Taken at face value, recent reports of fentanyl-tainted marijuana in Connecticut highlight the hazards inherent in the black market created by drug prohibition. Consumers who buy illegal drugs rarely know for sure exactly what they are getting, and the retail-level dealers who sell those drugs to them may be equally in the dark. But even in a market where such uncertainty prevails, opioid overdoses among drug users who claim to have consumed nothing but cannabis—like earlier, better documented reports of fentanyl mixed with cocaine—raise puzzling questions about what is going on.
One thing seems clear: The official warnings prompted by those reports are more alarming than the evidence justifies.
The proliferation of illicitly produced fentanyl as a heroin booster and substitute during the last decade or so has helped drive opioid-related deaths to record levels. Fentanyl is roughly 50 times as potent as heroin, and its unpredictable presence has increased drug variability, making lethal errors more likely.
According to preliminary data from the Centers for Disease Control and Prevention (CDC), the United States saw a record number of drug-related deaths last year: more than 93,000. Three quarters of those deaths involved opioids. “Synthetic opioids other than methadone,” the category that includes fentanyl and its analogs, were involved in about 83 percent of those opioid-related deaths, up from 14 percent in 2010.
Fentanyl and heroin have similar psychoactive effects. And since fentanyl is cheaper to produce and easier to smuggle than heroin, it makes sense that drug traffickers would use the former to fortify or replace the latter. But the idea that dealers would mix marijuana and fentanyl, two drugs with notably different effects, is much less plausible. Until now it amounted to nothing more than scary rumors.
Last week, however, the Connecticut Department of Public Health (DPH) announced that it has received 39 reports since July of “patients who have exhibited opioid overdose symptoms and required naloxone for revival” but who “denied any opioid use and claimed to have only smoked marijuana.” The most obvious explanation for those cases is that the patients falsely denied opioid use, which carries a stronger stigma than cannabis consumption. But the agency also reported that a lab test of a marijuana sample obtained in one of those cases detected fentanyl.
“This is the first lab-confirmed case of marijuana with fentanyl in Connecticut and possibly the first confirmed case in the United States,” DPH Commissioner Manisha Juthani said. Based on that finding, her department “strongly advises all public health, harm reduction, and others working with clients who use marijuana to educate them about the possible dangers of marijuana with fentanyl.” It says “they should assist their clients with obtaining the proper precautions if they will be using marijuana.” It also “recommends that anyone who is using substances obtained illicitly…know the signs of an opioid overdose, do not use alone, and have naloxone on hand.”
These warnings seem overwrought, given the meager basis for them. If the hazard Juthani describes were significant enough that it would be rational for cannabis consumers to “have naloxone on hand,” you would expect to see many more suspected cases in a state with more than half a million marijuana users. Assuming the single lab test result was accurate, it is not clear how fentanyl ended up in the marijuana sample. Did a dealer intentionally add the fentanyl, and if so why? Could the sample have been contaminated accidentally by the dealer, his customer, or the lab? Did the patient, contrary to his denial, deliberately dose his pot with fentanyl?
Forbes writer Chris Roberts posed those questions to Robert Lawlor, an intelligence officer who works for the New England High Intensity Drug Trafficking Area (HIDTA), an interagency drug task force. “We have some of those same questions,” Lawlor said. “From a business standpoint, it doesn’t make sense to put fentanyl on marijuana. So why is this happening? What is the purpose of behind putting it in marijuana? Those are some of the questions that are still out there.”
Notably, HIDTA is not telling marijuana users they should be on the lookout for fentanyl in black-market cannabis. “Marijuana [mixed with] fentanyl has been sort of an urban legend for a couple years now,” Lawlor said. “To try and decide whether it’s something real or just an urban legend is important for public safety and public health.”