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Fentanyl can't cause an overdose through skin, experts say: 5 fentanyl myths, debunked

Experts in addiction share the biggest myths they encounter and the harm it can do to people who use drugs.
NBC News; Getty Images

When people hear about fentanyl, it's often through horror stories of accidental overdoses or first responders being poisoned just by being near the substance.

Fentanyl is a synthetic opioid that is stronger than the naturally-occuring heroin, according to the Centers for Disease Control and Prevention. Over the years, fentanyl has become more prevalent in the nation's drug supply and has contributed to a rise in overdose deaths. Experts say misinformation about the drug can lead to increased stigma against people who use drugs.

TODAY spoke to two substance use experts who debunked some of the most prevalent myths surrounding fentanyl that they encounter.

Myth: Fentanyl is so powerful that touching it or being close to it can cause overdose

This is the most prevalent myth about fentanyl, and according to Dr. Sarah Wakeman, the medical director for Substance Use Disorder at Mass General Brigham in Boston, it’s “completely false.” The myth that touching or being near fentanyl can cause an overdose leads to "a lot of stress and anxiety and fear," she said, "especially for people who are first responders."

Dr. Ryan Marino, a medical toxicologist and addiction medicine doctor at the Case Western Reserve University School of Medicine in Cleveland, told TODAY that part of that fear is because of how deaths involving fentanyl have increased in recent years. Last year, over 100,000 people in the United States died due to an overdose.

Those deaths are "primarily because of fentanyl," Marino said, but occur in people who use drugs, not people who accidentally touch the substance. While fentanyl is a strong drug, touching it or being close to it shouldn't cause accidental poisoning, Wakeman said.

“You definitely cannot overdose or be harmed by simply being near fentanyl or touching it,” Wakeman said. “Doctors, nurses, pharmacy technicians (and) pharmacists are often in scenarios where they’re around fentanyl, where they may touch it or be in a room with it, and thankfully they’re never harmed.”

One June 2022 paper detailed an experiment where a researcher covered the surface of their hand in powdered fentanyl; the paper confirmed that there is "low risk of rapid absorption after brief dermal fentanyl exposure." In 2017, the American College of Medical Toxicology and the American Academy of Clinical Toxicology released a position statement saying that touching fentanyl was "unlikely to cause" an overdose.

Wakeman said that this myth can be particularly harmful to people who use drugs because it may cause people to hesitate when they encounter someone experiencing an overdose.

“(The fear) may actually delay care or result in even worse stigma,” Wakeman said.  

Myth: Consuming fentanyl causes immediate addiction

Wakeman said that this myth exists with many drugs, but "is not true of any substance." She added that many people receive fentanyl for medical purposes: Since the substance is an "effective and quick-acting pain medication," medical practitioners may use it during surgery or to help manage pain.

“If you’ve ever had a colonoscopy or a medical procedure, you have gotten fentanyl because it’s commonly used by anesthesiologists," Wakeman said. "If you had an epidural for pregnancy, for child birth, you probably had fentanyl."

But its effectiveness doesn’t lead to an immediate craving for it, Wakeman explained: “There’s no substance on Earth that I’m aware of that is instantly addictive. Whether it’s fentanyl or heroin or cocaine or methamphetamines, the majority of people who use them never develop an addiction.”

Three million Americans have had or have opioid use disorder, and while that may seem like a lot of people, upwards of 90 million Americans use prescription opioids in a year, according to 2015 data from the National Library of Medicine.

Myth: People have to go to rehab or “quit cold turkey” to recover from fentanyl addiction

According to Marino, there's no form of recovery that requires a person "quit cold turkey." Instead, that idea can actually be counterproductive.

“This idea that people should quit cold turkey is associated with increased rates of using drugs, increased rates of overdose (and) increased rates of dying,” Marino said.

Wakeman said treatment for fentanyl is the same as how doctors treat dependency on other opioids, like heroin and prescription medications. Instead of quitting cold turkey, Wakeman recommended that people who want to stop using drugs consider opioid substitution therapy, where an illicit substance is replaced with a prescribed opioid agonist like methadone or buprenorphine.

"Methadone and buprenorphine would be two first-line treatments," Wakeman said. "(Opioid substitution therapy) is the only treatment that's been shown to reduce mortality, is associated with a higher likelihood of remission or recovery, of not dying from an overdose or other causes."

Data from 2020 from the Pew Research Center found that opioid substitution therapy helps people "manage withdrawal symptoms, reduce illicit opioid use, and stay in treatment," while also reducing the "risk of death from opioid overdose."

Myth: All illicit drug manufacturers deliberately cut their drugs with fentanyl to cause addiction

While the drug supply is “very contaminated,” according to Wakeman, meaning that people buy illicit drugs and find another substance in them, there’s no reason to believe that the contamination is intentional in most situations. “The reality,” Wakeman says, “is probably much more complicated.”

“Illicitly manufactured fentanyl is found in lots of substances and has been found in cocaine, for example,” Wakeman said. “But it’s not an intentional poisoning. ... There may be inadvertent cross-contamination.”

This contamination, she said, can lead to a higher risk of overdose death, because people may not have the necessary tolerance to handle the substance.

“If you’re a person who uses cocaine who’s never been exposed to an opioid, you have no tolerance to opioids so even a very small amount could be enough to cause an overdose to kill you,” Wakeman explained.

A 2021 paper from Harm Reduction Journal notes that most people who consume drugs, such as cocaine or MDMA, aren't aware if fentanyl is mixed in their drugs. The paper notes that stimulants mixed with opioids are fueling the "4th wave" of the opioid crisis.

Myth: If naloxone is readily available, people will use drugs more

Naloxone, often known by the brand name Narcan, is a medication that reverses opioid overdoses by targeting receptors in the brain. It works on people who have overdosed due to fentanyl.

Wakeman and Marino both said it's important that people learn how to use naloxone and carry it, especially if they interact with people who use drugs. However, there's no reason to believe that making naloxone more accessible would cause more people to use illicit substances, Wakeman said.

“This idea that (if) we make naloxone more accessible, people are just going to use drugs and you’re sort of ‘enabling them’ ... is reminiscent of conversations around seatbelts,” Wakeman explained.

The theory, she said, was that "if you made people wear seatbelts, they were just going to drive more recklessly and cause more harm to that person." In the end, "that turned out not to be true."

A 2017 paper found that when researchers trained people who currently used or had used heroin in the past how to use naloxone, they were not more likely to engage in riskier behaviors, and the authors conclude such worries are "unfounded."

When naloxone first entered the public consciousness, Marino said, some considered it a "moral hazard."

“Narcan was a moral hazard, where if you gave people Narcan they would use more drugs and overdose more,” Marino said. “That was very heavily debunked and has not been borne out by any evidence.”