Illustration by Helena Warner
Near the end of September, the Sequoia Union High School District (SUHSD) released an email titled “Important Safety Alert.” The email warned the SUHSD community of a dangerous epidemic: rainbow fentanyl overdoses. Following the announcement, the district elected to begin supplying SUHSD campuses with Narcan, a drug that reverses opiate overdoses.
An abundance of misinformation surrounds rainbow fentanyl. The purpose of this article is to demystify the fentanyl epidemic and direct the SUHSD community to harm-reduction services.
What is Fentanyl?
Fentanyl is a synthetic opiate belonging to the same class of drugs as morphine, heroin, and methadone. Unlike opium, a derivative of the poppy plant, fentanyl is produced quickly and inexpensively because it does not require growing poppy plants. According to the Drug Enforcement Administration (DEA), Fentanyl is 100 times more potent than morphine, and as little as two milligrams can result in a lethal overdose.
Fentanyl exists in powder and chalk forms. It can be packed into pills and capsules, or dissolved in liquids. Illegal drug manufacturers use Fentanyl to lace or “cut” other illicit substances because of its versatility. Lacing drugs increases profits and the speed at which users develop dependencies. Dealers rarely advertise their products as fentanyl because of its negative reputation. Instead, they mix fentanyl with other substances and market it as “party” or “soft” drugs like cocaine, MDMA, prescription stimulants, downers (Xanax, Vicodin) and prescription opiates. Any substance that exists in pill, powder, chalk or liquid form can contain fentanyl. Oftentimes, these mixtures will not contain the advertised drug at all.
Traditionally, most teenagers consider illegal opiates like heroin “hard drugs.” Fentanyl shares this image. However, teenagers see other regulated substances less negatively. Adderall’s deceptively innocuous image is particularly dangerous. This stimulant is prescribed for the treatment of ADHD symptoms, including difficulty focusing. When taken by individuals without ADHD, the drug can boost focus and allow an individual to intensely fixate on a specific task, leading some high school students to take the drug as a “study booster.” While taking Adderall without a prescription puts the user at risk of legal and health consequences, fentanyl lacing in Adderall has made it exponentially more likely that a user will overdose, sometimes even on the first use. The same is true for any substance that exists in pill, powder, capsule, or chalk form.
First Use Overdoses and Narcan/Naloxone
The Centers for Disease Control and Prevention (CDC) estimated that drug overdoses caused 107,622 deaths in 2022. Synthetic opiate overdoses accounted for 71,238, or approximately 66%, of all drug overdoses. According to Dr. Laura Webb, a pediatrician in Menlo Park, illegal drug manufacturers can easily alter fentanyl to increase its potency because of its chemical structure. Webb explained, “Fentanyl is used intraoperatively, and already we are seeing certain children and teenagers have a tendency to be overly sensitive to the drug.” Medical fentanyl administration requires high levels of precision. On the street, fentanyl content can easily surpass double the lethal dose (DEA).
A lethal dose of fentanyl is about the size of two grains of sand, or even smaller. Additionally, fentanyl can have a negative drug interaction with the substance it is mixed with, which increases the likelihood of an overdose. Fentanyl is capable of being fatal on its own, but is especially dangerous when mixed with other opiates.
Fentanyl’s extreme potency makes first use overdoses more common. Webb said, “It is devastating how a young person with a bright future can make one poor decision that ends with their parents finding them cold in their bed.”
The most effective method of reversing an opiate overdose is administering Naloxone (Narcan). Naloxone is an opiate receptor antagonist typically administered through a nasal spray. Drugs like fentanyl or other opiates are agonists, meaning they increase neural activity, binding with endorphin receptors and releasing a flood of dopamine into the synapse, causing the euphoric “high.” Antagonists work in the opposite fashion, decreasing neural activity by binding to opiate receptors and blocking agonists from bonding. In short, fentanyl turns the faucet on, naloxone shuts it off. Narcan is relatively simple to use, however, it requires some basic training. This video explains how to administer the life saving drug. Narcan/naloxone is available in pharmacies. Dr Webb recommends, “all parents of pre-teens and teenagers keep Narcan in the house.”
The only way to accurately assess whether a substance contains fentanyl is with a fentanyl test strip. This inexpensive resource can save lives. Test strips are available online from services like Amazon, and several San Francisco clubs and bars have begun keeping test strips in restrooms. However, it is difficult for teenagers to access this service discreetly. M-A does not currently have fentanyl test strips.
There is a notion that harm-reduction services encourage drug use. Some argue that providing test strips and Narcan will create a false sense of safety, leading to increased teen drug use. Webb disputed this argument saying, “Time and time again, we have seen that more knowledge and harm reduction resources does not equal more use.” She cited the push for accessible birth control as an example of this phenomenon; people who were not previously sexually activity did not engage in more sex because of this resource.
The CDC provides instructions for the use of test strips.
Fentanyl’s molecular structure is easily altered. Chemically altered fentanyl (fentanyl analogues) can be far more potent than the standard drug. One analogue, carfentanil, can be more than 100 times stronger than fentanyl. Additionally, fentanyl test strips only pick up some analogues.
District Stocks Up on Narcan
Sequoia Union High School District is currently ordering Narcan, which will be distributed among its campuses. District nurse Kristen Coronado said, “We are working with the San Mateo Office of Education. They are the ones who get the actual Narcan, and then it is distributed to all the schools in the area.” Coronado compared the resource to EpiPensepipens kept in the office. However, the lifesaving drug cannot be distributed until all nurses and administrators have been trained in its proper application.
There is an abundance of misinformation about identifying fentanyl and assessing its potency. One myth specific to rainbow fentanyl is that color corresponds with potency. This myth is easier to debunk, given numerous conceivable ways to change the color of a substance (e.g. food coloring). However, some pseudoscientific methods of detecting fentanyl exist on the Internet. For example, some claim that you can detect fentanyl in Xanax by dropping it in water. Because fentanyl is water soluble, it is assumed that if the substance dissolves, it is laced because Xanax is fat soluble. Webb rejected this bogus method, saying, “The only way to detect fentanyl is with a test strip.” There are many reasons why a drug would not dissolve even if it contained fentanyl. Most capsules are made of gelatin, and are designed to dissolve in stomach acids, not water. Therefore, a capsule could be filled with only fentanyl, be submerged in water, and still not dissolve.
Fentanyl is a new epidemic. While drug use has always been a risky activity, it has become exponentially more dangerous in recent decades. Fentanyl not only increases addiction, but fatalities. It is important for our community to be aware of and proactive about this crisis. Narcan is the first step towards a safer environment, and test strips are a logical second. The implementation of harm-reduction services and education surrounding fentanyl will hopefully mitigate the dangers it poses to our communities.