The AVI sent along this article this week, which highlights the rising concern about passive fentanyl exposure among law enforcement. They have a quote from a rehab counselor who claims that just getting fentanyl on your skin would be enough to addict you, and that merely entering a room where it’s in the air could cause instant addiction. Given that it’s Reason Magazine, they then promptly dispute the idea that this is actually happening.
I was interested in this article in part because my brother’s book contained the widely reported anecdote about the police officer who overdosed just by brushing fentanyl off of a fellow police officer. This anecdote has been seriously questioned since. Tim expressed concerns afterwards that had he realized this he would have left it out. I’ll admit that since my focus was mostly on his referenced scientific studies, I didn’t end up looking up various anecdotes he included.
This whole story indicates an interesting problem in health reporting. STAT news has more here, but there’s a couple things I noted. First, the viral anecdote really was widely reported, so I’m not surprised my brother heard about it. It has never technically been disproven….outside experts have said “it almost certainly couldn’t have happened this way” but neither the police officer nor the department have commented further. This makes it hard for the “probably not” articles to gain much traction.
Second, the “instant addiction” part was being pushed by a rehab counselor, not toxicologists who actually study how drugs interact with our body. Those experts point out that it took years to create a fentanyl patch that would get the drug to be absorbed through the skin, so the idea that skin contact is as effective as ingesting or breathing it in seems suspect.
Third, looking at the anecdotes, we realize these stories are NOT being reported by the highest risk groups. Pharmacists would be far more likely to accidentally brush away fentanyl than police officers, yet we do not hear these stories arising in hospital pharmacies. Plenty of patients have been legally prescribed fentanyl and do not suffer instant addiction. The fact that the passive exposure risk seems to only be arising in those who are around fentanyl in high stress circumstances suggests other things may be complicating this picture.
While this issue itself may be small in the grand scheme of things, it’s a good anecdote to support the theory that health fake news may actually cause the most damage. While political fake news seems to have most of our attention, fake or overblown stories about health issues can actually influence public policy or behavior. As the Reason article points out, if first responders delay care to someone who has overdosed because they are taking precautions against a risk that turns out to be overblown, the concern will hurt more people than it helps. Sometimes an abundance of precaution really can have negative outcomes.
graph paper diaries 
I recently watched the 7/4/19 TV program = Elementary (21 Century Sherlock Holmes variant) on this topic. The agent = kokokol 1, supposedly a fentanyl variant manufactured by the Russians.
Below is the wikipedia link which did not come up on Google. I had to use Bing.
https://en.wikipedia.org/wiki/Kolokol-1
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One other important distinction that actually complicates your third point is to the kind of fentanyl people are exposed to. Medical fentanyl, to the best of my knowledge, is normally only prescribed in a transdermal patch. So when I was prescribed fentanyl, my pharmacist only ever handled the outside of a prepackaged box that held sealed patches. The only way someone could OD was by tearing open a patch and ingesting the gel inside. And to get to that dose the reports I’ve seen have been 2 or more patches.
But illicit fentanyl is a whole other thing. That is the loose powder form and hasn’t been packaged medically. No pharmacist is handling anything close to it.
Any fear around overdose or even a contact high through the skin is pretty outlandish. But, hypothetically, it is possible for some kind of high through accidental inhalation. The last police officer I talked to told me that it had been fairly standard for an officer to open a bag with a suspicious substance and take a whiff in order to rule out common possible alternatives to an illicit substance. He told me they were now restricted from doing that because of the fear of potential inhalation.
My guess is that this narrative has spread so far because people hear that medically prescribed fentanyl is absorbed through the skin and miss the part that the only way that works is through a highly specific gel and patch system. Then there is a remote chance, but still possible, of accidental inhalation and all of that gets muddled together.
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