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As public health officials and politicians raise alarms over a growing opioid epidemic in the United States, concern over the potential for accidental contact with the extremely potent drug fentanyl have become a prominent fixture on the Internet. Illustrative of this point is a chain e-mail that has hit our inbox multiple times: There are two aspects of this story to note. The first is that the original claim has its origins in a Facebook post by the Leachville Police Department in Arkansas which they have now removed and apologized for. The second is that the ability for an overdose to occur through incidental skin contact is extremely unlikely. While it's true that fentanyl can legally be prescribed in the United States in the form of a transdermal patch, which regulates a controlled release of the drug into the system via the skin, such a system is specifically engineered to penetrate the top layer of the skin. Much of the concern over accidental fentanyl contact, however, comes not from legally prescribed fentanyl, but black-market fentanyl in the form of a white powder. While the risk of overdose from this powder (which is potentially 80 times as potent as morphine and which can cause death in doses as low as 2 to 3 milligrams) via oral consumption is both acute and increasingly prevalent, experts have cast doubt on the reality of the risk of overdose from skin contact with this power or its residue. A high-profile incident in May 2017, in which a police officer potentially came into contact with fentanyl residue while searching a suspected drug dealers car in Ohio brought those fears to the forefront, was reported by NBC News at the time in the following way: However, experts later questioned this account. Jeremy Samuel Faust, an emergency medicine physician at Brigham and Women's Hospital in Boston and a clinical instructor at Harvard Medical School, wrote in a piece for Slate that while it is possible that Green inhaled or accidentally ingested the powder, he found the account of its effects to be dubious, at best: In that same piece, Faust cites Ed Boyer, a medical toxicologist at Harvard Medical School and Brigham and Women’s Hospital, who explains how crucial the differences between the powder and the patch form of the drug are: Further confusion on this issue can be attributed to a June 2017 document from the Drug Enforcement Administration briefing first responders on the risk of fentanyl. That document makes numerous references to the risk of overdose from skin contact with powdered fentanyl, and at the time of that document’s release, this was also the position of the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health. However, these organizations have since revised that stance due to lack of research on the topic, a position in agreement with a recent position statement by the American College of Medical Toxicology. As reported by Vice News: It should also be noted that the DEA briefing document from which the Leachville Police Department's claim appears to have its origins also explicitly warns against using alcohol based sanitizers (which applies to shopping cart wipes) to remove fentanyl, for fear that this could make skin more susceptible to absorbing the drug: Therefore, even if this document were based on the most recent science, the police departments interpretation of it would still be flawed. While accidental ingestion would in theory be a possibility, the scientific plausibility of overdose through skin contact alone has been called into question. Because everything used to create this claim has later been walked back, we rank it as false.
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