We Need a Public Health Response to Fentanyl.

Fentanyl Information Image

We all want ourselves, our loved ones, and communities to be safe and healthy. It’s normal to feel scared when you hear about fentanyl and the growing overdose crisis. Unfortunately, so much of the information on fentanyl promotes fear and criminalization instead of helping people. To address our collective safety and well-being—and save lives—information on fentanyl must be factual so people can make safer choices. Our responses to people who use drugs must be rooted in health.  

There is growing public acceptance of the fact that drug use is a health issue, not a criminal one. Unfortunately, some elected officials and members of law enforcement continue to call for punitive criminal policies. They have spread misinformation to drive up support for policies that hurt people instead of helping them.  


Fentanyl is a synthetic opioid painkiller. It is currently legal to treat patients with severe pain. This happens often after surgery. It is also commonly used for pain management under the supervision of a doctor.  

Medical fentanyl is made in a regulated laboratory with oversight. And it is packaged with accurate labeling. A doctor knows exactly what they are getting and can prescribe the dosage needed for the intended effect. Many chronic pain and cancer patients safely use fentanyl for pain relief. It can effectively reduce the effects of unrelenting, intolerable pain.

However, when people talk about fentanyl in relation to the overdose crisis, they are often referring to illicitly manufactured fentanyl and its analogues. Fentanyl analogues, also known as fentanyl-related substances, are often stronger (however, not always) than fentanyl but have similar, though slightly different chemical structures. Many times, these substances have been mixed into the heroin and counterfeit pill supply. However, in some markets, it has replaced heroin altogether. Illicit fentanyl is made with no oversight. It is not labeled. And people often do not know what/how much they are getting.


Criminalization has led to an unknown and increasingly stronger illicit drug supply that is driving the overdose crisis.

The U.S. Government increased penalties and double downed on enforcement and supply-side interdiction efforts as a strategy to stop drug production and entry. However, this just created the conditions for more potent, easily smuggled drugs like fentanyl to enter our communities. 

Restricting prescription opioids did not end demand for opioids. Instead, it just sent people to the underground heroin supply. Crackdowns on heroin led suppliers to produce cheaper, potent and easily smuggled fentanyl. Harsh fentanyl penalties incentivized fentanyl analogues to flood our markets. And now, history is once again repeating itself. The classwide scheduling of fentanyl analogues—which criminalizes all these substances more harshly, regardless of whether they are harmful or not—is leading to new and even more unknown drugs. We are seeing even more dangerous or potent opioids and tranquilizers. This includes xylazine, etizolam, benzodiazepines, and nitazenes overtaking some markets.

Simply put: crackdowns put us in a game of whack-a-mole. When we try to eradicate one drug, a new one comes up. Often, it is a drug that consumers are not prepared for or has unpredictable effects. As a result, it creates more harms, because people who use drugs are not aware of what they are using or how strong it is.

Harsher penalties for illicit fentanyl and its analogues also deter people from seeking lifesaving support. It can even prevent them from calling for help when someone is experiencing an overdose. This is because they are afraid of being prosecuted or facing other kinds of repercussions. This can include loss of employment, housing, or custody of their children.


In 2018, President Trump temporarily classified all fentanyl-related substances as Schedule I controlled substances. President Biden, despite apologizing for his tough-on-crime past and promising real criminal justice reform, has continued to support this policy. He has been advocating to make it permanent. Congress has also periodically extended the temporary classwide scheduling of these substances.

By putting fentanyl-related substances on Schedule I, they are criminalized the most harshly and it triggers the longest mandatory minimum sentences. The government is saying these substances have a high risk of abuse and no accepted medical use. As we shared above, the criminalization of heroin is what led to fentanyl. Criminalizing fentanyl will likely lead to new, stronger drugs that can only worsen the overdose crisis.

Classwide scheduling also makes lifesaving research efforts extremely burdensome and difficult. This is research that could find the next overdose-reversing medication or other medication that could help treat substance use disorder. In fact, of the few fentanyl-related substances tested on a limited basis by the FDA, at least one showed properties similar to the overdose-reversing medication naloxone. Others were found to be completely harmless and should never have been classified as Schedule I.

Experts and advocates have warned that classwide scheduling of fentanyl will lead to a harsh crackdown on low-level offenses. This includes possession, selling small amounts, and public use. Even a trace amount of an unknown (and potentially harmless) substance can trigger years in prison. This will have a disproportionate impact on communities of color, who are more heavily policed than other communities.

What makes this all especially unnecessary is that harmful substances would still be illegal without permanent classwide scheduling. The Controlled Substances Act and the Federal Analogues Act already allow the Department of Justice to prosecute people for substances that mimic fentanyl so long as they are proven to be harmful.


Unfortunately, many myths exist about fentanyl that lead to policies that hurt people instead of helping them. The most effective ways to address the presence of fentanyl and other analogues in our drug supply are evidence-based health and harm reduction approaches. And they are the only way we are going to turn the tide on the overdose crisis.

Instead of further criminalizing substances, we need a robust public health approach. This includes:


How do you identify a fentanyl overdose? 

It is possible to overdose with fentanyl, heroin, and other opiate drugs whether someone is snorting, injecting, or taking them in pill form. The risk of overdose increases drastically if combined with alcohol or other drugs, especially benzodiazepines, such as Xanax or Valium. Here are some signs to look out for if you think someone has overdosed: 

  • Loss of consciousness 
  • They are awake, but unable to talk  
  • Their body is limp  
  • Their breathing is shallow or slow 
  • Their skin looks pale / ashen or clammy  

It’s not possible to overdose on fentanyl through accidental skin contact.  

It is not possible to overdose on fentanyl or related analogues through accidental skin contact or from close proximity alone. This misinformation hinders appropriate responses to people who use drugs. And it fuels bad policy.

Fentanyl and its analogues do not readily cross the skin barrier. They do not aerosolize well. The only way to overdose on these substances is from injecting, snorting, or otherwise ingesting them. In the case of the fentanyl patch, you can only overdose from mixing with an absorbable solvent and applying very large quantities for a very long time.

Fears of fentanyl exposure and overdose risk could prevent law enforcement from responding to overdose. This is despite police often being the first to respond to most 911 calls for emergencies.

Unfortunately, law enforcement and others have often spread misinformation about fentanyl. They do this out of ignorance or to build support for increased policing and criminalization. Instead, they should focus on supportive responses that help people be healthier and safer. 

If Fentanyl were in Marijuana, it would be destroyed by flame and become inactive. 

Fentanyl is destroyed by flames and deteriorates in the heating processes. When smoking marijuana in flower form (i.e., via pipe, paper, lighting on fire and inhaling smoke), any hypothetical fentanyl contamination would be destroyed by the flame. If a marijuana edible—like a gummy or brownie—contained fentanyl, it would be destroyed in the heating and baking process.  In both cases, that would mean the fentanyl no longer has any effect. Sensationalized stories about widespread fentanyl-contaminated marijuana are overblown. Again, these stories are often perpetuated by police and media. In fact, reports are often later debunked or corrected.  

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