'Rainbow fentanyl' and Narcan in schools: What you need to know about illicit fentanyl

Leaders of the Los Angeles Unified School District recently made the decision to stock approximately 1,400 elementary, middle and high schools with the opioid overdose antidote Naloxone (also known by the brand name Narcan). This extraordinary step was taken after nine accidental fentanyl overdoses among their students, including a fatal overdose in a 15-year old girl, in the early weeks of the new academic year.

As an ER doctor, I am accustomed to using Narcan on a regular basis to reverse overdoses from various opioids, including heroin and prescription narcotics like Vicodin and OxyContin. Unfortunately, during the COVID-19 pandemic, the opioid epidemic was also surging. The year 2021 saw an estimated 81,502 opioid-related overdose deaths in the United States – an all-time high.

Fentanyl, a synthetic opioid, is a commonly used pain medication. Because of the recent adolescent overdoses in my hometown of Los Angeles, fentanyl also has become a household name. And unfortunately that has led to more than few misconceptions and myths about this drug.

Here are just some of the things you need to know about fentanyl.

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FACT: Fentanyl is 50 times more potent than heroin and 100 times stronger than morphine

Fentanyl is a synthetic opioid that we use to treat cases of severe pain. It has a prominent role in pain management of cancer patients, in particular. It can be given intravenously and is also prescribed as a lozenge, tablet, spray or transdermal patch. The danger of fentanyl is its potency.

FACT: Fentanyl overdose deaths are on the rise

The rate of overdose deaths involving fentanyl increased 56% from 2019 to 2020, according to the most recent data available.

LAUSD was motivated to act in particular by data showing that fentanyl was identified in more than 75% of adolescent overdose deaths nationally. The fact that 80% of overdose deaths among those 15-19 years was unintentional highlights the unseen danger our adolescent students face.

MYTH: You can overdose on fentanyl by just touching it

This is perhaps the biggest pervasive myth about fentanyl.

There have been multiple reports of police officers claiming to have suffered an accidental dangerous overdose from fentanyl because their skin came into contact with fentanyl powder that was found when they responded to an emergency call. In addition, the TV show "Blue Bloods" aired an episode in 2017 in which a police officer overdosed after touching a tray containing fentanyl.

You cannot overdose on illicit fentanyl thru skin contact. While medical grade formulations of fentanyl include patches, illicit fentanyl cannot be absorbed by the skin. In fact, pharmaceutical companies spent millions of dollars and years of research developing the proper formula for a medical-grade fentanyl patch because it's so difficult to deliver the effects of fentanyl via the skin.

In addition, us doctors and nurses are around fentanyl frequently. Both the IV form we use for pain control and in taking care of patients who overdosed on fentanyl. And we're never harmed.

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Myth: Fentanyl overdose is easily treatable with Narcan

Anyone who works on the front-lines of the ER will tell you that treating a suspected fentanyl overdose is the most challenging and dangerous type of opioid overdose we encounter.

While a IV drug user who accidentally overdoses on heroin or an elderly patient who forgets they already took their pain medication and takes a second dose may respond to one dose of Narcan, patients who overdose on fentanyl often require multiple doses of Narcan because of its high potency. These patients require constant observation and critical care to monitor their oxygenation and ventilation.

Narcan is an opioid antagonist. It works by attaching to and blocking the opioid receptors so that the opiate in question cannot continue to influence the central nervous system, and most importantly, breathing. I often put patients with severe fentanyl overdoses on an IV "drip," meaning they receive a continuous infusion of Narcan to block the fentanyl until it wears off. These patients often require ICU level of care.

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Myth: 'Rainbow fentanyl' is the biggest threat to our youth

Public health and DEA officials have recently been sounding the alarm about rainbow-colored fentanyl pills — basically illicit fentanyl pills given different colors. Some officials believe that drug cartels are manufacturing "rainbow fentanyl" to target young people. They have claimed cartels are trying to increase profits through addiction to fentanyl pills that more closely resemble Skittles.

However, harm reduction experts and toxicologists are skeptical.

MDMA and other club drugs have featured bright colors for decades. The rainbow-colored fentanyl pills confiscated by the DEA are cleared marked with "M" and "30" – making them readily identifiable as pills, raising the question if adolescents would actually mistake them for candy. And it's unlikely teens have the discretionary income to afford the drug anyway.

The greater danger is likely from illicit drugs like cocaine and street narcotic pills like Percocet that are also laced with fentanyl to enhance the high. Even kids or adults who have taken a narcotic before can easily be overwhelmed by the smallest laced dose of fentanyl.

Fentanyl is part of a bigger problem

At the time of this writing today, the Justice Department announced that the DEA had seized more than 10.2 million fentanyl pills and 980 pounds of fentanyl powder between May 23 and September 8. They estimate this is the equivalent to 36 million lethal doses.

The bottom line is that illicit fentanyl is a dangerous facet of the ongoing opioid epidemic in this country. An epidemic that continues to spiral out of hand.

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Michael Daignault, MD, is a board-certified ER doctor in Los Angeles. He studied Global Health at Georgetown University and has a Medical Degree from Ben-Gurion University. He completed his residency training in emergency medicine at Lincoln Medical Center in the South Bronx. He is also a former United States Peace Corps Volunteer. Find him on Instagram @dr.daignault and Twitter @MichaelDaignau3

This article originally appeared on USA TODAY: Fentanyl myths: What to know about Narcan, rainbow fentanyl and more