Public Health Alert as Deadly Rainbow Fentanyl Looks Like Sweet Tarts

Doctors are urging parents to be extra careful this Halloween due to an increase in the highly lethal drug fentanyl that's entered the United States. "Yes, parents should be concerned about fentanyl this year.," Travis Henson, MD Medical Director Emergency Department Dignity Health St Bernardine Medical Center tells us. "There has been a large influx of fentanyl into the US from Mexico. Drugs are being laced with it and we have seen unsuspecting adults overdosed on this medication by taking their normal illicit drugs that have been laced.  Fentanyl can also be laced or added to candies that look just like the familiar candy kids eat.  They taste sweet and there would be no indication it's been poisoned." 

In addition, Henson reveals that emergency rooms are seeing an uptick in fentanyl cases. "Drug dealers are lacing drugs with it and unsuspecting people are taking in fentanyl when they had no clue they were getting fentanyl along with their normal drug.  Typically these people are found unconscious and brought to the ER. We have to have a high index of suspicion, but we will often give narcan, the antidote, and it can wake them up.  Because fentanyl is so strong, it can sometimes take two or three doses of narcan to revive someone.  We have seen people die from this, especially if they don't get to medical personnel fast enough."

Less than two months after the Drug Enforcement Agency issued a public warning, "of an alarming emerging trend of colorful fentanyl available across the United States," authorities seized thousands of fentanyl pills at Los Angeles airport from someone going through security around 7:30 a.m, the Los Angeles County Sheriff's Department said in a statement. "LA County Sheriff's Narcotics Bureau Detectives and Drug Enforcement Agency (DEA) agents assigned to a task force at the Los Angeles International Airport seized approximately 12,000 suspected fentanyl pills." 

According to the statement, "The suspect attempted to go through TSA screening with several bags of candy and miscellaneous snacks with the intent of boarding a plane.  However, it was discovered that inside the "Sweetarts", "Skittles", and "Whoppers" candy boxes were fentanyl pills and not candy.  The suspect fled prior to being detained by law enforcement but has been identified and the investigation is on-going."

As kids get ready for trick-or-treating the DEA warns, "Since August 2022, DEA and our law enforcement partners seized brightly-colored fentanyl and fentanyl pills in 26 states.  Dubbed "rainbow fentanyl" in the media, this trend appears to be a new method used by drug cartels to sell highly addictive and potentially deadly fentanyl made to look like candy to children and young people…"Rainbow fentanyl—fentanyl pills and powder that come in a variety of bright colors, shapes, and sizes—is a deliberate effort by drug traffickers to drive addiction amongst kids and young adults," said DEA Administrator Anne Milgram. Read on—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.

1

What to Know About Fentanyl

Female pharmacist with protective mask on her face working at pharmacy.
Female pharmacist with protective mask on her face working at pharmacy.

Kelly Johnson-Arbor, MD, FACEP, FUHM, FACMT Medical Toxicologist and Co-Medical Director at the National Capital Poison Center tells us, "Fentanyl is a powerful opioid analgesic that was developed in the 1960's and initially marketed as an intravenous anesthetic agent. Since then, fentanyl has been used in the United States, typically in hospital settings, for the treatment of severe pain. While some opioid analgesic drugs are derived from the opium poppy plant, fentanyl is synthetic in nature, meaning that it must be created in a laboratory setting. Historically, prescription fentanyl has been manufactured in the controlled and scientific laboratories of pharmaceutical companies.

These formulations of fentanyl are carefully studied and regulated by the United States Food and Drug Administration (FDA). In recent years, however, illicit and non-pharmaceutical formulations of fentanyl have been introduced into the United States. These illicit fentanyl products are not regulated by the FDA. They are manufactured in clandestine laboratories, trafficked into the United States, and sold as pills or powders. Illicit fentanyl may be sold on its own or added to existing recreational drugs. Currently, most overdoses and deaths in the United States related to fentanyl are due to illicit fentanyl exposures."

Ricardo Whyte, MD Addiction Psychiatrist Section Chief of Psychiatry with Dignity Health St. Bernardine Medical Center  and Killing Burnout explains, "People should know that fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. It is also a prescription drug that is also made and used illegally. It can be used to treat patients with severe pain especially after surgery or it can be used to treat patients with chronic pain who are physically No longer able to experience benefit from other opioids due to a condition called tolerance.  tolerance is a phenomenon in which a person needs higher and or more frequent amounts of a drug in order to get the same desired effect that a lower dose once provided. People should also know that fentanyl can be given as an intramuscular shot, a patch that can be put on a person's skin, or as a lozenge that can be sucked like a cough drop."

2

Why Fentanyl is so Deadly

pharmacist squeezes hand sanitizer to the customer
pharmacist squeezes hand sanitizer to the customer

Dr. Henson explains, "Fentanyl is a drug used in hospitals safely.  It isn't a bad drug when used properly.  What can make fentanyl so deadly is that it is 50 times stronger, or more potent, than heroin and 100 times stronger than morphine. It is a major contributor to fatal and not fatal overdoses in the US.  Small amounts of this drug can be quite deadly."

Dr. Johnson-Arbor says, "Fentanyl is an extremely potent drug. It's approximately 100 times more potent than morphine. Respiratory depression, which is another term for slow or ineffective breathing, is a side effect of all opioids. When breathing slows or stops, the brain, heart, and other organs do not receive adequate amounts of oxygen, and this oxygen deprivation leads to organ failure and death. Because fentanyl is so powerful, the consumption, inhalation, or intravenous administration of small doses of the drug can cause people to have life-threatening respiratory depression. As little as 2 milligrams of fentanyl is enough to cause severe respiratory depression and death in humans."

Dr. Whyte tells us, "Provisional data from the CDC's National Center for Health Statistics report that there were an estimated 107,622 drug overdose deaths in the United States during 2021, an increase of nearly 15% from 2020. Specifically, the new data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021, with fentanyl being a major player. One of the dangers that makes fentanyl so problematic is that it is a synthetic opioid, which can be 50 to 100 times more potent than morphine. In other words even small quantities of fentanyl have the potential of being lethal and associated with overdosing.  It's also much cheaper to make than its counterparts. This has resulted in it being mixed with other illicit drugs to increase their potency, which has contributed to the significant increase in fatal overdoses.  When people overdose on fentanyl the drug can cause their breathing too slow or stop altogether resulting in decreased oxygen delivery to the brain causing a condition called hypoxia. If the brain is devoid of oxygen for too long the result can be a coma, permanent brain damage and even death."

3

Why Kids Are Being Targeted

Dr. Henson states, "Kids are an easy target.  They like candy and their small bodies will be quickly affected by small amounts of fentanyl.   If you were trying to hurt someone, hurting their kids is an easy way to do it.  Giving kids candy with fentanyl is an act of terrorism."

Dr. Whyte adds, "Theoretically, the drug industry attempts to get children hooked on drugs at a young age, as it would lead to higher revenues over time. However, when it comes to the dangers of contaminated Halloween candy, this sounds much like past years' hoaxes of razor blades in candy or poisoned treats. It seems that with the spooks of Halloween, each year comes with a tale of villainous offenders that could hurt our children.  Nonetheless, as a parent, we should always be mindful of the safety of our children." 

4

Signs of Fentanyl Overdose

smoothies for kids
smoothies for kids

According to Dr. Johnson-Arbor, "Fentanyl overdose causes respiratory depression (a slow or absent breathing rate). People who overdose on fentanyl or other opioids may appear to be sleeping, but their respiratory rate may be dangerously low. When this happens, oxygen cannot effectively enter the body and organs become deprived of oxygen. If fentanyl overdose is not treated promptly, permanent brain damage or death can occur.

Fortunately, there is an antidote for fentanyl called naloxone (Narcan®). Naloxone is available as a nasal spray that is easy to use by bystanders and first responders. It does not require specialized training to administer, and it's available without a prescription in every state. While naloxone can rapidly reverse the respiratory depression that occurs after fentanyl overdose, people who receive naloxone still need medical observation due to the potential for recurrence of overdose symptoms."

5

How to Help Keep Kids Safe This Halloween

adult halloween costume
adult halloween costume

Dr. Henson says, "Parents should know where the candy is coming from.  Kids should not take candy from people they don't know.  All candy should have original manufacturer packaging.  Bulk candy that is already open is strictly off limits.  I would trick or treat in neighborhoods where the neighbors are known and the candy is in wrappers and unopened.  Many people are doing small parties and doing trunk or treating instead, where children go from car to car with people they know and getting candy from the "trunk" of a car."

Dr. Johnson-Arbor explains, "In 2022, brightly colored fentanyl pills, often called "rainbow fentanyl" were discovered in the United States and seized by the United States Drug Enforcement Agency (DEA). Across the United States, from California to Connecticut, the DEA has intercepted and seized fentanyl pills that were packed inside candy boxes and bags labeled as "Nerds", "Skittles", and "Sweet Tarts". There is no evidence at this time that rainbow fentanyl is being specifically marketed to children as candy, and it's certainly possible that the candy boxes are instead being used to conceal the drugs from the DEA and other authorities. However, these stories are quite concerning, especially during trick-or-treating season when many of us are giving away or eating candy. To keep kids (and adults) safe from unintentional fentanyl exposures this Halloween, distribute and eat only pre-packaged candy. Avoid the consumption of homemade Halloween treats, and discard any candy that is not professionally wrapped and packaged in its original container. Also, do not take any pills that were not prescribed to you by a licensed medical professional."

Dr. Whyte says, "Rather than taking away yet another opportunity for kids to be kids, parents should be mindful of strategies that allow their children to have fun, safely. 

Here are some tips that parents can do every year (not just this one) for safe Halloween Trick or Treating: 

1) Trick or Treat in your own neighborhood, or in a neighborhood where you actually know the neighbors. In communities where neighbors know each other, it is far less likely that your children would be getting anything dangerous in their treat bags. Also, it is more likely that you would know if there are certain homes that would be better to avoid. For example, homes where there are many occupants that come and go, homes that have occupants that are known for drug or alcohol abuse, or homes that house registered offenders (you can search your neighborhood on www.Meganslaw.ca.gov). 

2)Stay with your children and keep them in eyesight. It is a good rule of thumb to accompany children as they go trick-or-treating, in order to make sure they are safe. Tell your children to stay on the porch when receiving candy, and to never enter a person's home. If you see something that looks strange, have your child skip that home.

3)If your children are trick-or-treating with friends, make an effort to get to know the other parents. Do not let your child go with adults you do not know.

4)Check your child's candy bag before they consume any candy. Throw out any items that are opened, torn, or look suspicious.

5)Follow Trick or Treat etiquette. 

–Respect the lights on/off rule. Don't bother people in homes that have their lights turned off. 

–Ring/knock on doors (if the light is on) and wait patiently for a response. If there is no response, move on to the next home. 

–Accept what is offered, and thank the giver. 

–Use sidewalks and pathways, don't walk through lawn and gardens.

–Respect an appropriate ending time. Typically, homes will turn off lights between 8-9pm, especially if Halloween falls on a school night." 

6

Types of Candy Fentanyl Would Most Likely be In and Visual Signs to Look Out For

Happy family celebrating Halloween
Happy family celebrating Halloween

Dr. Henson says, "Fentanyl could be in any candy, particularly any candy that has been opened.  Many times the candy will be bright colored and the candy could be in a wrapper and in a bag to make it seem official.  We have also seen fentanyl found in common candies like skittles and whoppers, just to name a few.  Bottom line: don't accept candy from anyone you don't know." 

Dr. Johnson-Arbor shares with us, "The DEA has seized illicit fentanyl pills that were packaged in candy boxes, but it's unlikely that drug cartels will give away free fentanyl pills disguised as candy this Halloween. Drug dealing is a business, and giving away free fentanyl is a money-losing endeavor. Rather, it's more likely that people will unintentionally overdose on fentanyl that is present as a contaminant of other street drugs (like cocaine or heroin). Fentanyl does not have a characteristic appearance, and there is no easy way for people to confirm that a street drug does or does not contain fentanyl. Fentanyl may appear visually attractive and brightly pigmented (e.g., "rainbow fentanyl") or it may be packaged in pill or powder formulations. To avoid exposure to fentanyl, do not use pills or drugs that are not prescribed to you, even if they look professionally made or resemble standard prescription drugs (like Percocet or oxycodone)."

Dr. Whyte adds, "The concern raised by the DEA recently has to do with "rainbow fentanyl" which refers to fentanyl pills and powders that come in a variety of bright colors, shapes, and sizes. The DEA states this is a deliberate effort by drug traffickers to drive addition amongst kids and young adults. As such, candies that could be similar in look include SweeTarts, Nerds, and Skittles. There have also been reports of fentanyl pills packaged in candy containers that have been seized at various airports. However, it is important to note that while the pills were attempted to be smuggled in candy containers, it is not likely that these same packages were planned to be distributed during Halloween. Rather, it may have simply been a poor attempt to sneak pills through security checkpoints. The truth is that the likelihood that drug traffickers would be freely handing out fentanyl pills this Halloween is low for a number of reasons. First, incidental ingestion of a drug is not likely to produce addiction in children. Second, since very low doses of fentanyl can be lethal (2mg, which can fit on the tip of a pencil), consumers would be more likely to die of accidental ingestion, leaving drug traffickers with fewer people to target. Third, who gives out free drugs? And my personal favorite, if your child can pick out the carrot you tried to hide in their chicken nuggets, I have a feeling they would notice the "candy" that looks different."

7

All Forms of Fentanyl are Deadly

man holding a glass of alcohol and a handful of pills
man holding a glass of alcohol and a handful of pills

Dr. Johnson-Arbor emphasizes, "All forms of fentanyl are potentially deadly, and deaths related to illicit fentanyl use are increasing in the United States. If you or a loved one has unexpected or unwanted symptoms after using opioid analgesics, including fentanyl, contact Poison Control for expert, nonjudgmental, and personalized advice. There are two ways to contact Poison Control: online at www.poison.org or by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day. To learn about how to obtain naloxone, visit https://www.naloxoneforall.org/."

Dr. Whyte says, "Halloween stories aside, this issue does bring up a very real and scary subject of the increasing rates of drug addiction, particularly involving fentanyl, in recent years. 

To me, the real issue is the prevention of addiction. We all know that as stressors increase, so does a person's inclination to engage in avoidance or escape behaviors, which are the breeding ground for addiction. So, what can we do to prevent this cycle? We need to intervene at the first sign of distress, what many are identifying today as burnout. If we can increase resilience and decrease burnout well before it becomes unbearable stress and the need to escape with drugs, we'll have a chance at fighting against this epidemic. For more information on ways to combat burnout and build resilience, check out www.killingburnout.com."