Here's a story that keeps getting told: A first responder or member of the public comes into accidental, superficial contact with fentanyl. They have some symptoms — dizziness, tingling, difficulty breathing — and collapse, often needing an overdose antidote and a trip to the hospital.
It happened in Kansas City, Kansas, in June, when a police officer fell to the ground after touching a bag that had fentanyl-laced pills in it. It happened in North Carolina in September, when two sheriffs deputies began to feel ill after returning to the office after a drug bust. And it happened in Fountain last week, when a police officer felt lightheaded and was taken to the hospital after searching a car in which fentanyl was found.
The problem with this story, medical experts say, is that it's impossible to overdose on fentanyl just by touching it or being in proximity to it. The drug, a synthetic opioid more powerful than heroin or morphine, cannot be absorbed through the skin, and it won't aerosolize into the air; to feel its effects — and potentially overdose — a person has to ingest it, snort it or inject it.
"Chemically, powdered fentanyl doesn't absorb through the skin," said Sarah Axelrath, a Denver addiction medicine physician. " ... I really don’t know how you would have any fentanyl nervous system effects from fentanyl unless you intentionally ingested it through snorting or smoking."
One toxicologist, Ryan Feldman, wrote in a medical journal about spilling liquid fentanyl on his hand, with no effect.
The exception is fentanyl patches, but that process is much more complicated than it sounds, said Ryan Marino, a medical toxicologist and addiction specialist at Case Western Reserve University's School of Medicine. Patches are the result of extensive pharmaceutical research and engineering, far different from the illicit fentanyl found in the street supply. Even with pharmaceutical-grade patches, Marino said, a patient has to wear the patch for hours before they start to feel the effects of the medication.
In a statement, Denver Police spokesman Doug Schepman said that "officers are trained to take precautions" with fentanyl and other substances.
"Potential exposure routes of greatest concern include inhalation through nose or mouth, ingestion and needle puncture," he said. "Any of these exposure routes can potentially result in a variety of symptoms that can include the rapid onset of life-threatening respiratory failure."
Schepman added that though skin contact is "also a potential exposure route," it's not likely to cause an overdose "unless large volumes of highly concentrated powder are encountered over an extended period." Officers are told to wash their hands if they come into contact with the drug, to wear latex gloves when dealing with suspicious substances and to be cautious in areas where fentanyl is known or expected to be present.
The symptoms described in stories about fentanyl exposure often aren't what happens when a person overdoses from opioids, Axelrath and Marino said. The main symptoms to look for during an actual fentanyl overdose, Marino said, are a depressed level of consciousness — essentially, nodding out — along with shallow or abnormal breathing.
The symptoms of chest pain, dizziness and tingling? Axelrath said those describe panic attacks, likely triggered by poor education and information about fentanyl and its properties.
The story has spread so frequently across the United States in recent years that the American College of Medical Toxicology has a special place on its website about fentanyl exposure reports. It even issued a statement — back in 2017 — reminding the public that "toxicity cannot occur from simply being in proximity of the drug" and that anyone who gets powdered fentanyl on their skin can address it by "simply washing it off." Schepman said that "brief skin contact with fentanyl or its byproducts is not expected to lead to toxic effects if any visible contamination is promptly removed."
Marino said he suspects the story keeps getting run, in part, because of the amount of misinformation about fentanyl in the United States and in the media. He also said it can also be used for political or policy gains.
Axelrath agreed.
"What I think is happening is there is widespread misinformation and fentanyl panic all across the nation right now because of the increase in overdoses and because of poor information about what fentanyl is and where it comes from," she said.
One study, published in the Health and Justice journal last year, found that nearly 80% of first responders reported they faced "great risk" of overdosing from touching or inhaling it. After first responders were given training about the drug, that dropped to below 40%.
The impact of fentanyl misinformation goes beyond misunderstanding and inaccurate news articles, Marino said: Resources are wasted on unnecessary protective gear, and in some cases, people have been charged with additional crimes for exposing first responders to fentanyl.
The implications go even further beyond that, he and Axelrath said.
The "reason why this matters is because if fentanyl misinformation spreads and leads to a first responder being afraid to administer aid to someone overdosing," Axelrath said, "more people will die."
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