Letter: ‘Rainbow fentanyl’: fact vs. fiction

If you’ve seen or heard the news in the past month, you’ve likely heard about “rainbow fentanyl.” There has been a lot of fear and panic from parents about their children being given candy containing fentanyl this Halloween.

The good news is there is no evidence to suggest there is fentanyl being laced into Halloween candy. This hasn’t been proven or even claimed by the Drug Enforcement Administration. The bad news is that middle and high schoolers can purchase pills through social media, friends or family. These pills may mimic the appearance of legitimate prescription pills but can contain fentanyl, which can be deadly even in small amounts.

Fentanyl is driving the opioid epidemic, which is worse in the U.S. than in any other country. We need evidence-based strategies that are likely radically different from the approach we have taken in the past to address this crisis. We hope we can ease fears around rainbow fentanyl and help clear up any misconceptions.

Fentanyl is a medication that is commonly prescribed that has been around since 1959 as an intravenous anesthetic. It is used for treating severe pain during and after surgery, for cancer patients and for people with chronic pain. It is also commonly used during labor. Fentanyl is frequently safely and effectively prescribed but can be very dangerous for people who obtain it illegally or accidentally ingest it. It was also involved in over two-thirds of overdose deaths in 2021, in part due to its potency (it is 50 times stronger than heroin and 100 times stronger than morphine). There is no evidence that has been provided by the DEA of new campaigns from cartels targeting children or that fentanyl is being laced into candy.

“I don’t see any evidence that the DEA has produced that supports that conjecture,” Nabarun Dasgupta, a researcher studying illegal drugs at the University of North Carolina told NPR.

Drug experts say brightly colored fentanyl is not new and has nothing to do with children. It may be to distinguish types of pills from one another. Young kids who see these bright colors do not have access to large amounts of money and do not make for good repeat customers. There are also severe punishments for dealing drugs to kids.

Our coalition does medication takebacks many times throughout the year and has done so for many years. All of the medications being dropped off to us for safe disposal have been prescribed by doctors. What we end up with is many bags full of rainbow-colored pills. Pills are different colors to help pharmacists, doctors and patients distinguish them from one another. In the case of “rainbow fentanyl,” these different colors could help drug users identify what is in them and their potency and may actually help keep people safe.

Teens are using drugs (including prescription drugs that are not prescribed to them) at lower rates than in years past, yet unfortunately, we have seen more overdoses. This is not because of the colors of the pills, and there is no evidence linking these to “rainbow fentanyl.” It is because our drug supply is unpredictable and contaminated. If you buy a pill on the streets, it may be illicitly manufactured and not from a pharmacy and may contain fentanyl, which is a lot more potent, increasing the risk of overdose, especially if you don’t know you’re taking it and are opioid-naive.

DEA Administrator Anne Milgram, in a Fox News interview, said: “We have not seen any connection to Halloween. I want to be very clear, if we see it, I promise, you have my commitment, any credible evidence, we will come out and we will tell you.

“What we do see is social media; we see fake pills. … We see rainbow pills, a new tactic being used by the cartels, and here’s what we worry about: We have middle schoolers and high schoolers who are dying of fentanyl poisoning. We have 12-year-olds, 13-year-olds, 14-year-olds who are dying. And so we are not seeing it in elementary school. We have not seen it with Halloween candy. But the bottom line is that this is all over social media, and so we know it’s out there.

“Parents, we are begging families and parents to talk with their loved ones and to talk with their children. Never take a pill that wasn’t prescribed directly to you. Help your child come up with an exit strategy. What do you do if a coach or a best friend or another member of your family offers your kid a pill? What should they do? No legitimate pharmaceuticals can be sold on social media, so make sure your kids know that. And finally, just understand that many people who are dying of fentanyl poisoning had no idea that they were taking fentanyl.”

Fentanyl is a potent drug that has caused a lot of overdose deaths, but we need our work to be based on evidence if we are going to deal with this crisis appropriately.

Brandon del Pozo, an addiction medicine researcher at Brown University, told NPR that false alarms and drug scares matter because they distract attention from need for better health care and addiction treatment at a moment when more than 100,000 Americans are dying from overdoses.

It’s time for evidence-based messaging and drug policy. Hopefully, the DEA will be held to a high standard of evidence-based messaging as a trusted government agency. We have seen how damaging it is for any agency to broadcast speculations without evidence backing them up. The DEA also issued an alert about brightly colored fentanyl being smuggled in a Lego box but also acknowledged in this alert that this was not to appeal to children but to “deter law enforcement attention.”

One simple way to prevent others from accessing prescription medication or other substances is to secure it in a lockbox or locked cabinet. Please contact us if you need one.

Naloxone is another important tool for anyone taking opioids. We offer this resource for free, and it is also available to any person through the North Carolina standing order at any pharmacy. While not perfect, fentanyl test strips also help identify fentanyl in substances, including fake pills.

Please check out the FDA’s Halloween Safety Guide for this year and be aware as a driver or a pedestrian to watch for extra foot traffic and cars when crossing streets. Tell your kids not to accept or eat any candy that is not commercially wrapped and to throw away anything that is damaged, discolored or if the wrappers are torn. Have a happy and safe Halloween!

For more information, please see the following sources:
• “Is ‘Rainbow Fentanyl’ a Threat to Your Kids This Halloween? Experts Say No.”
• “‘Rainbow Fentanyl’” Is Probably a Good Thing at This Point.”
• “Fentanyl Overdose: U.S. Teens Fastest Growing Group to Die.”
• “What to Know About ‘Rainbow Fentanyl’ and Its Risks for Kids.”

— Miranda Poe
Prevention coordinator
RHA Health Services
Asheville