SEATTLE — Illegal fentanyl use has pervaded public transit and even the streets of downtown Seattle. The problem poses the question of whether inhaling second-hand fentanyl smoke or fentanyl exposure to the skin has any dangerous effects.
Fentanyl-related overdose deaths in King County have risen significantly in recent years. The latest data from King County shows there were 712 fentanyl-related deaths in 2022, compared to 385 in 2021.
The highly potent opioid can be found as a pill, or in powder form. It can be injected, or smoked. While its illicit use is widely reported, the drug is also used as a powerful painkiller in hospital settings.
"It's very effective at relieving pain, making people nice and sleepy, and when used in a controlled setting by trained experts, it's actually very safe," said Dr. Daniel Warren, an anesthesiologist at Virginia Mason Franciscan Health in Seattle.
Warren also serves as the hospital's physician lead for its opioid guiding team and specializes in post-operative pain, particularly with patients with substance use disorder.
But Warren emphasizes fentanyl that is illegally produced, can be deadly.
"When we get into these unpredictable mixtures of fentanyl-related compounds, those can be thousands of times more potent than even heroin," Warren said. "It's important to start out by saying there aren't a lot of scientific studies to give us really good guidance."
However, Warren added the risk is low.
"We have reason to believe that the vast majority of the fentanyl when smoked, is captured within the person smoking it," Warren said.
Public Health - Seattle & King County published a Q&A with the Washington Poison Center, which echoed the same information, saying most of the drug is filtered out by the user before there is second-hand smoke.
"I think the public should be reassured that second-hand fentanyl exposure is very unlikely to cause any real clinical effect for them as a casual passerby," Warren said.
As for skin exposure, Warren said that also has minimal risk, since the drug is primarily absorbed through mucus membranes, such as those found in the lining of the mouth.
"In general, we would expect that most powder forms of fentanyl are not reliably absorbed through the skin," Warren said.
All of this matters, Warren and the WPC said because people should not hesitate to help someone who may be overdosing.
"Because seconds matter in these situations, any delay in rendering aid could mean loss of life," Warren said.
Warren emphasizes more research needs to be done, adding if anyone suspects they have touched fentanyl powder, they should wash their hands with soap and water immediately, if possible, as a precaution.
The Centers for Disease Control and Prevention has a list of advice for first responders on how to protect themselves, should they be exposed to fentanyl.