn against the dangers of fentanyl-laced bills.” It turns out that officers had found two bills that tested positive for methamphetamine and fentanyl. This would be a dangerous issue if you decided to eat the bills (as you know most normal humans do) but otherwise wouldn’t cause harm. This is again an example of how this disinformation spreads.

There is a second problem with this: drug assault and homicide laws. As part of the current war on opioids, many states have passed laws that enable prosecutors to charge people distributing drugs for any harm or death caused by those drugs. And if an officer “OD’s” from handling the fentanyl, then that is grounds for additional charging. And that has deep implications for both our criminal legal system and our ongoing mass incarceration problem.

Fentanyl is a BIG issue in the US. We don’t need law enforcement and irresponsible media outlets making it worse. Unfortunately, both institutes often benefit from maintaining a constant state of low-level fear in our population.


Note: Jay L Gischer notes below that reducing somatic issues to just being “in the mind” or worse “made up” is a mistake. I totally agree with that, especially as I have a mild anxiety disorder. That isn’t my intent here. There is also enough social science on the topic of contagions to suggest that triggering ideas can be as contagious as biologically transmissible diseases. And I think it’s worth noting that due to a variety of factors some folks are more susceptible to an idea triggering some form of somatic response.


[1] – To this point about the pre-cognitive loading of danger and policing, similar rhetoric is found in training around traffic stops and assuming everyone is armed. Traffic stops are taught to be the most dangerous part of a police officer’s job (and they historically were usually because of ongoing traffic, not attacks on officers). If you are an individual with an underlying anxiety condition, it’s not hard to see how this can create problems in the way you carry out your work in these circumstances (including the role of cognitive biases in the processing of information).

[2] – That detail was previously reported in a New York Post article that helped amplify this initial story: “Justin, who reportedly worked in law enforcement for many years, said he believes that the dollar Parsons picked up was laced with fentanyl, which caused her to suffer an adverse reaction.”

FILED UNDER: Health, Law and the Courts, Policing, Science & Technology, , , , , ,
Matt Bernius
About Matt Bernius
Matt Bernius is a design researcher working to create more equitable government systems and experiences. He's currently a Principal User Researcher on Code for America's "GetCalFresh" program, helping people apply for SNAP food benefits in California. Prior to joining CfA, he worked at Measures for Justice and at Effective, a UX agency. Matt has an MA from the University of Chicago.

Comments

  1. Jay L Gischer says:

    I’ve had a lot of contact with people with somatic symptoms, somatic illness. It is real. It affects them in a real way. A whole lot of their denial has to do with the dismissive “It’s all in your head” sort of approach.

    I do find it a bit surprising that someone with no history of anxiety disorder would get a panic attack or display somatic symptoms. However, we would not necessarily be privy to that history of anxiety disorder, so there’s that…

    Don’t take me as disputing the thesis – it seems sound. I trust that touching fentanyl or inhaling a bit is probably not going to kill someone. I just want to massage the language a bit.

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  2. Matt Bernius says:

    @Jay L Gischer:
    Oh, I think somatic illness is completely real. I’m sorry if the article reads that way and I’ll see about correcting that.

    The issue, to your point, is that said anxiety attacks are not caused by the chemical properties of fentanyl and are not in any way consistent with an actual fentanyl overdose.

  3. Kathy says:

    It’s getting so I’m beginning to suspect people love a panic.

    The skin evolved to be a barrier between the body and environment*. It began with the evolution of cell membranes when unicellular life first evolved, going on 4.5 billion years.

    It’s a pretty good barrier, and few things can get through it. Fewer still get through it and spread over the body. Speaking of drugs, cocaine can get through the skin. We even do it on purpose. Topical anesthetics contain forms of cocaine, for example (well, related compounds at any rate). But you don’t get high from a topical anesthetic.

    Some forms of chemical weapons can be absorbed by the skin, and these can cause damage and even death. Nerve agents are an example. But think of the concentrations required for that.

    *It can even be argued that evolution has consisted of getting salt water adapted lifeforms (cells) to colonize land and fresh water bodies.

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  4. Just Another Ex-Republican says:

    Fear sells, and yellow journalism is worse than ever. No clue how to rein it in without running smack into the First Amendment. Hopefully the pendulum will swing back the other way at some point but the Internet and cable have supersized hysterics, misinformation and propaganda much more than the truth so far.

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  5. Matt Bernius says:

    @Kathy:

    But think of the concentrations required for that.

    To that point, you can theoretically OD on aerosolized AIRBORNE fentanyl, but the amount necessary for that to happen is huge (edit: and the length of exposure) and all but impossible under most field conditions (edit:except perhaps lab raids).

  6. MarkedMan says:

    It doesn’t just get into the air and make people overdose.

    I think some of the reason this rumor started is because it is technically true, meaning that aerosolized it is a very, very dangerous thing indeed, but that it can’t become aerosolized just by, say, having it puff up in the air. But yes, the threat detection people are very concerned about state actors that have the technology to aerosolize it (again, not trivial!), and no doubt various police officials have been involved in some of these discussions and tests. I know for a fact that the NYPD has been briefed. And, FWIW, the effects would be pretty close to what the rumors say it is. It is easy to see how it could have morphed into the rumor.

  7. Mu Yixiao says:

    Typo

    many states have passed laws that enable prosecutors to change people distributing drugs

    [Matt: TY for that, I’m a bit surprised that was the only one folks have reported so far.]

  8. MarkedMan says:

    @Matt Bernius:

    but the amount necessary for that to happen is huge and all but impossible under any field conditions.

    Do you have a source for that? Or are you perhaps confusing “aerosolized” and “airborne”? Because I know for a fact that it is a very real concern to certain agencies responsible for public safety, serious people doing very serious research and planning.

    Now, I haven’t seen any data, and I know better than to google it. But I do know they are actively concerned about it, and seem more concerned than other better known substances (which they are also quite concerned about). This stuff isn’t my main work by far, but I’ve been around it for three years now and it freaks me the hell out.

  9. I was just talking to my wife about this yesterday. This story fits long-term patterns on how we talk about drugs, whether it was scares linked to opium and the Chinese in the late 1800s, cocaine and Blacks in the 1920s, Mexicans and marijuana in 1930s, or more recently things like bath salts, we seem to crave the need to make these issues into massive threats to the point of national panics to justify the war paradigm as a means of fighting drugs.

    To be clear, I am not discounting the threat posed by fentanyl, but it would be nice if we could have some sense of proportion.

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  10. Matt Bernius says:

    @MarkedMan:
    Great catch, that should have been airborne and not aerosolized. As far as the source, this is the most condensed analysis I found (it addresses both points):

    Inhalation exposure risk for fentanyl and fentanyl analogs

    Inhalation is an exposure route of concern if drug particles are suspended in the air. Fentanyl has potentially high bioavailability (12–100%) by inhalation [14,15]. It is highly suspected that weaponized aerosolized carfentanil and remifentanil were used to subdue hostage takers of a Moscow theater in 2002. One hundred and twenty-five died as a result of this weaponized aerosolized exposure [16]. Although an optimized airborne dispersal device is unlikely to be encountered in a local event, we considered such a scenario for respiratory protection.

    Industrial producers of fentanyl use time-weighted average occupational exposure limits (OEL-TWA) for alfentanil (1 mcg/m3), fentanyl (0.1 mcg/m3), and sufentanil (0.032 mcg/m3) to limit exposure [17]. At the highest airborne concentration encountered by workers, an unprotected individual would require nearly 200 min of exposure to reach a dose of 100 mcg of fentanyl. The vapor pressure of fentanyl is very low (4.6 × 1 0−6 Pa), suggesting that evaporation of standing product into a gaseous phase is not a practical concern [18].

    https://www.tandfonline.com/doi/full/10.1080/15563650.2017.1373782

    So if aerosolized in bomb form and deployed in a closed environment, there would be issues. That’s fundamentally different than most law enforcement exposures outside of manufacturing facilities.

  11. Jay L Gischer says:

    @Jay L Gischer: I mean, I kinda do think people like a good panic, like @Kathy says. The panic carries a message, usually. This is the stuff of folklore.

    The folklore around this has the message of “this stuff is dangerous”. Which it is. Fentanyl is very dangerous. Just not as dangerous as the exaggerated stories of it make it. This is well within a long tradition of tall tales, and exaggeration for impact.

    Everyone does that. Maybe everyone always has done that. I have a reaction to it that is unusual, just like my reaction to the word “hysteria” in Matt’s title. My reaction is something in the nature of “Don’t fill my psyche with lies or half-truths”. Of course, some slip in anyway.

    The issue of course, is when the exaggeration for impact gets taken as grounded truth. Which happens a lot these days.

  12. Kathy says:

    @Matt Bernius:

    And it’s still inhaled, not absorbed through the skin.

    Maybe an N95 mask would protect against that.

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  13. Matt Bernius says:

    @Jay L Gischer:
    I wondered if it was the use of “hysteria” in the headline. I went back and forth on that. Using something like mass psychogenic illness wasn’t exactly pithy. That’s the challenge of headlines.

    @Steven L. Taylor:
    100% to this point. Thanks for calling that out.

  14. wr says:

    @Steven L. Taylor: “This story fits long-term patterns on how we talk about drugs, whether it was scares linked to optimum and the Chinese in the late 1800s, cocaine and Blacks in the 1920s, Mexicans and marijuana in 1930s, or more recently things like bath salts, we seem to crave the need to make these issues into massive threats to the point of national panics to justify the war paradigm as a means of fighting drugs.”

    It’s kind of the way Republicans talk about “woke” issues and has about the same relationship to the truth. For instance, yes, somewhere someone said “defund the police,” now Fox (and several commenters around here) insist that every Democrat has been saying that all time time and this is why Dems are doomed to lose, so we must throw AOC off a bridge and throw our support behind the Josh Gottheimers of the world, even as he vows to fight any tax increases on the rich.

    How’s that for hijacking a thread? (Sorry, Matt…)

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  15. Michael Reynolds says:

    @wr:

    now Fox (and several commenters around here) insist that every Democrat has been saying that all time time

    Allow me to explain reality. Here are five statements. See if you can guess which would get news coverage and come to define the person writing the statements:

    1) Puppies are cute.
    2) I like ice cream.
    3) Kill all the Jews.
    4) I enjoy long walks on the beach.
    5) Otters are also cute.

    Are you thinking well, he’s certainly right about puppies. Let’s focus on puppies!

    You’re a professional writer, a professional communicator. You understand perfectly well how things work. ‘Someone, somewhere,’ said ‘Defund?’ How very Trumpian: Why, I’ve never even met that person who testified! What? Defund, you say, why I never heard of such a thing.

    Can we not just admit the crashingly obvious fact that it was a stupid position to take? Are we so weak and so brittle we cannot admit that sometimes we say stupid shit? And then, rather than defend every stupid thing that’s said ,we should maybe walk it back?

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  16. gVOR08 says:

    Fentanyl, a synthetic opioid, is a major component of the current overdose epidemic in the US.

    Whu?! I thought Biden and defund were responsible for the overdose epidemic. At least that’s what FOX says.

    @Kathy:

    It’s getting so I’m beginning to suspect people love a panic.

    You’ve nicely summarized FOX’s business plan.

    1
  17. Just nutha ignint cracker says:

    Moving to a parallel issue mentioned in your post, I would prefer that people with anxiety issues seek meaning for their lives in fields outside of those granting the opportunity to arm themselves and shoot/kill the subjects with whom they interact. Putting guns and tasers in the hands of people with anxiety issues seems to be asking for trouble beyond the “we need a good guy with a gun” myths that we already wrestle with too much as a society.

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  18. Stormy Dragon says:

    @Michael Reynolds:

    As the old adage goes, “if you’re explaining you’re losing”. In a sane world admitting it was a stupid position to take and moving on would be great, but in the real world, admitting you were wrong just hurts you even more.

    The other problem if, moderates seem to think “of, if we just stopped talking about X” we’ll be okay. In reality, the Republicans will just switch to Y, or Z, etc. There will always be something new, and the only way to stop it entirely is become completely silent.

    If you can’t figure out how to win in spite of our opponents misrepresenting you, you’re never going to win, because there’s no way to get your opponents to represent you accurately.

    4
  19. Just nutha ignint cracker says:

    @Michael Reynolds: “Can we not just admit the crashingly obvious fact that it was a stupid position to take? Are we so weak and so brittle we cannot admit that sometimes we say stupid shit? And then, rather than defend every stupid thing that’s said ,we should maybe walk it back?”

    Things must be very different in the rarified climes you frequent. Down here, I don’t know anybody who has the problem you describe. And I live where 60% of the voters pulled the lever for FG twice. Fwk. Even the geezers at the Baptist rest home that my friend lives at know that the whole “lefties all want to defund the police and get us all killed” schtick is bullshit.

    2
  20. Matt Bernius says:

    @wr:

    How’s that for hijacking a thread? (Sorry, Matt…)

    Pretty effective in terms of hijacking. At least you immediately apologized.

    4
  21. Stormy Dragon says:

    Another aspect of this I think is overlooked here: overemphasizing the danger of fentanyl exposure serves as another convenient excuse for a lack of restraint on the part of the police when dealing with non-violent suspects.

    4
  22. wr says:

    @Michael Reynolds: The Right is going to find any single thing any Democrat anywhere in the world says and blow it up into hysteria. And your solution is what? Have the Dems police every person in the country to make sure no one says anything Fox can use?

    Here’s a fun anecdote: A doctor reports that she has a ten year old patient pregnant because of rape and had to cross state lines to get her an abortion. Within moments, the entire right wing attacked. The story was a lie because it was based only on one source. The doctor was lying about the pregnant child because that doesn’t ever happen (despite every Democrat being a pedophile). There was never a report of the rape. Disgusting Dems made it all up.

    Then the rapist pleads guilty. Now the doctor has to be investigated because she didn’t turn in the right paperwork. She’s guilty of violating her patient’s privacy. She should be jailed for doing this abortion.

    And now let’s talk about the really important fact — the rapist has a Hispanic last name, so he must be illegal, which means this is all Biden’s fault.

    Apparently your solution to the whirlwind of lies the Republicans throw up would be for the doctor to have never said anything.

    4
  23. wr says:

    @Matt Bernius: Hey, I’m still mad at Fentanyl for killing Tom Petty. Don’t want to let it get too much attention.

    4
  24. Mu Yixiao says:

    @Mu Yixiao:

    [Matt: TY for that, I’m a bit surprised that was the only one folks have reported so far.]

    I’m an editor of many (many) years. In blog posts, I let a lot of stuff pass without comment*. But I thought this one might cause enough confusion to be worth pointing out (and I thought it was funny).

    If any of the authors her would like me to edit posts for style**, grammar, punctuation, and/or typos, I’d be happy to do so. But… unless it’s significant, I find that most errors aren’t worth mentioning.

    ======
    * A lot of the quoted text here has egregious formatting errors–most commonly missing spaces between words.

    ** “Style Guide” stuff, now “how you do things”. Unless you forget the Oxford comma. Don’t forget the Oxford coma, Mr. McGee. Trust me, Mr. McGee. You wouldn’t like me when you forget the Oxford comma.

  25. MarkedMan says:

    @Matt Bernius: The case you reference is the one that gives people nightmares

  26. Matt Bernius says:

    @MarkedMan:
    Which case?

  27. MarkedMan says:

    @Matt Bernius:

    It is highly suspected that weaponized aerosolized carfentanil and remifentanil were used to subdue hostage takers of a Moscow theater in 2002. One hundred and twenty-five died as a result of this weaponized aerosolized exposure

    My impression is that the anti-terrorism people suspect that the “accident” was no accident. That it was just an excuse to see the results of a deployment in a crowded theater.

  28. Jim Brown 32 says:

    @wr: No, the message is that Republicans are groomers that would lie cover their kid raping voters. They also hate children and doctors.

    Politics ain’t beanbag

    1
  29. OzarkHillbilly says:

    @Michael Reynolds: ‘Someone, somewhere,’ said ‘Defund?’ ………………………….
    Can we not just admit the crashingly obvious fact that it was a stupid position to take?

    I guess nobody ever noticed (did you?) that any number of elected DEMs (from Biden on down) said that that was nothing they would ever propose or it would never become DEM policy. Right? Tell me, wtf DEMs should they have done beyond what they did do? Shoot the people* calling for defunding the police?

    *and please tell me wtf policy those people crying to “DEFUND THE POLICE!” should have pushed for considering the fact that we have been “reforming” the police for decades and yet not a dawgdamned thing has changed in all that time?

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  30. Jax says:

    @Kathy: The first time I encountered Fentanyl first-hand, it was in patches my aunt used to wear. This is when it first became a thing that was legal to prescribe, after the “Oxy panic”. I never took her patches, obviously, but my asshole cousin robbed her several times and she lived in misery for weeks dealing with her back pain because she didn’t want to turn him in. (He’s an 8 time felon, they should’ve locked him up and thrown away the key in the 80’s)

    It is THAT addictive, though. My aunt still lives, a sputtering mess, having lit her own foot on fire from dropping her lit cigarette on her oxygen hose because she has that fentanyl patch every night and can barely function. There’s a sweet 2-3 hour window where she’s coherent once a day, but she gladly slips back into the fog.

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  31. steve says:

    I have personally drawn up and given a lot of fentanyl. If it was absorbed across the skin in significant amounts I should be dead. It just isn’t absorbed easily that way.

    Just a couple of points. Carfentanil is 100 times more potent than fentanyl. My resident group had a narcotic researcher from Utah come talk with us about his work with DoD and carfentanil. They were trying to develop it for use in subduing hostage takers without harming the hostages. I dont think it worked out as carfentail is hard to reverse with Narcan and hard to get it to people fast enough. A small amount of inhaled carfentanil could be trouble.

    The symptoms are very odd for someone receiving a narcotic. I have never seen anyone gasp for breath. People generally get sleepy. Think of addicts using heroin. In the end stage when you are heavily overdosed you would have airway relaxation and an obstructed airway. With partial obstruction you would get snoring sounds, not gasping and you wouldn’t remember it.

    Steve

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  32. Thomm says:

    Is no one noticing the obvious lie that they can’t test for synthetic opioids?

  33. @Mu Yixiao:

    now “how you do things”

    I think you meant “not” 😉

    There is zero doubt I could use an editor. Blogging isn’t really amenable to much editing, alas.

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  34. @Matt Bernius:

    “[U.S. Transportation Security Administration (TSA) public affairs] wrote in an email [to The New York Times]. He identified powders including fentanyl…‘that could be used to irritate or harm aircraft passengers and aircrew if released during flight.’”

    https://www.nytimes.com/2018/06/21/travel/tsa-powder-rules.html