Drug overdose deaths have already reached disturbingly high levels across Washington, with 2,646 people dead over the past year from all types of drug overdoses and more than 1,800 of those deaths linked to synthetic opioids including fentanyl. While overdose hospitalizations are twice that high for all categories of drugs together, fentanyl is different: More people die from fentanyl overdoses than end up in the hospital.
According to the Centers for Disease Control and Prevention, overdose deaths involving synthetic opioids other than methadone, which includes fentanyl and fentanyl analogs, increased more than 22% from 2020 to 2021.
Health experts maintain that fentanyl and methamphetamine levels on public transportation and other surfaces haven’t been detected at levels high enough to harm the general public. But the researchers behind the UW study say not enough data is available to make the same determination for transit operators.
Their findings reveal a potential labor issue for these employees, and the need for both improved support for Washingtonians experiencing addiction and more information about the potential health impact of long-term secondhand exposure.
“There is not an established body of literature for what the long-term effects would be of being exposed to fentanyl at work for a working lifetime,” said Marissa Baker, assistant professor of environmental and occupational health sciences at UW and a co-leader of the assessment, which took place last spring.
After taking air and surface samples on 11 buses and 19 train cars in Washington and Oregon, Baker and her research team found that a quarter of air samples contained fentanyl at detectable levels; methamphetamine was found in all of them. In surface samples, residue from methamphetamine was detected uniformly as well, with fentanyl found in more than half.
Drug residue is not unusual: According to Dr. Robert G. Hendrickson of the Oregon Poison Center, most drugs leave traces. “It’s not entirely surprising to be able to detect really trace amounts of those in a public space like this,” he explained in a September news conference on the findings. “Any time someone is handling, smoking or using a drug, there’s going to be a small amount identified. And in fact, you can identify cocaine on dollar bills and other paper money, and that has been evident for decades now.”
The findings are consistent with heightened opioid use in the Northwest, a local reflection of national drug-use trends. “This study aimed to determine if drugs could be detected in public transit, and it can. This is reflective of the volume of drug use currently in our communities and a reminder for the community to develop solutions to decrease drug use over the long term,” said Hendrickson in a joint statement written with the Washington Poison Center’s Dr. Scott Phillips.
Use of fentanyl, a highly addictive synthetic opioid, has been growing in Washington and across the nation. A more potent alternative to heroin and prescription opioids, it is both cheaper and easier to obtain, but also deadlier. Fentanyl is 50 times stronger than heroin and 100 times more potent than morphine, according to public health officials. They say the drug is more attractive to people looking to get high, as well as those dealing with pain.
In Washington, Drug Enforcement Administration records for Washington show that from 2019 to 2022 the amount of fentanyl seized increased by 1670%. The DEA Seattle Field Division reports it seized twice as much fentanyl in Washington in 2022 than in 2021.
The origins of the opioid crisis are complex and numerous, but one factor is a major shift in the drug supply, said Brad Finegood, a strategic advisor with Public Health — Seattle & King County.
“We’ve gone from a drug supply that is primarily agricultural-based” — one that produced mainly heroin, cocaine and methamphetamine — to “a drug supply that’s synthetic, easy to produce in high, high numbers,” and, with the transition from heroin to fentanyl, is “much more lethal and addictive and also a lot cheaper.” Fentanyl also has a shorter half-life than heroin, which means people who use it have to use larger amounts to avoid going through withdrawal. “It’s a recipe for disaster,” said Finegood.
And unlike heroin, fentanyl can be smoked. In the past, needles served as a boundary for some people who used drugs. That’s not true anymore. “People were injecting heroin in order to use heroin for the most part,” said Finegood. “With fentanyl, the needle isn’t necessary. People were using drugs and saying, ‘Well, I’ll never use a needle’ — there’s a stigma that goes with that, that provides some level of threshold — and now that people are just smoking fentanyl and methamphetamine predominantly … it’s so much easier for people to have onset into these much more addictive drugs.”
Moving away from needles can also prevent people who use drugs from obtaining support: “A lot of our systems of care, like needle exchanges, were set up to prevent disease transmission, and also bring people in to provide a lot of other ancillary services,” said Finegood. Because people can smoke fentanyl, they may be less inclined to seek these out.
As harmful as fentanyl is, the person most affected is the one using it, not those around them, according to the University of Washington Addictions Drug & Alcohol Institute. Unlike more volatile substances, fentanyl disperses quickly in the air when ignited, with the majority of the drug entering the body of the person smoking it. Since the UW assessment came out, public health officials have emphasized the low risk of secondhand exposure to fentanyl.
In their statement, toxicologists Phillips and Hendrickson explained that the amount of fentanyl and methamphetamine detected in the study are extremely small — too small to produce physical effects in a transit rider after short-term exposure. “Therefore, individuals who use public transportation for travel needs should continue to feel safe doing so,” they said.
But there’s a big difference between a 30-minute passenger commute and a transit operator’s 10-hour shift, said Baker, and the potential health impact of longer exposures is not well understood. While health officials have stressed that it would be very unlikely for secondhand exposure to fentanyl to cause an overdose, “there are a lot of health effects that happen before overdose, that from a public health perspective, we don’t want to happen,” she said.
Persistent internet myths are more pervasive than the science about secondhand exposure to fentanyl, and can make people fearful of scenarios that aren’t actually harmful, or sow further stigma.
Last year, nonprofit fact-checking website Politifact dug into a claim on social media that a person in Jackson, Tennessee, had died simply from touching a dollar bill that had fentanyl on it, a claim the fact-checker found “physically impossible.” That didn’t stop area law-enforcement agencies from issuing warnings about touching fentanyl; such uncritical reports can lead to sensationalized new coverage and add to stigma around drug use, which can fuel prejudice that’s counterproductive to recovery efforts. As Finegood put it: “Stigma kills.”
According to the University of Washington Addictions Drug & Alcohol Institute, it’s not possible to overdose from touching fentanyl, and there have been “no clinically confirmed overdoses” from secondhand exposure to fentanyl smoke. Given these basic facts, myths about the drug don’t hold up to scrutiny. But they can and do sow fear and misinformation — and take attention from substantive conversations about the lack of data surrounding long-term secondhand exposure to the drug.
In the meantime, transit operators have reported physical symptoms after secondhand exposure to drugs on buses and trains, for reasons Baker attributes to in-transit drug use.
Even if operators are reporting symptoms inconsistent with exposure to opioids, Baker said, they could be having reactions to other drugs. While much news coverage of the UW study emphasized its fentanyl findings, the sampling detected methamphetamine at higher levels, and drugs are also commonly mixed.
“We don’t know if it was fentanyl that was being smoked,” said Baker. Even if it was, she said, smoke exposure on its own can cause a number of physical symptoms. So can psychological distress. And all of these scenarios are related to drug abuse, she added. With operators in mind, Baker and her research team have shared a number of recommendations for transit agencies, including protective measures for drivers like improved filtration systems and cleaning, operator training that includes the use of naloxone to reverse overdoses among riders, and mental health support.
“The goal, of course, is to reduce harms and reduce impacts to vulnerable populations with any kind of public health policy,” she said. “And in this situation, obviously, individuals who use drugs are a vulnerable population. But I would also say that bus drivers and train operators would also be considered a vulnerable population, because they are working in an environment where they do not have control over the air they breathe.”
More long-term solutions to the impact of the opioid crisis will take time. For a long time, said Finegood, treatment models for addiction required people to prove their desire for change by jumping through numerous administrative hoops.
“What we know now,” he said, “is that having to put up all these hurdles and barriers to care for people is a hindrance.” One barrier he was particularly focused on concerns access to evidence-based treatments like methadone and buprenorphine, he said, bringing them to people more directly so that fentanyl is no longer the cheapest, most accessible option.