It is not an overstatement to suggest the appearance of fentanyl on our streets has caused panic of an unparalleled level among Americans. This panic is warranted to large extent, insofar as fentanyl is exponentially more likely to produce overdose and fatal overdose than heroin, or other drugs not mixed with fentanyl. Further, the public’s reaction is supported by the appearance of fentanyl in illegally manufactured “prescription” pills from so-called “pill-mills” like Percocet and Oxycodone.
But there is a another dimension of the panic that surrounds incidental exposure to fentanyl by first responders (police, EMT’s, et al.) premised on the belief that incidental exposure can lead to significant medical complications or fatal overdose. That simply touching fentanyl can cause overdose or death. This is not the case, and is not supported by the science.
Incidental exposure to fentanyl—e.g., simply touching fentanyl or getting powdered fentanyl onto clothing—is extremely unlikely to cause any medical complications. The American College of Medical Toxicology and American Academy of Clinical Toxicology report the risk of clinically significant exposure is “very low” and that “no reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids.” Further, they found “incidental dermal absorption [absorption through the skin] is unlikely to cause opioid toxicity.”[i] What’s more, video evidence has been published showing verified fentanyl being held in the bare hand of a person without consequence.[ii]
To be direct, “a clear consensus from medical experts that overdose from incidental skin contact is a medical impossibility.”[iii] Symptoms reported by first responders—increased heart rate, blurred vision, etc.—are experiencing the “’nocebo effect—a phenomenon in which individuals believe they have encountered a toxic substance and therefore experience the expected symptoms of exposure.”[iv] Nevertheless, belief that overdose can occur from simply touching fentanyl is widely pervasive among first responders: studies have shown that approximately 80% of first responders hold this belief.[v]
To be clear, fentanyl is incredibly dangerous and deadly. So why is it important to correct myths like this about fentanyl? Because believing myths like simply touching fentanyl will cause overdose perpetuates stereotypes about people who use drugs as being toxic to even be around or to attempt to help. Such beliefs might cause a person to delay, or even refuse, helping a person who has overdosed for fear of being passively exposed to fentanyl. This is precisely why such myths are dangerous, albeit unintentionally.
[i] See, American College of Medical Toxicology and American Academy of Clinical Toxicology, “ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders,” Published online 2017 Aug 25. doi: 10.1007/s13181-017-0628-2; see also, B. Del Pozo, E. Sightes, S. Kung, et al., “Can Touch This: training to correct police officer beliefs about overdose from incidental contact with fentanyl,” Health and Justice, 9:34 (2021).
[ii] https://www.facebook.com/chad.sabora/videos/pcb.10156508251551241/10156508237216241/?type=3&theater.
[iii] R. Winograd, S. Phillips, et al. “Training to Reduce Emergency Responder’s Perceived Risk of Overdose from Contact with Fentanyl: early evidence of success” Harm Reduction Journal, 17:58 (2020)(emphasis added).
[iv] Winograd et al. (2020).
[v] See Persaud and Jennings, “Pilot Study on Risk Perceptions and Knowledge of Fentanyl Exposure Among New York State First Responders,” Disaster Med. Public Health Prep. (Cambridge University Press: 2019):1-5; and Winograd et al.