What is rainbow fentanyl? Colorful pills drive new warnings about deadliest drug in the US

By Jacqueline Howard, CNN

A new wave of concern has spread across the United States over multi-colored “rainbow fentanyl” pills, powders and blocks — that look similar to candy or sidewalk chalk — being sold and used in several states, and potentially posing a threat to young people.

But parents of young children should not overly panic, and the emergence of this new product is one small part of the larger ongoing opioid crisis.

Rainbow fentanyl comes in bright colors and can be used in the form of pills or powder that contain illicit fentanyl, a powerful synthetic opioid, making them extremely addictive and potentially deadly if someone overdoses while trying to achieve a high off of the drugs.

This multi-colored fentanyl may appeal to young people or fool them into thinking it’s safe, but experts say illicit fentanyl has been hiding in what appears to be other products for a long time, and fentanyl is fentanyl — it’s all dangerous, rainbow or not.

“Colored fentanyl pills have been around for a few years. Typically, they’ve been blue pills labeled ‘M30’ to counterfeit oxycodone, which is a much weaker opioid,” Joseph Palamar, an associate professor in the Department of Population Health at NYU Langone Health, who has studied trends in illicit fentanyl, said in an email to CNN.

“I think the big difference people are concerned about is with regard to accidental ingestion. People are worried that their kids will take one of these pills thinking they’re another drug or even thinking they’re some sort of candy,” Palamar said. “I don’t think the color of the pills greatly increases danger to people who don’t use fentanyl, but there is always a possibility of someone who uses fentanyl leaving their pills around in the reach of children.”

He added, “We need to keep in mind that these pills cost money so people aren’t going to be throwing them on the ground for kids to find. I don’t think people will be giving these pills out as Halloween candy.”

Where rainbow fentanyl warning originated

The US Drug Enforcement Administration released a warning in August advising the public of this “alarming emerging trend” of “colorful fentanyl available across the United States.”

At the time, the agency said that it and its law enforcement partners seized the brightly colored fentanyl and fentanyl pills across 18 states. Fentanyl remains the deadliest drug threat facing the nation, according to the DEA.

But the DEA did not specify in its announcement whether rainbow fentanyl had led to overdoses or deaths among young people.

“Rainbow fentanyl — fentanyl pills and powder that come in a variety of bright colors, shapes, and sizes — is a deliberate effort by drug traffickers to drive addiction amongst kids and young adults,” DEA Administrator Anne Milgram said in the August announcement.

Since then, some colleges and universities are cautioning students about the presence and dangers of rainbow fentanyl, and the California Department of Public Health has alerted K-12 school administrators in the state about rainbow fentanyl being “a new trend.“

At Children’s Hospital Colorado in Aurora, physicians have been seeing more fentanyl exposures among both young children and adolescents, Dr. Sam Wang, the hospital’s pediatric toxicologist, told CNN on Friday. While he and his colleagues are aware of rainbow fentanyl warnings, he hasn’t heard any patients or parents mention it.

After all, the bottom line, he said, is that fentanyl is fentanyl, whether it comes in the form of rainbow-colored pills or simply a white powder.

“It’s just coming out in a different form to potentially be more attractive, more quote unquote ‘fun’ to use because it looks potentially fun to take,” said Wang, an associate professor of pediatrics at the University of Colorado Anschutz Medical Campus.

And when young people use illicit drugs, they sometimes don’t know what they really contain, or how dangerous those substances might be.

When it comes to rainbow fentanyl, “the fentanyl itself is going to be the same issue as the counterfeit pharmaceutical fentanyl. We don’t know how much is in it — it can vary. We don’t know the type of fentanyl,” Wang said. “And so those concerns transmit, still, over to this product. It’s just now this looks like it has a potential danger for young children and then also, it’s going to be more attractive for people to use and have consequences from that.”

The rise of fentanyl

The United States has been facing an opioid overdose epidemic — and waves of opioid overdose deaths — for decades, starting with a rise in prescription opioid overdose deaths in the early 2000s, followed by a rise in heroin overdose deaths beginning in 2010 and, most recently, a rise in synthetic opioid overdose deaths that started in 2013, fueled by potent fentanyl.

Pharmaceutical fentanyl is a synthetic opioid intended to help patients, such as those with cancer, manage severe pain. It is 50 to 100 times more potent than morphine, and typically prescribed in the form of skin patches or lozenges. But most recent cases of fentanyl-related harm, overdose, and death in the United States are linked to illegally made fentanyl, according to the US Centers for Disease Control and Prevention.

The latest data suggest that annual drug overdose deaths have jumped 44% from before the Covid-19 pandemic. There were about 76,000 deaths reported in the 12-month period ending March 2020. The CDC’s latest provisional data show that more than 109,000 people in the United States died of a drug overdose in the 12-month period ending March 2022.

Synthetic opioids, including fentanyl, were involved in more than two-thirds of overdose deaths in the year ending March 2022. Deaths involving synthetic opioids increased by a staggering 80% over the past two years, CDC data shows.

Rainbow fentanyl has been receiving attention due to the bright colors of the products, but the illicit fentanyl that the products contain represents a continuation of the ongoing opioid epidemic. The only difference between rainbow fentanyl and the fentanyl products of the past appears to be the coloring.

“The reason it’s colored is just to differentiate products. If we had a regulated market, they would be differentiated in different ways — we do not. It has nothing to do with marketing to kids at all, period, whatsoever,” said Maya Doe Simkins, co-founder of the Opioid Safety and Naloxone Network and co-director of Remedy Alliance, a collection of harm reduction groups that work to make naloxone more accessible.

Simkins likened the different colors of rainbow fentanyl to how people used food coloring in heroin in the past, and she said the colors are sometimes used to differentiate batches.

“It’s just a differentiation between your product, my product or this batch and the next batch,” she said.

Increasing fentanyl seizures

Illicit fentanyl has long been hiding in drugs, and its presence appears to be on the rise.

A study, published in the journal Drug and Alcohol Dependence in May, found that the number of fentanyl-containing powder and pills seized by law enforcement in the United States rose between 2018 and 2021.

The weight of powder fentanyl seizures increased from 298.2 kilograms in 2018 to 2,416 kilograms in 2021, and the number of pills seized increased from 42,202 in 2018 to 2,089,186 in 2021, according to the study, of which Palamar was the lead author.

“We found that not only has fentanyl seizures been increasing, but the proportion of pills seized to overall fentanyl seizures has been increasing. The proportion of pill seizures increased from 14% in early 2018 to 29% in late 2021,” Palamar wrote in his email to CNN.

“We don’t have information regarding what these seized pills were purported to be, but we think many were disguised as oxycodone or even Xanax,” he wrote. “Seizures of these counterfeit pills have been increasing at a rapid rate, suggesting increasing availability, and availability is going to continue to increase.”

With this increase, counterfeit pills have been more difficult to identify, but Palamar said that people can use test strips to detect traces of illicit fentanyl if they have concerns.

“People can purchase fentanyl test strips for as little as a dollar. Most of these strips are meant for urine testing but they can detect the presence of fentanyl if used correctly,” Palamar wrote.

“I highly recommend that anyone who plans to use an illegally purchased pill or an illegal powder like cocaine test the drug before using,” he added. “There are also hundreds of newer fentanyl analogs and other opioids that can be very dangerous that test strips can’t detect. I do worry that test strips will give some people a false sense of security, but they’re something.”

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CNN’s Nadia Kounang and Deidre McPhillips contributed to this report.