What you need to know about "Rainbow Fentanyl"

IIn late August, the US Drug Enforcement Administration (DEA) issued a warning to the public to watch out for a ‘worrying emerging trend’: colored pills and powder versions of powerful opioid fentanyl, known as “rainbow fentanyl”. “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 adults,” the agency said.

While fentanyl does threaten the lives of young people — especially if they don’t know they’re taking it — some drug experts warn that focusing only on the rainbow version can hide other equally dangerous types of the drug. Here’s what you need to know about Rainbow Fentanyl and how to protect yourself and your children.

The focus on Rainbow Fentanyl can be misleading

Illegally produced fentanyl is very dangerous in any color, and some drug experts worry that there is too much focus on the risks posed by rainbow fentanyl. “Kids are given pills and some of them die from them. It’s an absolute distraction,” said Dean Schold, co-founder of the nonprofit FentCheck, which provides fentanyl test strips and drug education.

Another problem is that the DEA has uncovered no evidence that the colors were designed specifically to attract children. Fentanyl has been available in colors for years and some research there is found this color is one way drug users recognize illegality the power of drugs. “It actually keeps them safe because they know what they’re getting for each color,” says John E. Ziebel, senior public health analyst at RTI International, a nonprofit research institute promoting science-based solutions to public health problems.

However, if a substance is marketed as a prescription pill such as oxycodone or xanax, teenagers and other young people who use drugs may not realize they contain fentanyl, says Dr. Scott E. Hadland, a pediatrician and addiction specialist at Massachusetts General Hospital and Harvard Medical School. The illegal drug supply in the US is very dangerous, in part because substances sold as one drug may contain a mixture of others, including dangerous substances such as animal tranquilizer xylazine and benzodiazepines. This randomness increases the chances of overdose due to the combined effects of the drugs, as well as the possibility that a person may consume too much of an opioid.

Hadland worries that multi-colored fentanyl could make it more “interesting or exciting” to young people. But, he says, “fentanyl is now everywhere on the market. I don’t know if it will be something new to attract teenagers who haven’t used it before.

Children are already at risk from fentanyl

Over the past several years, the number of annual overdose deaths among 14- to 18-year-olds in the U.S. has increased, rising from approximately 490 in 2019 to about 950 in 2020, according to analysis published in JAMA in April. A growing proportion of teen overdose deaths involve fentanyl; the drug was involved in more than two-thirds of overdose deaths in 2021.

It’s also more common for manufacturers to push fentanyl to look like prescription drugs, says Joseph Palamar, an associate professor at New York University Langone who studies the epidemiology of drug use. For example, many colored fentanyl pills are blue and stamped with the M30 logo to resemble the drug oxycodone. In a study published in Drug and alcohol addiction in May, Palamar and colleagues found that the portion of fentanyl seized in pill form rose from 13.8 percent in 2018 to 29.2 percent in 2021. “I would caution [my children] that illegally obtained pills can contain fentanyl and that exposure to even a small amount can be enough to kill someone,” he says.

How to protect your children

It’s essential to keep all medications out of the reach of young children, Palamar says. “I’m not sure if the manufacturers or marketers intend these new pills to appeal to children, but what worries me is that they i can attract children,” Palamar says. “What worries me is if a parent or sibling of a child leaves one of these fentanyl pills around and then someone — a child or an adult — eats it thinking it’s candy.”

Keeping an open dialogue with teens about the dangers of illegal drugs can help keep them safe, Hadland says. Teens need to know that illegally obtained pills can contain fentanyl and that even a small amount of fentanyl can be fatal, he says.

Parents should also consider keeping the opioid overdose medication Narcan by hand, which can save someone’s life. “I think of it as a fire extinguisher,” Hadland says. “It’s the thing you always want to have in your home but never want to actually use.”

Some teens use illicit drugs to cope with an addiction or mental disorder, and parents should watch for red flags, Hadland says. For example, teenagers often use alcohol, marijuana, or nicotine before turning to riskier drugs; it’s especially worrisome, he says, if a teenager is a frequent substance user. Other warning signs may include difficulties at school and changes or deterioration in their relationships. However, prevention is best and ensuring children get support for any mental health issues is one of the best ways to prevent drug use.

“I think the conversations are often quite alarming: ‘Look at this new drug! Imagine if that happened in your community!” Hadland says. “We also need to remember that many of the young people who use these substances are struggling with mental health or addiction issues that remain completely unresolved. And we need to make sure we provide resources for that.”

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