Fentanyl, and you

I had thought the whole “fentanyl paranoia” thing had run it’s course by now, but it apparently has got a hell of a set of legs.

As a now-retired elder, I think it’s probably my duty to gently guide the youngling peace officers in their path of Public Service, so let us engage in a little rational thought experiment.

Why does Mookie need to snort fentanyl, if all he has to do is rub a little powder on his arm?

More importantly, if you’ve made it through your third solo patrol, you should have figured out that while Mookie isn’t necessarily smart he is pretty cunning. To say nothing of inventive when it comes to ways of avoiding the attention of Da Law.

Syringes — a/k/a “Paraphernalia” — are a wonderful example of “Probable Cause”, and a reason to search Mookie from his toenails to the last follicle on his head, thus stumbling across any number of his sins.

If Mookie can avoid carrying around paraphernalia, and thus bypass these little indignities, he will do so with an avid quickness. If fentanyl can be efficacious via simple contact … why should Mookie need a needle?

I don’t know if you’ve come across your first drug lab yet, but I’m here to tell you that “lab safety procedures” in your average bathtub lab, or stash house don’t quite make it up to the level that the American Chemical Society would like to see.

So why aren’t the purveyors of recreational pharmaceuticals stacking up like cordwood and solving the problem all on their own if skin contact is all that is required?

 Stop freaking out about possible skin contact with possible fentanyl — if it were that bad, the fentanyl problem would be self-correcting.


Something beautiful.
Much brave, very courage

12 thoughts on “Fentanyl, and you”

  1. It’s fascinating the number of law enforcement agency PR departments that don’t understand this.

    It’s almost as if they have some ulterior motive for panicking people about fentanyl…

  2. To be fair, tolerance is part of the reason that the fentanyl problem *isn’t* self solving. That and easily accessible Narcan.

    This is where working in hospice gives one a very odd perspective on drugs. There are no shortage of people who have never taken anything stronger than Tylenol, and even that under protest, so when we need to give them morphine to treat acute shortness of breath at 0200 while they’re dying of , the tiny dose we start people on hits them like a ton of bricks and they sleep for 18-20 hours (though I will personally argue that most of that response is caused by people suddenly not being in pain and being able to sleep off the exhaustion caused by the pain).

    On the other side, we have yon former heroin addict, for whom that dose does absolutely nothing because they have an insane opioid tolerance, and we spend days ramping up pain meds to doses that make DEA agents cry before we finally talk the person into letting us put them in respite for a week so we can start them on methadone (which was initially made for controlling pain in order to reduce the use of other opioids and therefore the side effects of those opiods) and slowly titrate that up to a level that still makes DEA agents cry but is at least only one drug instead of the six drugs they were on before.

    That’s not even taking drug seeking behavior into account, just tolerance. So there are likely people with so little tolerance (and probably a genetic predisposition to react strongly to opioids) that incidental exposure to street fentanyl (which is similar to but different from the fentanyl I use in hospice or a hospital uses via IV) will kill them. Mostly, though, I agree with the sentiment here. The skin is a generally very effective barrier to pretty much everything, which is part of what makes topical medications so challenging. The real issue isn’t touch, it’s getting that shit in any mucus membrane at all, which is *really* easy to do when it’s in powder form.

    1. Having had the misfortune to be one of the people who even codeine sends into a stupor or worse, I can attest to this. Dental and other minor surgery can get interesting! Waking up from a D & C with the medical staff clustered around and a crash cart beside me is not a good memory and not JUST because I lost the baby.

  3. I’m guessing those investigating smelled what they discovered, had no idea they were basically taking a hit of a powerful opioid, and when their senses reacted, their reaction was of panic.

    From my perspective of current law enforcement procedures, even if fentanyl was absorbed through the skin, the latex gloves they usually wear when searching would prevent unwanted exposure.

  4. Public safety agencies peddle the contact overdose nonsense, and ignorant news outlets (mostly local TV) lap it up as a ready-made panic story for gullible viewers.

    It’s a distraction. “Pay no attention to that innocent person we beat to death; look at what brave heroes we are, risking death by overdose just by coming within a hundred yards of an addict!”

  5. The patches, or contact transfer, require a carrier solvent (like DMSO) to penetrate the skin. Hence the alarums and excursions about EMTs keeling over on occasion, due to extended contact with damaged patches or affected skin. Yet another reason to teach CPR and First Aid with copious use of barrier materials.

    Mucous membranes are a thinner and easier barrier to cross with powder, like any opiate. IV or injection use requires enough fiddly moments and calculations that the response ought to include Bag, Body, Rubberized, One Each.

    Journalists – much easier solution: One original idea and a glass of ice water. Apply simultaneously, then call EMS.

  6. I sometimes wonder if people got confused about fentanyl because patients get it as a patch and think it’s easily transmissible through skin contact.

    I was on a fairly strong dose of intravenous fentanyl while in the hospital after my cancer surgery, and then on the patch for about two months after. I don’t get why/how people abuse it. My personal experience was that it took my pain away, but didn’t make me feel loopy or light headed at all. Same with tramadol, it took the pain away but I never felt intoxicated by it.

    1. Perhaps the reaction to the drug is different if you aren’t dealing with pain. An anecdote: Before accepting a morphine patch for her terminal cancer pain, my mother was assured that it would not make her loopy as long as the dose was just enough to alleviate her pain. Sure enough, she appeared unaffected by the drug. When she switched from chemo (trying to beat the cancer) to radiation therapy (for end of life comfort), she began to get a bit loopy. It was over a decade later before I put two and two together, realizing that reduced pain should probably have been accompanied by a reduced morphine dose. Had she been in hospice care, they might have recognized and adjusted for that, fwiw.

  7. The issue is compounded by the appearance of Carfentanyl which is like 100x stronger and is typically only used for rhinos and elephants. It has turned up in drug seizures. All it takes is a sloppy rookie accidentally getting some in thier eye or nose or something like that…. you don’t have enough narcan to deal with that.

  8. “ I don’t know if you’ve come across your first drug lab yet, but I’m here to tell you that “lab safety procedures” in your average bathtub lab, or stash house don’t quite make it up to the level that the American Chemical Society would like to see.”

    I suspect that the “lab safety proceedures” of your typical drug lab would appall Wile E. Coyote…and he once set up a lab to make nitro in a shack on some railroad tracks.

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