My Daughter's School District Warns That Nicotine Vapers Could Be Unknowingly Inhaling Fentanyl

It is hard to find evidence of this "disturbing trend."

This week I received a "Drug Awareness and Prevention Alert" from my daughter's school district. As is typical of these communications, the message from the Plano, Texas, Independent School District (ISD) mixes sensible advice with alarmist rhetoric and misinformation. That is a risky combination, because skeptical students and parents who recognize the anti-drug nonsense may be inclined to dismiss all of the warnings, including those that have a basis in fact.

The alert mentions "fake pills laced with fentanyl," which is a real thing, then adds that fentanyl "can be disguised as candy in order to lure younger kids," which is not a real thing. But this claim was especially striking: "The recent trend of accidental overdoses involving fentanyl is a stark reminder of the hazards posed by this very dangerous opioid. Please be aware that this is not just in the form of pills in our community, but also in the form of injectables into vape cartridges."

The context makes it clear that Plano ISD is talking about nicotine vape cartridges, because its warning is immediately followed by this: "While Plano ISD has always had policies prohibiting tobacco use on campus, we know that the rise of vaping among teens continues to be an issue." The Round Rock, Texas, ISD issued a similar warning. "A disturbing trend is altering vaping devices by injecting fentanyl, methamphetamine, and other illegal substances into the vaping liquid," it says. "The fragrant vape juices make these dangerous and highly-addictive drugs difficult to detect and can expose unknowing students to harmful and potentially deadly substances."

Has fentanyl actually been detected in vape cartridges that people thought contained only nicotine and flavoring? Neither school district presented any evidence to substantiate that claim, which seems to be based on reports about two distinct phenomena: 1) people who deliberately vape fentanyl and 2) people who vape black-market cannabis extracts that allegedly contain fentanyl. The first situation does not involve "unknowing" consumption, while the second seems to be imaginary. Neither involves nicotine vapers who inadvertently inhale fentanyl.

The incident described in a September 2020 bulletin from the Drug Enforcement Administration (DEA) falls into the first category. In September 2019, the DEA says, local authorities in San Diego County, California, reported a "suspected fentanyl overdose death." DEA agents "searched the residence and seized approximately five pounds of narcotic substances," including "fentanyl powder and multiple fentanyl related substances." They also found "vape pens, syringes, a pill press (which tested presumptively positive for fentanyl), and methamphetamine."

This case did not involve nicotine vapes or inadvertent fentanyl consumption. "The roommate of the deceased, who admitted to vaping fentanyl on a regular basis, told agents there was fentanyl and possibly carfentanil located in their shared residence, as well as fentanyl-laced 'vape' tanks," the DEA says. The San Diego County Medical Examiner said "this was [the] first case in which they had found fentanyl in vape pens."

Last year, the Rocky Mountain Poison Center warned that Colorado teenagers "have been experimenting with vaping fentanyl." That "cluster of adolescents overdosing on opioids" clearly did not involve "unknowing" consumption either.

On its face, a February 2022 incident in Pennsylvania more closely resembles the scenario imagined by Texas school officials. Mifflin County School District Superintendent Vance Varner reported that staff had confiscated "three vape pens" at Mifflin County High School. He said "school resource officers" found "the vaping devices were altered with fentanyl or heroin being injected through the vaping liquid."

It's not clear how the officers knew there was fentanyl in the vape pens. The CBS affiliate in Harrisburg said the pens "tested positive for fentanyl or heroin" (emphasis added). That suggests the identification was based on field tests, which are often inaccurate. As you'll see, that is a recurring problem.

Nor is it clear who "altered" the "vaping devices." Were students deliberately consuming "fentanyl or heroin" (assuming those drugs actually were present), or did they think the cartridges contained something else? If the latter, was the something else nicotine or THC? In any case, since Varner said the vape pens were "altered," he was not claiming that the manufacturer was responsible. That would be like blaming cigar manufacturers when consumers stuff their products with marijuana.

Jill Pecht, the clinical director of a company that provides counseling services to students in the school district, suggested that middlemen had secretly spiked the cartridges with fentanyl. "Some of the kids that I've seen recently have not been aware that there was fentanyl laced with the vapes, so it was a big shock and of course caused a lot of problems," Pecht told the Fox affiliate in York. "They would say, 'My friends would never do that to me.' You have to be 21 to buy a vape, so they're getting them from friends of friends, and somewhere along that friend line they're not being friends because they're taking these vapes apart and putting fentanyl in them."

That does not make a whole lot of sense either. Replacing or fortifying heroin with fentanyl, which is more potent and cheaper to produce, makes economic sense. So does pressing fentanyl into tablets disguised as pain pills that sell for $5 to $25 each on the black market. But why replace cheap nicotine with relatively expensive fentanyl and sell it to people without telling them?

There is another reason to be skeptical of stories like this one. Ryan Marino, a medical toxicologist, emergency physician, and addiction medicine specialist at University Hospitals Cleveland Medical Center, notes that "fentanyl breaks down/decomposes so quickly/easily at such low temp[eratures]" that adding it to smoked marijuana is not a practical delivery method. "Could a commercial vape be used for fentanyl?" he writes. "It is possible but it would have to be very intentional."

A May 2022 report about vape cartridges confiscated at a high school in Woodinville, Washington, looks even sketchier. "We received reports that a number of students purchased vape cartridges from at least one fellow student," the school district told parents. "The reports also indicated that after vaping with those cartridges, some of the students became sick. There is a concern that the cartridges may have contained illegal substances including Fentanyl."

In this case, there was "a concern" that the cartridges contained fentanyl or other "illegal substances" but no actual evidence that they did. And it's not clear whether these cartridges were supposed to contain nicotine or THC.

A January 2023 incident at New Rochelle High School in Westchester County, New York, involved THC rather than nicotine, and it turned out to be a false alarm. A student took a "hit off a vape thinking it was marijuana," New Rochelle Schools Superintendent Jonathan Raymond reported. The student "suddenly became very disoriented" and was "not feeling well."

According to a report from the NBC station in New York City, "the student went to see the school nurses, who are trained to spot and treat possible opioid overdoses." They "quickly administered Narcan to help the student, who was later hospitalized." The student was released that night.

"For the first time, our nursing staff had to use Narcan to save a student who vaped what the student believed to be marijuana," Raymond said. "The vape almost cost that student their life….This device is still in our community, potentially threatening the health or lives of any others who use it….While we have not confirmed the substance that harmed our student today, we know that any vaping devices or drugs purchased on the street may—and likely do—contain the synthetic opioid fentanyl, and even the smallest dose can be lethal."

Initial news reports echoed Raymond, saying the nurse's quick administration of the opioid antagonist had saved the student from a potentially lethal overdose. But a police investigation debunked that story. "The latest information we received was that there were no opioids in the student's system," said Capt. J. Collins Coyne. "It seems that the student may have had a bad reaction and Narcan was administered as a precaution. Thankfully it was not more serious." In other words, this was not an example of a black-market marijuana vape tainted by fentanyl, let alone a nicotine cartridge that was surreptitiously spiked with fentanyl.

A February 2022 report involved "a vaping device with THC and fentanyl" that was found at North Scott High School in Eldridge, Iowa. Again, this is not an example of fentanyl-laced nicotine cartridges. And although North Scott Superintendent Joe Stutting said a field test came up positive for fentanyl, subsequent laboratory testing detected only THC.

As that case illustrates, suspicions and field tests are not enough to verify the presence of fentanyl. Last August, when state officials held a meeting about "The State of Illicit Drugs in Tennessee," they cautioned against drawing any conclusions without laboratory confirmation. Although "they were aware of reports of fentanyl in vape pens," the NBC affiliate in Knoxville reported, they said "it's never been proved by laboratory testing in Tennessee."

A 2022 scare about fentanyl-tainted vapes in Lander County, Nevada, likewise turned out to be unfounded. "There was recently a warning put out to parents in the Lander County School District that vape pens containing THC laced with fentanyl were found in the student population," Nevada News Group reported in May. "But shortly after the incident, the Lander County Sheriff's Office released a [corrective] statement."

The sheriff's office noted "several incidents involving Battle Mountain school students having adverse reactions shortly after ingesting prohibited substances." But it said "current information indicates the cause of the reactions stemmed from the use of high concentration THC Vape and THC wax," adding that "we have no credible information that the substances ingested by the students contained Fentanyl."

In 2019, the Fox affiliate in Salt Lake City reported that Brian Besser, a DEA supervisor in Utah, had read "an alarming DEA intelligence report stating fentanyl had been found in unregulated vape cartridges in other areas of the nation." The story did not specify whether these were nicotine or THC vapes, although Besser implied it was the former. "We are starting to see fentanyl make its way into the vaping industry," he said, "and we see that we are definitely going to see the death counts go up."

If "unregulated vape cartridges" sometimes contain fentanyl, of course, that would underline the hazards of the black market created by prohibition, where quality and potency are highly variable and unpredictable. Those hazards are amply demonstrated by fentanyl in heroin, fentanyl in ersatz pain pills, fentanyl in cocaine, and fentanyl in methamphetamine. But the only report about fentanyl in vapes that turns up in a search of the DEA's website is the aforementioned bulletin about the man who died after intentionally consuming fentanyl.

I asked the DEA if it actually has reason to believe that people who vape nicotine need to worry that they may be inadvertently vaping fentanyl, and I will update this post if and when I receive a reply.* But given the scant evidence of the "disturbing trend" perceived by anxious school officials, this looks like another misguided scare tactic aimed at deterring teenagers from vaping.

[This post has been updated with Ryan Marino's comments.]

*Update, March 2: In response to my query, the DEA noted its report about intentional fentanyl vaping but nothing that would support warnings about inadvertent fentanyl consumption via tainted nicotine or cannabis products.