On Tuesday, Chad Sabora, a former opioid user who now helps others with harm reduction, and Sarah Sottile, a Ph.D. in neuroscience and pharmacology, posted a video that showed Sabora intentionally touching a visible quantity of verifiably genuine fentanyl.
Why did Sabora and Sottile do this and post it on Facebook? Simply to prove a point: The urban myth that merely touching fentanyl can cause clinical and potentially life-threatening effects is, as I reported last year, total nonsense. Since May 2017, when the story of an Ohio drug enforcement officer who believed he overdosed on fentanyl simply by brushing some powder off his vest went viral, two main reactions have emerged: truth, and the American way—which it probably bears stating, are increasingly antonyms.
On the side of truth, reason, science, and dispassionate analysis have been the nation’s top expert bodies on medical toxicology who issued a joint statement on the issue; the Centers for Disease Control and Prevention, which amended some of its previous misleading language on the topic to make things more clear; and the White House, which released recommendations from an interagency working group that included participation from the Justice, Transportation, Health and Human Services, and Homeland Security departments—as well as the FBI and the DEA, among others. All of these stakeholders have reached the same conclusion: Brief occupational skin exposures to fentanyl and its other potent opioid analogs pose no clinical threat to anyone. It is safe to give naloxone (the highly effective opioid antidote) to patients with suspected opioid overdose without fear of getting exposed to fentanyl in the process. In fact, the only way to get pain relief, high, or sick from dermal exposure to these compounds is through prolonged intentional efforts, via specially designed skin patches manufactured by pharmaceutical companies to help patients with chronic illnesses safely receive appropriate analgesia.
On the side of drivel bolstered by Americans’ appetites for “eyewitness news” have been a number of local authorities peddling what amount to ghost stories masquerading as true tales from the front lines. They make for great headlines and evening news segments. The stories have become archetypal and run like something like this: A first responder participating in a police action against a suspected drug dealer believes he or she has been exposed to fentanyl, even passively. He or she then experiences some symptoms which, for the most part, appear to have nothing to do with the types of clinical effects that genuine opioid overdoses cause. Two treatments are given: time and naloxone. The patient feels better. The naloxone gets the credit, though it is likely that time was the truly efficacious “medicine,” as is common in cases of what are likely to be panic attacks (understandable given the alarming nature of these tall tales). Of course, there is never any follow-up evidence that real exposure ever occurred. In some cases, there is direct proof debunking the initial claim that fentanyl exposure even occurred, though once a major media outlet picks up the original story, it doesn’t seem interested in correcting it.
This is the context for Sabora and Sottile’s video. Sabora plays the guinea pig, while Sottile provides some scientific expertise qua color commentary. Their video gets at a central and disappointing truth about how people form their scientific beliefs: People don’t respond to rigorous policy statements from experts. They don’t want egghead medical researchers and pharmacologists “docsplaining” the difference between fantasy and reality. What they want, as Sabora and Sottile clearly understand, is a low-budget movie of an ex-junkie pouring a whole bunch of fentanyl powder onto his bare hands so that they can all sit there and watch as precisely nothing happens.
While I wish such an anecdotal demonstration were not necessary, and that scientific reason and the opinions and statements from bona fide experts were enough, the internet (and the world) is a now a better place because of Sabora and Sottile’s yeomen demonstration. I hope it makes first responders confident that they can go about their jobs without fear so that they can continue their much-needed work making our communities as safe and drug-free as possible—maybe even saving a few lives in the process.
The opinions expressed in this article are solely those of the author and do not reflect the views and opinions of Brigham and Women’s Hospital.
