About Fentanyl
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Symptoms of fentanyl overdose are like those experienced when overdosing on other opioids and can include:
Small, constricted “pinpoint pupils.”
Falling asleep or losing consciousness.
Slow, weak, or no breathing.
Choking or gurgling sounds.
Limp body.
Cold and/or clammy skin.
Discolored skin (especially in lips and nails).
Seizures.
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Exposure to fentanyl can occur when someone ingests fentanyl by injecting, smoking, eating, and deliberate inhalation like snorting. Fentanyl exposure through other methods like inadvertent inhalation, second-hand smoke, or touching the fentanyl are not recognized as being a realistic risk to safety. (source) Currently different street drugs like cocaine, methamphetamine, and heroin, are being found to contain fentanyl, so caution should be used when taking any illicit drugs. This includes any pills that appear to be legitimate prescription pain pills that are not acquired through one's medical provider. There have been no verifiable instances of fentanyl being found in substances such as marijuana or vaporizers.
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Fentanyl can only have an effect if someone smokes, snorts, eats, or injects the substance. Incidental exposure (as would happen through touching or walking into a room where fentanyl has been smoked) does not pose a safety threat. (source) Failure to help and/or get help out of fear of an incidental exposure can impede the provision of timely assistance to someone experiencing an overdose. Fentanyl is a potent opioid that, if consumed through smoking, snorting, eating, or injecting, has the potential to cause an overdose in individuals who do not have high opioid tolerance.
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Fentanyl causes overdose symptoms such as respiratory depression and cardiac arrest to onset more quickly, so it is vital to respond as soon as possible. First responders are encouraged to continue their standard practice of wearing gloves when handling unknown substances or paraphernalia found at an unfamiliar location. Individuals rendering assistance to someone overdosing are not at risk of overdose via incidental contact and are encouraged to provide naloxone as soon as possible to the individual. Fentanyl will respond to naloxone and is not naloxone resistant.
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The primary myth surrounding fentanyl exposure is that incidental exposure can cause overdose. (source) Although responding to situations involving fentanyl is understandably stressful,the American College of Medical Toxicology, American Academy of Clinical Toxicology, and other bodies of research have stated that there is very little risk of clinically significant secondary exposure. Individuals who appear to be experiencing exposure symptoms may instead be experiencing psychological stress due to the perceived danger of fentanyl. This phenomenon is sometimes called the nocebo effect and takes place when fear of an exposure causes the expected adverse effect, even if a substance poses no reasonable risk. Additional education around the facts and myths related to fentanyl and exposure are a means to decrease concerns about personal risk while responding to a scene of an overdose.
About Naloxone
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CDPHE only tracks the doses of naloxone given to eligible agencies and the agency types through the Naloxone Bulk Purchase Fund. CDPHE does not track the use of naloxone by those agencies.
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Agencies interested in applying to access naloxone through the Bulk Purchase Fund should visit cdphe.colorado.gov/naloxone-bulk-purchase-fund. CDPHE’s Overdose Prevention Unit verifies each organization’s eligibility and provides technical assistance to ensure each entity has the correct training and requirements to acquire, maintain, and administer naloxone safely. Entities eligible to receive naloxone through the Bulk Purchase Fund include:
A unit of local government.
A person that is not a private entity and makes a defibrillator or AED available to aid the general public.
A school district board of education of a public school.
The State Charter School Institute for an institute charter school.
A governing board of a nonpublic school.
A harm reduction organization.
A law enforcement agency.
Institutions of higher education.
Libraries.
Community service organizations.
Religious organizations.
Local jails.
Multijurisdictional jails.
Municipal jails.
Correctional facilities.
Private contract prisons.
Community Corrections Programs.
Pretrial Services Programs.
Probation departments.
Local public health agencies.
Mental health professionals.
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The FDA has indicated that the timeline for the availability and price of this over-the-counter product will be determined by the manufacturer, Emergent BioSolutions.
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CDPHE will continue to monitor both fatal and non-fatal overdoses in the state and expects that increased access to naloxone will result in a decrease in opioid-related overdoses on a local level in the coming years. CDPHE’s goal is to reduce overdose deaths by increasing access to naloxone and knowledge of how to use it to respond to an opioid overdose. Additional avenues of access enhance individuals' likelihood of carrying narcan and being prepared in the event of an overdose.
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We are working with our partners to dispel myths and misconceptions about fentanyl so communities are prepared to respond. School districts understand they are an important part of the solution to reducing overdose deaths and have expressed a desire to have the tools necessary to respond if an emergency occurs. Here are some important facts:
Fentanyl is a potent synthetic opioid that has been increasingly common in the illicit drug supply. This is particularly worrisome as some adolescents may experiment with other illicit substances that are potentially contaminated by fentanyl without their knowledge.
Regardless of potency, any opioid overdose can be reversed with the use of naloxone if administered in a timely manner.
Naloxone is safe to use and causes no harm if administered in the case of a non-overdose emergency.
The Colorado Department of Public Health and Environment is committed to doing all we can to prevent drug overdoses in the state and one of our current strategies is to increase access to naloxone.
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Though the Colorado Department of Public Health and Environment cannot give legal advice, we are able to provide information on the laws governing our programs, including the Naloxone Bulk Purchase Fund.
The laws governing the Naloxone Bulk Purchase Fund do not contain any express prohibition regarding distribution to a minor. Similarly, neither 13-21-108.7(3) nor 12-30-110(1)(a), C.R.S. include language disallowing persons under the age of 18 from carrying and administering naloxone. While it appears that minors would be afforded the protections of these statutes when acting in good faith to administer an opioid antagonist to an individual the person believes to be suffering from an overdose, we encourage you to consult legal counsel outside the department for help with your questions.
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The illicit drug market is driven by economic motivations that rely on demand and engaging repeat customers. It is not economically advantageous for individuals who sell illicit drugs to sell to children or knowingly provide fatal doses to their customers.
There is no reasonable evidence to suggest that selling or giving fentanyl to children would lead to economic gain, as individuals who have no or low tolerance to opioids are at higher risk of dying from overdose.
As the illicit drug supply continues to evolve, it remains important to provide individuals with factual drug information and encourage engagement in proven harm reduction and public health strategies. Colorado Department of Public Health and Environment efforts include staying informed on the latest research and empowering statewide partners as they respond to the overdose epidemic’s impact in their communities.
Our harm reduction efforts focus on ensuring that people who use drugs are able to reduce the risks associated with drug use. Evidence-based harm reduction strategies, such as the use of fentanyl test strips, are vital in preventing death and injury associated with both legal and illegal drug use.
CDPHE continues to work with partners statewide to establish and sustain evidence-based programs that reduce the harms associated with substance use and prevent overdose death.
About Xylazine
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Some parts of the country have seen an increase in xylazine being added into other substances. Xylazine is a veterinary tranquilizer and produces some of the same sedative effects as opioids. Some individuals may knowingly consume xylazine, while others may not be aware that it is present in the substances they use. Xylazine is not an opioid, so its effects cannot be reversed with naloxone. Due to its unresponsiveness to naloxone, it is important to utilize rescue breathing or CPR when providing aid if the individual is not breathing. Xylazine use can also cause abscesses, necrosis, and cellulitis. The presence of xylazine in the illicit market speaks to the unpredictability of the illegal drug supply.
At this time, xylazine is not common in Colorado’s drug supply. The Colorado Department of Public Health and Environment monitors drug overdoses, both fatal and non fatal, and will respond accordingly if there is an increase in xylazine-related overdoses in the state. Colorado has had very few xylazine-related overdoses to date, and we have not yet seen an uptick in these cases in the state.
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Data on both fatal and non-fatal overdoses from all substances can be found at the data dashboard on the Colorado Department of Public Health and Environment’s Overdose Prevention webpage.