A Deep Dive into Fentanyl Exposure

A Deep Dive into Fentanyl Exposure

By: Lucy Connery, MPH, Mia Dickinson, & Matt Fitzsimmons, MA

Introduction

Although most data suggest that exposure to fentanyl through e-cigarette use, skin contact, or airborne inhalation is unlikely, online and community-based discourse around the potential risks of fentanyl exposure continues. Beyond these concerns, the belief that cannabis is commonly contaminated with fentanyl has become widespread. This is largely due to sensationalization and a lack of accountability from news media sources. News stories of teens or loved ones experiencing an opioid overdose after using an e-cigarette stir community concern around drug safety and overdose prevention. However, without the appropriate follow-up reporting and data transparency, it is impossible to verify that fentanyl or any other opioids were detected in these cases. Current research is clear: Fentanyl is not infiltrating the cannabis supply, nor is it causing overdose through vaping, skin contact, or airborne inhalation. Accurate, comprehensive reporting is needed to set the record straight on how people are being exposed to illicit fentanyl.

Where You Get Your Drugs Matter

As noted in the first installment of this series, medical-grade fentanyl is a safe and effective pain-management medication when used as prescribed. In healthcare settings, clinicians rely on medical-grade fentanyl because it is predictable, regulated, and appropriate for many patients [1]. Similarly, cannabis from medical settings or state-licensed distributors is considered to be generally safe for most adults, when used appropriately [2].

However, people obtain healthcare and medications through a variety of channels, not all of which are regulated. According to the U.S. Drug Enforcement Administration [3] in 2025, the primary risks associated with controlled prescription drugs are misuse (using a medication in ways other than prescribed) and diversion (sharing leftover prescriptions with family or friends). Some individuals purchase medications online if they don’t have a primary care provider or they can’t afford their prescription. However, many online pharmacies operate illegally and fall outside FDA regulation. The DEA’s 2025 National Drug Threat Assessment reported that these illegal pharmacies often sell counterfeit pills containing fentanyl or other substances to unsuspecting consumers.

This means that drugs—including cannabis products—purchased from unregulated online retailers carry a risk of fentanyl (and other) contamination. Importantly, the DEA clarifies that fentanyl is not being added to legitimate prescription medications; rather, drug manufacturers have been known to press fentanyl into pills that resemble legal prescriptions. Due to recent supply chain issues with the chemical required to produce it, fentanyl manufacturers are also cutting their supply with other prescription and illicit drugs, such as xylazine or medetomidine, in order to maximize profit [3]. Since illicit fentanyl is far more expensive than substances like cannabis, it is not financially practical for sellers to add fentanyl to cannabis products.

In addition to the cost consideration, the effects and relative potency of cannabis and fentanyl are different. For the individual who is expecting cannabis effects, the onset of fentanyl effects would not be expected. With recent movements to decriminalize and legalize cannabis use, access to the regulated cannabis supply has expanded, further reducing the risk of exposure to contaminants [4].

Opioid overdose deaths are overwhelmingly tied to illicitly manufactured fentanyl circulating in the unregulated drug supply [3, 5]. The markets through which people access their medications and/or cannabis products are important to understand to prevent accidental exposure to contaminants. These concerns about access points feed into broader public fears about contamination in commonly used products like cannabis and nicotine vapes.

Exposure Pathways Matter

Even if intentionally combined, fentanyl cannot be smoked or vaped in the same way as cannabis, given key differences in their respective melting and burning points. Cannabis and nicotine can be ingested through inhaling smoke from the burning plant matter, but if fentanyl is burned, the powder is destroyed and cannot cause euphoria [9]. Fentanyl can be vaporized and inhaled, a process which is usually undertaken using an open flame under a glass or foil surface, but it would require an excess of 450 degrees Fahrenheit. Such a high temperature cannot be achieved with most widely available vaping devices [10]. In other words, powdered fentanyl cannot be added to cannabis buds or tobacco leaves and smoked, and it can only be vaporized if the equipment used is specialized or modified to handle higher temperatures.

Fentanyl’s appearance in e-cigarettes is highly unlikely, but any nicotine or THC vaping device bought on the illicit market carries the risk of unwanted contamination. For nicotine, an easy way to tell if an e-cigarette is FDA-approved is to check if it has a flavor. As of 2025, the FDA will no longer approve vaping devices with any flavor other than that of existing smoke-based nicotine products (ex. Tobacco, menthol, etc.) for marketing to the public [11].  Enforcement varies geographically, with some states like New York, New Jersey, California, as well as a handful of others, completely restricting sale of flavored nicotine products [12]. For cannabis, anything other than a product personally bought in a dispensary is not under the purview of state safety regulations.

Second-Hand Smoke & Direct Physical Contact

People also worry about being exposed to fentanyl through skin contact or through the air. As fentanyl overdoses have increased, stories on social media or in the news have been circulating about first responders or bystanders who were harmed by accidental fentanyl exposure while trying to assist someone who overdosed [12, 13]. These stories have fueled fear and confusion, yet research consistently shows that such forms of exposure are not capable of causing an overdose [14, 15].

Differentiating Opioid from Non-Opioid Overdoses

Even amongst properly regulated devices, THC and nicotine overexposure can both result in medical emergencies that may mimic the signs and symptoms of an opioid overdose. Differentiating between symptoms caused by nicotine or cannabis and those caused by opioids is vital in the treatment of all three cases of potential over-exposure.

Cannabis

Cannabis toxicity, or “greening out”, can result in symptoms that include fright, unease, near unconsciousness, and, in more serious cases, ataxia (loss of control over body movement), hallucination, and, rarely, a short coma [22-23]. Greening out is often characterized by a deep feeling of dread or fear, but cannabis overexposure is non-fatal and unlikely to create lasting harm. People who experience these symptoms are not likely to hurt themselves or others [22-23]. As cases increase, treatment protocols for cannabis toxicity continue to develop [22-23]. Most cases of cannabis toxicity are the result of ingesting edible variations of THC, although it can result from any administration method, including vaping, for the cannabis naive [22-23].

Nicotine

Nicotine poisoning can also manifest in a sudden, extreme manner and can itself be potentially fatal, even more closely resembling an opioid overdose than cannabis. Unlike powdered fentanyl, the nicotine formulation found in e-cigarettes can be absorbed into the skin in large enough quantities to cause serious poisoning [24]. Nicotine poisoning appears with nausea and vomiting, increased salivation, abdominal pain, pale skin color, sweating, increased blood pressure/heart rate, rapid, heavy breathing (hyperpnea), ataxia, loss of balance, difficulty walking, tremors, headache, dizziness, muscle twitching, and seizures [21, 25]. At the initial stage, the primary difference between opioid overdose and nicotine overexposure is how heavily the person is breathing. The core functionality of an opioid overdose results in a distinct lack of breathing, while initial nicotine poisoning results in heavier breathing [21, 25].

If exposure is serious and symptoms are allowed to progress, nicotine poisoning begins to present with diarrhea, low blood pressure (hypotension), slow heart rate (bradycardia), shock, coma, muscle weakness/paralysis, shallow, difficult breathing, and eventually respiratory failure. Death (via paralysis of the muscles in the lungs) can occur within an hour of exposure to the lethal dose. Nicotine poisoning can be treated in a hospital setting with activated charcoal, benzodiazepines, and other, more symptom-based, methods. If an overdose is treated swiftly, the prognosis is good. Nicotine poisoning can occur from contact with nicotine, especially for someone who is nicotine naive. In recent years, serious poisonings were more likely to result from accidental skin contact with the fluid contained within vapes and e-cigarettes than from overuse [21, 26].

While fentanyl exposure through vaping cannot be ruled out completely as a possibility, there are a handful of active prevention measures and productive ways to learn more about the depth of the risk at our disposal. Access to regulated markets and drug testing strips are protective factors against all contamination in the drug supply, intentional or not. Understanding the key differences in how drug overexposure presents can help responders more effectively treat the individual at risk, as well as prevent inaccurate media reporting of opioid overdose.

Consequences of Fentanyl-Related Misinformation

Conclusion

Overdose prevention efforts depend on urgency and accuracy. Peer-reviewed literature demonstrates that fentanyl risk primarily comes from the unregulated drug supply and through intentional use pathways, not through cannabis contamination or physical contact [3, 5, 12]. Transparent reporting and education on fentanyl exposure pathways are vital in ensuring overdose prevention efforts are targeted, effective, and human-centered. Expanding access to regulated products, drug checking technologies, rapid treatment referral, and overdose response education will do far more to reduce harm than reacting to unsupported contamination fears. By grounding public conversations in verified data rather than speculation, we can better protect communities by focusing attention where the risk and the opportunity for impact are greatest.

References