This article, in a slightly edited form, first appeared on Pain News Network on April 27, 2019.

Usually, we think of bombs, missiles, rockets, and dangerous chemicals as weapons of mass destruction (WMD). However, Task & Purpose reported on April 15, 2019 that James F. McDonnell, who heads the Department of Homeland Security’s (DHS’s) WMD division, wants to classify fentanyl as a potential WMD. He proposed this in a February memo to then-DHS Secretary Kirstjen Nielsen.

The drug’s “high toxicity and increasing availability” make it “attractive to threat actors seeking nonconventional materials for a chemical weapons attack,” according to McDonnell. It is not clear that he is correct. In any case, he neglected to mention that fentanyl has a legitimate medical use, too.

What Is a Weapon of Mass Destruction?

According to Title 18 U.S.C. §2332a, weapons that can kill or severely injure “through the release, dissemination, or impact of toxic or poisonous chemicals, or their precursors” fall into the category of weapons of mass destruction.

WMDs are meant to kill the maximum number of people in the shortest amount of time. On the other hand, fentanyl — even when it is laced with heroin — is not intended to kill people. Drug cartels want to make money. Their goal isn’t to murder their customers.

McDonnell thinks fentanyl fits the definition. However there isn’t much evidence for classifying fentanyl as a WMD, but McDonnell’s suggestions could still find support for reasons that have more to do with politics than science.

History of Fentanyl

Fentanyl is a powerful synthetic opioid typically prescribed to patients in acute pain or during surgeries. According to data from the National Center for Health Statistics, 48 million surgical inpatient procedures were performed in the United States in 2009. Most of those procedures involved administering fentanyl intravenously as an analgesic.

Fentanyl was first developed in 1960 by Belgian chemist Dr. Paul Janssen. The patent for fentanyl was obtained under his company name, Janssen Pharmaceutica.

It was first approved by the Food and Drug Administration (FDA) in 1968 and introduced to the marketplace as an analog for Demerol with plans that it would be used only for palliative care.

In 1978, I coauthored with my professor mentor, Dr. T.H. Stanley, a manuscript titled Anesthetic Requirements and Cardiovascular Effects of Fentanyl – Oxygen and Fentanyl – Diazepam – Oxygen in Man: Anesthesia Analog that described the use of high dose fentanyl for cardiac anesthesia.

The anesthetic technique we described allowed patients to undergo coronary artery bypass and valve replacement more safely and with greater success because of fentanyl’s unique pharmacologic properties. The technique was considered a seminal event in anesthesia for cardiac surgery.

Since the publication of that paper, millions of people have successfully undergone heart operations. The advance of using fentanyl in anesthesia may have helped some of those patients survive their heart operations.

It wasn’t until the late 1980s that testing was done for delivering fentanyl through a transdermal patch for the treatment of cancer-related pain and noncancer chronic pain. Later, transmucosal delivery of fentanyl was made available for cancer breakthrough pain. Each of these new uses of fentanyl exposed millions of Americans to the drug without evidence of an inordinate degree of harm if it was used as directed.

In contrast, nonpharmaceutical fentanyl has caused enormous harm. But as use of the drug proliferates so, too, do myths about its real dangers. McDonnell’s memo fits into an overarching narrative that bestows almost magical properties on fentanyl.

What’s Behind the Fentanyl Panic?

In New York Magazine, Sarah Jones writes about a Bloomberg News story describing the possibility that fentanyl could be used as a WMD. The article claims the opioid “is so potent that even a small amount — the equivalent of a few grains of salt — can be lethal.” However, the title of Jones’s article is “No, Fentanyl Isn’t a Weapon of Mass Destruction.”

The opioid crisis is real, and the use of illicit fentanyl is often lethal. But mischaracterizing the effects of fentanyl may be only a political maneuver.

As Jones points out, the DHS’s WMD division has experienced a decline in funding because of the Trump administration’s focus on immigration and building a wall at the border. One way to reclaim some of that money for the WMD division is to build a case against fentanyl.

Other drugs, such as ricin, pose greater risks because they’re more easily attainable and are probably more lethal than fentanyl. However, the word “fentanyl” packs a far larger emotional punch than “ricin” does because of the public’s familiarity with it.

The Pentagon realized the harm that an opioid attack could cause when the Russian military used aerosolized carfentanil against terrorists who had taken over a theatre in Moscow in 2002. The drug killed dozens of hostages and their captors, and it put the U.S. on notice that opioids could be weaponized. But carfentanil wasn’t fentanyl.

Protecting Access to Legitimate Fentanyl

The opioid crisis is largely driven by the illicit use of nonpharmaceutical fentanyl and fentanyl analogs, not prescription fentanyl. Solving the opioid problem will require making greater efforts to reduce the illegal production and distribution of the counterfeit fentanyl.

Could fentanyl be weaponized and used to attack citizens? Maybe, but not easily.

However, before we classify the chemical fentanyl as a WMD, we need to know what that would mean for its legitimate use during surgery, or for cancer and chronic pain patients. Access to the medication for the treatment of pain must be part of the calculus in assessing if a relatively safe and effective drug should be classified as a WMD.