An epidemic of fentanyl misinformation: How politicians fail to understand the synthetic opioid

Illicit fentanyl, a powerful opioid that is driving overdose deaths in North America, is a major public health crisis — and some policymakers believe the drug is so deadly, it should be reclassified and put into the same category as nuclear bombs and mustard gas.

As the U.S. midterm elections edge closer, calls to label fentanyl a "weapon of mass destruction" (WMD) have emerged from both Democrats and Republicans. In June, Rep. Lauren Boebert (R-CO) introduced the "Fentanyl is a WMD Act," a short, two-paragraph bill that directs the Department of Homeland Security (DHS) to "treat illicit fentanyl as a weapon of mass destruction."

The draft legislation, which has nine Republican co-sponsors, hasn't gone far in Congress yet. But in the same month, Rep. Tim Ryan (D-OH) introduced a similar bill with more specifics. Ryan's bill would empower the federal government to "go after international trafficking syndicates and root out illicit manufacturers and traffickers to take action to stop fentanyl from reaching the border." It, too, has stalled in Congress, with only one Democratic co-sponsor.

Neither bill has much detail as to how DHS would go about doing so, nor do they cite any evidence that such a label would actually do anything to address skyrocketing overdose deaths. Nearly 110,000 people died from drug overdoses in the 12-month period ending in May 2022, according to estimates from the Centers for Disease Control and Prevention. Harsh punishments already exist for fentanyl, which has played an outsized role in these deaths, but is often not the only drug involved.

Nonetheless, demands to change fentanyl's definition have intensified, with a growing number of Republicans using the framing to attack Pres. Biden and other Democrats. Sen. Ted Cruz (R-TX) claimed in September that drug cartels are "exploiting President Biden's open borders," while "Hillbilly Elegy" author James David Vance, a Republican candidate in the Ohio Senate race, has pushed conspiracy theories that fentanyl is being deliberately used to target and kill "MAGA voters" and their kids.

The Biden Administration has responded, with Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy (ONDCP), saying this at a September 23rd press conference: "The threat of illicit fentanyl is serious for our nation and across the globe. This is the reason that simply designating it—or any drug—as a 'WMD' would not provide us with any authorities, capabilities, or resources that we do not already have and are already applying to this problem." Regardless, this proposed strategy doesn't seem to be going away soon.

So what would labeling fentanyl a WMD actually do? The Department of Homeland Security defines a weapon of mass destruction as "a nuclear, radiological, chemical, biological, or other device that is intended to harm a large number of people." Does it really make sense to confine this drug to the same category as chlorine gas and anthrax?

First, this is not a new idea. In 2019, DHS floated labeling fentanyl in WMD, according to an internal memo obtained by Task & Purpose; for whatever reason, the agency never changed their position. DHS, ONDCP, the Drug Enforcement Administration (DEA) and the Department of Defense did not respond to Salon's request for comment.

Those who work in health care, however, are deeply dismissive of the idea. Dr. Ryan Marino, a medical toxicologist, emergency room physician and addiction medicine specialist at University Hospitals Cleveland Medical Center told Salon that this idea doesn't pass "the sniff test" and would only complicate things for medical providers.

"Fentanyl is not a weapon," Marino said. "Fentanyl is already a restricted drug, and in medicine we deal with shortages on necessary and invaluable medicines like fentanyl frequently just because the DEA can arbitrarily restrict production and supply of any controlled substance if they want."

For example, the DEA controls how much Adderall can be produced every year, with the agency partially to blame for the current nationwide shortage. Labeling fentanyl a WMD could result in similar supply chain chokeholds.

"Opioids have been demonized a lot," Marino said. "This makes it even worse and impacts one of the most valuable drugs we have to treat pain, sedation and anesthesia."

First synthesized in 1960, fentanyl was developed as a powerful alternative to morphine. It is considered a Schedule II controlled substance, which means that the DEA feels it has "a high potential for abuse," but still has medical benefits in some contexts. Drugs in Schedule I, like LSD, cannabis and heroin, also have "a high potential for abuse" but "no currently accepted medical use."

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Fentanyl is used safely in hospitals around the country every single day. This is the difference between pharmaceutical fentanyl and illicit fentanyl, the latter often deceptively sold on the street as heroin or other drugs. "Fentanyl" in this context is really a soup of different substances, some like xylazine that aren't even opioids, but also a cocktail of chemically related drugs called fentanyl analogs.

Some fentanyl analogs are actually less potent than fentanyl or heroin, but outside of drug checking services, users have no idea what they may be getting. Other analogs, like carfentanil, are so potent they are used to tranquilize elephants and are 10,000 times more potent than morphine. However, aside from occasional clusters, carfentanil is rarely found in street drugs these days.

While only a few grains of fentanyl can be deadly, that's not typically how the drug is encountered on the street. Unevenly mixed with cutting agents into powders or fake pills, its purity can vary widely, with such unpredictability being a major factor in its lethality. A dose someone took the day before may be widely more potent than a dose taken today. However, naloxone, an opioid overdose reversal drug, seems to still work against these analogs just like other opioids.

"The fentanyl that we have on regular people in the U.S. is not pure by any means. It's often mixed with a lot of stuff," Claire Zagorski, a licensed paramedic, program coordinator and harm reduction instructor for the PhARM Program at the University of Texas, told Salon. "All of the deaths that we're seeing in overdoses attributed to fentanyl are just because of an unregulated supply and because fentanyl is showing up into more and more substances."

Zagorski said in "no way" is fentanyl a WMD. "It's a little irritating calling it a weapon of mass destruction, particularly for those of us who remember 9/11 and all of the panic around that," Zagorski said. "It places fentanyl in the same group as bioterrorism agents and bombs and things like that. … I feel like if they wanted to go down this terrorism route, it would just be fuel to the fire. It would be so bad and just completely against what we know makes sense from a public health standpoint."

Many of those calling for fentanyl to be labeled a WMD cite a horrific incident on October 23rd, 2002, in which some 50 Chechen terrorists, armed with Kalashnikov rifles and grenades, stormed the Dubrovka Theater in Moscow. The rebels took nearly 1000 people hostage, demanding the withdrawal of Russian troops from Chechnya. Russian security forces surrounded the theater for around four days, ending the standoff by pumping a noxious gas into the theater.

The toxic fumes incapacitated the armed militants, who were all executed, presumably while unconscious. As for the hostages, hundreds were hospitalized and more than 130 died. Many questions remain about the crisis, with differing accounts describing the gas used as carfentanil, or a mixture of carfentanil and remifentanil, another potent fentanyl analog.

However, "The identity of the aerosol has never been officially disclosed," according to a 2020 review in the journal ACS Chemical Neuroscience, with other drugs like benzodiazepines and halothane being implicated. So far, only one study has been able to strongly link carfentanil to the attack, and it only had a sample size of three. The way in which the hostages were treated after being knocked unconscious undoubtedly played a role in their outcomes, as some were denied medical care for hours and doctors were never told what gas had been used on the victims.

"People will argue about the Moscow Theater Hostage Crisis, and to those people I would love to see their evidence on how to weaponize fentanyl. There is none," Marino said. "That's just a non-sequitur because it's an unrepeatable event."

Zagorski agreed, describing the theater siege as a "James Bond-level scenario" that's "tremendously unlikely" to repeat itself. "If someone did want to do something like that to harm a bunch of Americans, it would be a lot easier to use something else than fentanyl," she said.

As tragic as this incident was, experts argue it doesn't remotely resemble what drug use or even drug trafficking is like. More than 90 percent of illicit fentanyl is seized at legal ports of entry, not alleged gaps in the border wall. And it is smuggled most often by U.S. citizens, not migrants or asylum seekers. Fentanyl can easily be shipped through the mail, so even closing the border would likely do little to stop the flow of the drug into the states.

The sharp rise in fentanyl trafficking can be attributed to the Iron Law of Prohibition, which posits that increased drug penalties will encourage the development of more potent products that can more easily be hidden for smuggling. For example, during the Prohibition Era, distilled spirits like moonshine dominated the market, because it was easier for bootleggers to transport than beer or wine. In other words, the fentanyl flood has less to do with some diabolical master plan orchestrated by China or Mexico, and more to do with simple economics.

"There seems to be this belief that drug sellers are like cackling evil villains," Zagorski said. "When really, they're just business people that are responding to the context that they're doing business in."

The misinformation surrounding fentanyl and its (lack of) potential as a WMD fits neatly alongside myths that fentanyl is so deadly merely touching it can cause an overdose (not possible) or that "rainbow fentanyl" is being marketed to kids or slipped inside their Halloween candy (also not happening.) That hasn't stopped right wing pundits from slinging these rumors in an attempt to paint Democrats as soft on crime or something akin. Maybe fentanyl isn't a weapon of mass destruction, but it's clearly a weapon of mass disinformation.

But if fentanyl is so deadly it should be categorized alongside Agent Orange and hydrogen cyanide, then perhaps it makes sense for policymakers to offer an alternative: a regulated supply of opioids and other drugs with known purity. This model, called "safe supply," has been trialed in some countries like Canada and Switzerland, with growing evidence that removing the variability of illicit drug use can drastically reduce fatal overdoses.

"I think a lot of the panic that we're seeing now is almost an inadvertent argument for safe supply," Zagorski said. "People just don't realize that that's what they're really advocating for."