Addiction: The Next Step

Clearing Up Confusion: Fentanyl Facts & Fiction

• NYS OASAS

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Can simply touching fentanyl really lead to an overdose? Join us in the latest episode of Addiction: The Next Step, as we debunk this and other pervasive myths.

Isabel Byon:

The New York State Office of Addiction Services and Supports, or OASAS, provides this podcast as a public service. Thoughts and opinions expressed do not necessarily represent or reflect those of the agency or state. This is Addiction: The Next Step.

Jerry Gretzinger:

It's time for another episode of Addiction, the Next Step, the podcast brought to you by the New York State Office of Addiction Services and Supports. I am your host, Jerry Gretzinger, and you know today we're going to be talking about some myths, some misinformation, specifically about harm reduction supplies and tools and services that are out there, because we're doing an awful lot as an agency and as a state to make sure that people have access to harm reduction supplies and we want to make sure that people understand you know the reality about using them, what they do, how they work. And we have some folks who are joining us now to shed some lights on the truth, the facts, because they know what they're talking about. And these people are Cameron Coleman he's the project director and Biz Berthe, also a project manager here with OASS. Thank you both for sitting down with us this afternoon.

Jerry Gretzinger:

And so you know, let's get right to it. We're talking about the supplies, the things that are out there that help people, you know, understand harm reduction and be able to practice harm reduction. So I know one of the things that we've heard about in the past and I think we've discussed here and there, yet people continue to have some misunderstanding of it is the products where fentanyl can be present and cause, you know, the risk of an overdose, and one of them and we've had people talk about it and ask about it is cannabis different kinds of cannabis. Is that a place where somebody can or should be concerned about fentanyl's presence and its ability to cause an overdose?

Cameron Coleman:

It's a really good question, Jerry, a great place to start from and, I think, something that comes up really frequently. That's a really common misperception that comes up and not at the fault of any one person in particular, because there are a lot of point of fentanyl itself as a substance. So fentanyl, as a powdered substance, has a much lower burning point than cannabis does. So, even hypothetically, if someone were to sprinkle fentanyl powder on top of cannabis and then light it directly to a flame, the potent component of fentanyl would be deactivated before it would enter your system. So that isn't an incident where somebody could overdose from cannabis through fentanyl, could overdose from cannabis through fentanyl.

Cameron Coleman:

However, with that said, I think it's important to note that there are reasons why this has come up in the media and there are varying reasons that have led to the different reports of this happening. Sometimes it's due to misinformation, or know misinformation, or a lack of understanding, lack of the full context around what the person was consuming at the time. Sometimes you know somebody will say that the only thing they consumed was cannabis because of fear of stigma you know around the other substances that they may be using of stigma. You know around the other substances that they may be using. So that information, does you know, tend to come out after the fact, once those reports have already flooded their way through the media. So, iz, I don't know if you have anything else to add on that.

Jerry Gretzinger:

Yeah, so sorry, sorry, go ahead oh yeah, go ahead. No Biz, please, please.

Biz Berthy:

I mean I was just going to add also that you know sometimes you've seen reports coming from drug checking sort of facilities and something that Cameron and I have learned through a lot of guidance from folks at COHMH and some of the leading drug checking scientists really in the nation, is that drug checking is quite complicated and it's very, very ery easy to misread the samples. And that's why I think, like the gold standard is to always export that might not be the right word but to send your samples to the lab that is attached to the drug checking machine so that way it can be verified before you go public with any kind of statement about what might be in the sample.

Jerry Gretzinger:

Understood, right, that that makes sense. So I wanted to go back to the talk about, you know, people being concerned that it could be in cannabis, and we talk about the burning point, certainly, and so that applies to whether somebody's got something, you know, cannabis that's rolled in a rolled form and they're going to light it, or even even a vape, which I know is a popular delivery method for cannabis, right?

Cameron Coleman:

Yep, absolutely, and that um that actually made me think of a um another. Another point that I did want to mention about um fentanyl in general, with the burning point of it, is that um fentanyl can be, and is, frequently smoked. That is a common route of administration for folks who do use fentanyl by choice, that that is their substance of choice. It can be smoked. However, in order to smoke it in a way that isn't going to exceed its burning temperature and deactivate the effects, the desired effects of the substance, it needs to be lit through a glass barrier or an aluminum barrier, similar to the way that methamphetamine or crack would be consumed, where you're not lighting the drug itself to a flame. So just to clarify that it can be smoked, it's just specifically when you light it to a flame that that is what deactivates it.

Cameron Coleman:

So to answer the vape component of it because that is something that there was somewhat recently a report of that in the media of a vape that was brought into a health department where they offered a drug-checking service and were able to run the sample on the drug-checking device in-house and the immediate result that popped up for them was that there was fentanyl present.

Cameron Coleman:

So then that circulated its way through the media. However, as Biz said at that point, the information was released before that sample had gone through a round of confirmatory testing. And in reality, those drug checking services do have limitations, one of the primary limitations being that it can't test liquid substances. So even trying to test the oil that could come from a vape on one of these machines is inevitably going to produce false results, because the machine itself doesn't even have the capability of testing that type of substance. So in that specific circumstance, when they sent that sample to confirmatory testing, there was no evidence of fentanyl found. I believe the report had also said there was ketamine or Vyvanse present, and both of those were also found to be false.

Jerry Gretzinger:

All right, well, that's good to know. Just one more piece on the talk about cannabis before we move on to something else. I know cannabis. It can be delivered in many different forms, right? So we're talking about the type that is burned. There are edibles, I mean there's everything. There's sodas, there's so many different ways now. So the only time when we can say absolutely, if there's fentanyl in it, it's burned. We're talking about in the burned form, correct? Is there the potential for fentanyl in an edible or in a beverage or something like that?

Cameron Coleman:

That's a. And I think something that can come up a lot because there are so many different f. Acso I think edibles is a good example of that, because in order to make edibles, there is some type of heating process where you have to turn, you know, extract the THC from the cannabis and then turn it either into a butter or an oil. So through that process the fentanyl would be burned off, because going through the oven that temperature would be too high that it would burn the fentanyl off. Similarly with the vape. The temperature of a vape is significantly higher than that of a normal flame. So even if it theoretically made its way into a vape, that would also be deactivated or destroyed before it made it into your system. deactivated or destroyed before it made it into your system.

Cameron Coleman:

So where there is a will, there is a way.

Cameron Coleman:

If there is someone who is actively trying to consume fentanyl and cannabis together, I'm not going to sit here and tell you that there's no way that they could do that, particularly through the consumption of concentrates, where that method of consumption does look a little more similar to the way that somebody would smoke methamphetamine where there is a glass barrier or a foil barrier. But with that said, there have not been any incidents of that happening, of that situation happening, so it's not at this point. You know cause for concern, and I think more so would come as a result of intention, and someone you know doing that and combining those substances because they wanted to consume both of them simultaneously.

Jerry Gretzinger:

All right. Now obviously, you know, when we talk about the whole issue of presence of fentanyl and cannabis, there's so many pieces of it, which is why we, you know, we'd want to explain it as clearly and fully as we can. But there are, you know, some other misperceptions, you know myths, if you will, about the presence of fentanyl and what fentanyl does. So you know a couple of things here. I'll rattle them off and you guys jump in and tell us you know true, false, yes, no, accurate or not. So can somebody actually a reaction or overdose from simply touching fentanyl?

Biz Berthy:

Oh, that is a myth.

Biz Berthy:

Should we elaborate or no?

Jerry Gretzinger:

You can, if you like the second part of that. I was going to say like or inhaling it if it's present in the air.

Biz Berthy:

No, and I think that goes back. That's also a myth. That goes back to sort of some of the science and and chemistry really that that ameron was getting at earlier around, like burning points and vapor, how certain substances can vaporize into the air. Um, and that's just. It is not the case all right.

Jerry Gretzinger:

um, yeah, yeah, go ahead.

Cameron Coleman:

I was just going to add to that um by saying that um. that is. you know. There's a lot of. When. We. The landscape of the drug supply currently, right, is that the drug supply is an unregulated supply where there are various things that pop up. There is new contaminants that pop up, and it's like kind of playing whack-a-mole sometimes, and when a new thing pops up that folks that you know, general public is not familiar with.

Cameron Coleman:

It's really easy to develop a lot of fear around that and to sometimes kind of like demonize a specific substance.

Cameron Coleman:

But what we know about fentanyl is that fentanyl itself is a medication, is an opiate, that is used every single day in hospitals all around the world.

Cameron Coleman:

It is used in epidurals, it's used when people get surgeries. It's a very commonly used medication. So when we think about it in that lens and then you put that same logic to these incidents of it being present on the street, if it was that you know dangerous and lethal to even be around, would they be dispensing it in hospitals as easily as they do? You know, do people in hospitals where you know need to wear hazmat suits or that you know very thorough PPE to protect themselves? And then, similarly, when we think about like apply that logic to its presence in the street, if it was such a lethal substance that if you touched it or were near it that you could die, thinking about the amount of hands that one bag of fentanyl has to go through before it gets to the hands of people who are using it. You are talking about street level dealers, you're talking about bigger level dealers cartel, people who are very likely not utilizing PPE or anything like that and likely aren't touching it or handling it and all of those people would have been impacted if it wasn't that lethal.

Jerry Gretzinger:

So now I want to kind of switch gears a little bit to some of the medications that are out there to assist with opioid use disorder and such so methadone, buprenorphine, two of the medications that are out there and available, and you hear criticism sometimes when people may suggest oh well, using one of those is like replacing one substance for another. How would you respond to that?

Biz Berthy:

Yeah, I would just say that I would, you know, adamantly oppose that stance. I mean, for, especially when it comes to methadone, that's been. Both methadone and buprenorphine have been considered the gold standard of treating opioid use disorder for many decades now and, like I said, particularly methadone and that is that is just simply not the case chemically. I know I keep saying that, but that is that's the truth and you know I don't want to bore everyone getting into all of this.

Jerry Gretzinger:

And I know we've had other episodes of the podcast too where we've talked about it and the effectiveness of it and how how much good it does and there is it's just a level of misunderstanding sometimes, which is why we like to sometimes repeat ourselves to make sure that message is getting across to everybody. What about?

Cameron Coleman:

I keep adding on to these, but I'm very passionate about these topics and I think that's something that comes up really frequently with methadone and buprenorphine, and I think that's something that comes up really frequently with methadone and buprenorphine, and I think something like that is so vital to bring up within that context is it goes back to the current landscape of the drug supply that people have access to.

Cameron Coleman:

Enrolling in those services are doing so as a means of risk mitigation, so that they know what they're putting in their body, opposed to what they're purchasing on the street, which they don't necessarily know 100% what it is. And at this point there are so many adulterants in the supply that could be fatal to someone that when we talk about you know long-term effects of methadone, if someone stays on methadone for their whole life, isn't that going to impact them long term? Well, if the alternative is that you know they're denied methadone so that they go to the street to purchase whatever it is there, very realistically the length of their lifespan will be cut short anyway by methods of you know an unregulated and unsafe supply. So when we think of it like that, it's really just a matter of enabling people to, you know, have the tools to make those choices for themselves and live as long as they're able to.

Jerry Gretzinger:

Yeah, Kind of along those lines. People who think or suggest that methadone or buprenorphine creates a pleasurable or euphoric feeling for the user. True, false.

Cameron Coleman:

Both. It can be true or false. It depends, because there's also varying usages. There's varying doses. If somebody is on a higher dose, there may be more euphoria, whereas if someone is on a very low dose, it may not even touch their craving, may not even impact them or help them. Necessarily, and specifically with fentanyl and now with nitazines in the supply, which is another very powerful opioid, what we're finding and seeing more and more is that minimum dosing has needed to be increased because it's not even touching the withdrawal effects of fentanyl.

Jerry Gretzinger:

And then we also we've done a lot of talk about naloxone Narcan is one of the brand names, obviously, and that's the opioid antagonist right so that if somebody is in the process of an active overdose this can reverse that overdose and save a life. But again, when we talk about the criticism sometimes this gets some people say, oh well, naloxone, narcan, it just encourages people who use substances to continue using substances.

Biz Berthy:

I would say that's false. I think that's just the wrong framework to approach any life-saving medication, whether it's naloxone or, you know, medicine for diabetes, insulin, anything. I think you know our goal should be enabling people to stay alive and, you know, make the choices that they feel that they need to make to stay healthy and well. But you, just you can't do that if you, you know, if you pass from a fatal overdose. So I would say that is very much false.

Cameron Coleman:

Yeah, um, and an analogy that I love to make when this comes up, because this also comes up very frequently, is, uh, that saying that naloxone enables um drug use is like saying that having a fire extinguisher enables fires, that if you have a fire extinguisher on site, you're more likely to set fire around you. Uh, You're not necessarily more likely to do that at all, you're just now empowered with the tool to be able to, you know, mitigate the harm if it does happen.

Jerry Gretzinger:

Yeah, that's a good comparison to make. And so we'll finish up with another question about naloxone. And you know the nasal delivery is like a four milligram dose, and some people wonder can you administer as many doses of naloxone as you want, or do you run a risk if you do too much or too little? So what's the story on that?

Biz Berthy:

Yeah, I think that comes from a place of, again, not necessarily misinformation, but I think there's just a lot of general confusion about where we are in terms of what's happening with the drug supply, as Cameron's mentioned a few times, and so it is true that it's a game of whack-a-mole and people don't really know what they're getting anymore.

Biz Berthy:

It's true that in some cases, certain supplies are more potent than what they might have been in the past, and so it might be the case that people need more than a single dose of Narcan nasal Narcan. However, I think what we really try to explain to people is that there are real consequences in terms of side effects for people that have had naloxone administered on them, which you know it causes basically instant withdrawal symptoms once they've come to, which is incredibly unpleasant for the person experiencing those symptoms. And of course, it can also, you know, it also increases the risk of overdose for that person later on. So I mean it doesn increases the risk of overdose for that person later on. So I mean it doesn't last in the system that long and then, once it's gone, you know that person's really going to be experiencing those withdrawal symptoms.

Biz Berthy:

And we just have to be mindful of not creating the worst case scenario for someone, which is why, you know also, we always really encourage people to wait the standard three at the minimum, three to five minutes in between each dose that you administer to someone, to make sure, because our opioid receptors are not in our noses, they're in our brains.

Biz Berthy:

So it's going to take a second and three minutes, if you were to sit here for like three minutes in utter silence. That's hard, and it's especially hard when you're trying to save the life of someone that you potentially deeply care for. I completely understand I myself have been there before but it's just something that you have to do to make sure that the medication is doing what it needs to do before you're going in and administering. You know many more doses which I've heard. You know just yeah, I've heard offhand that that some people are doing that.

Cameron Coleman:

Absolutely

Cameron Coleman:

It's a very common instance of situations where multiple doses of naloxone were used, particularly when you hear of those situations where it was like six to eight doses.

Cameron Coleman:

it took six to eight doses and many of those instances, when you look further into it, they were not waiting three minutes in between each dose, not necessarily waiting a full minute, and just feeling really anxious after 30 seconds, which makes sense. It's a really stressful, anxiety-producing and scary situation to be in. Now, as I said, the more that you use, the further you are pushing that person into withdrawal, the sicker they're oasas. nygov to be when they wake up and the more likely they are going to be to then use again as soon as they feel sick and go right back into an overdose.

Jerry Gretzinger:

Well, you know, I think we certainly don't want anybody to feel confused. You're like oh, should I do one, two, four, six, eight? No, the whole premise here is that we're making naloxone available, test strips available, because we want everyone to be prepared to help save a life right, and we're trying to clear up some myths and some misunderstandings. And to that end, I want to refer people to our website, oasas nygov. Oasasnygov, and once you're there, we have all kinds of information. We actually have information that talks about how to administer naloxone, how to use test strips all of that information. So if you want to know more, that's where to find it. That's also where you can order these supplies, and we encourage you to do that. Cameron and Biz, thank you guys so much for sitting down and having this conversation with us today. It's always good to try to, you know, clear the air of misunderstanding, and I think we did a lot of that today.

Cameron Coleman:

Thank you so much,

Jerry Gretzinger:

all right. oasas.

Jerry Gretzinger:

And hey, you know what I'll put out there too. We don't always do this, but I'm going to do it today. If somebody's out there listening and you have a question, something you're not sure about, some maybe misunderstanding that you've got, send us a message and I'll give you the email address. It's communications, just the word communications at oasas. nygov, and we'll take care of that. We'll get it on here. We'll get some experts to give you some information and try to, you know, put aside more of those myths and misunderstandings. Again, guys, thanks so much for sitting there and chatting with us for the last 20 minutes or so, and thank you for checking out this episode of Addiction. The Next Step I'm your host, jerry Gretzinger, and we will talk to you and see you next time.

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