Fentanyl exposure myths continue to ignite debate

Plus, posts discussed kratom products and “flysky,” an emerging illicit substance causing concern in Pittsburgh.

This past week, a video of a police officer collapsing after allegedly touching fentanyl during an arrest sparked continued fentanyl exposure myths. Other posts highlighted the Food and Drug Administration’s new recommendation to classify certain products containing kratom, an herbal supplement, as controlled substances. Additionally, social media users asked questions about when to use naloxone in response to headlines about “flysky,” a combination of heroin and the animal tranquilizer medetomidine that is appearing in the Pittsburgh area’s illicit drug supply.

In response, communicators may correct fentanyl exposure myths, share the risks of kratom and flysky, and answer questions about when naloxone is effective.

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What’s trending nationally in conversations about opioids

On August 2, an X user shared a video that reignited myths about fentanyl exposure. In the video, a South Carolina police officer collapsed after touching a rolled-up dollar bill that came from the pocket of a person she was arresting. Just before collapsing, she asked another officer to get her naloxone, although her symptoms did not match the signs of an opioid overdose. The post—which received approximately 12.3 million views, 35,000 likes, 7,700 reposts, and 3,400 comments as of August 6—alleged that the bill was contaminated with an unknown substance, which some commenters believed to be fentanyl. Those commenters falsely claimed that touching fentanyl can cause an overdose. However, many other commenters debunked the myth. Another X user who identified himself as a doctor shared a repost, which received approximately 2.6 million views as of August 6, correctly stating, “You physically can’t absorb fentanyl from an ‘exposure’ like this.”

On July 29, the FDA recommended that certain products containing 7-hydroxymitragynine (7-OH)—a concentrated byproduct of the kratom plant—be classified as controlled substances. The FDA’s announcement said that 7-OH has “potential for abuse because of its ability to bind to opioid receptors” and noted that the agency had already issued warning letters to several companies that were allegedly distributing products containing 7-OH that claimed to treat health conditions. Several articles discussed the recommendation, which will be reviewed by the Drug Enforcement Administration. Reactions across social media platforms were mixed. Some social media users said they were grateful for a potential crackdown on 7-OH products, sharing personal stories about how they had allegedly developed a dependence on the substance and struggled to quit. Others expressed concern that making 7-OH products controlled substances would limit access to all kratom products. Some shared how they used kratom products to manage withdrawal symptoms after stopping opioids.

In late July, officials warned that a new drug called “flysky” is appearing around Pittsburgh. The drug is heroin laced with medetomidine, a tranquilizer used in veterinary medicine. It has been linked to at least two recent overdose deaths in the area. In response to social media posts sharing articles about flysky, commenters expressed confusion about whether naloxone would be effective against it, as one official in an article said, “...if you overdose on medetomidine, Narcan is not going to save you.” Many expressed stigmatizing attitudes toward people who use drugs. Some shared information about Pennsylvania harm reduction programs that provide free naloxone.

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Recommendations for public health professionals

Each week, the Infodemiology.com team will provide messaging recommendations in response to some of the trending narratives outlined above. These helpful tips can be used when creating content, updating web and FAQ pages, and developing strategy for messaging about opioids.

False claims that fentanyl overdoses can occur through skin contact repeatedly emerge in response to videos showing police officers experiencing an alleged accidental overdose. In response, communicators may emphasize that while fentanyl is a potent opioid that is involved in most U.S. overdose deaths, you cannot overdose on fentanyl by touching it or by accidentally inhaling a small amount. People who use drugs are at risk of fentanyl overdose because fentanyl, like other opioids, can slow or stop breathing. Fentanyl is also often unknowingly mixed with other street drugs, which increases the risk of overdose.

Conversations about new FDA recommendations provide an opportunity to explain that while kratom and its derivatives are legal in most states, kratom is not currently regulated by the FDA as an approved medication or supplement. The DEA lists kratom as a “drug and chemical concern,” which means that consuming it can potentially lead to substance use disorder. Messaging may stress that kratom may cause serious side effects like liver damage, dizziness, trouble breathing, seizures, and delusions. It has also been linked to a small number of deaths (however, nearly all deaths from kratom also involved other drugs). Some research shows that people may become dependent on kratom. Communicators may want to share information about approved medications for opioid use disorder, as well as local drug treatment centers, recovery groups, therapist directories, and SAMHSA’s National Helpline (1-800-662-HELP), which connects people to treatment.

In response to conversations about flysky, messaging may emphasize that naloxone is effective against opioid overdoses, including those involving heroin. Communicators may explain that experts recommend administering naloxone any time an overdose is suspected because of the likelihood of opioids being present. Communicators may outline the signs of an opioid overdose and emphasize that bystanders witnessing a possible overdose should dial 911, administer naloxone, check for breathing, perform CPR if trained in it or if instructed by a 911 operator, and stay with the person until emergency services arrive. If overdose symptoms do not resolve, give additional doses of naloxone every two to three minutes until the person begins to breathe normally or until help arrives. Messaging may stress that it is safe to administer naloxone even if a person is not overdosing or is not overdosing on opioids. Explaining how to use naloxone and where to get it nearby is recommended. Communicators may also want to share information about local harm reduction programs that offer naloxone and other services.