Numbers are supposed to be neutral. They come from investigations, spreadsheets, and death certificates, and they look like facts we can trust. But numbers do not have to be fabricated to mislead. They can be technically accurate and still tell a false story when “detected” becomes “caused,” when “involved” becomes “alone,” and when a preliminary suspicion becomes a headline. Consider what happened in May 2026 in Mountainair, New Mexico. Three people died in a home where investigators found fentanyl, para-fluorofentanyl, and methamphetamine. Eighteen first responders later reported symptoms such as nausea, coughing, and dizziness. Officials were careful in their language: they said they were working “under the assumption” that fentanyl was responsible, and they noted that most of the responders who were evaluated had no symptoms. Yet news outlets around the country described the event as an “apparent fentanyl exposure.” That word, “apparent,” means one thing to a physician or a lawyer—that causation has not been established—and another thing to a reader scanning a headline. To most people, “apparent fentanyl exposure” simply means fentanyl did this. By the time the phrase is shortened in a news feed, repeated on social media, or quoted in a political speech, every trace of uncertainty has disappeared. The number of deaths is real. The drugs found are real. The symptoms are real. But the story that connects them may not be, and that distinction matters because real people make desperate decisions based on the story they hear.
The phrase “apparent fentanyl exposure” is not harmless. It creates a particular kind of fear, one that has little to do with what toxicologists actually know. Medical toxicologists have repeatedly explained that clinically significant poisoning from incidental skin contact with fentanyl is extremely unlikely. That does not mean fentanyl is safe, or that people who use it illicitly are not at risk. It means the idea that simply being near the drug, or touching a surface where it was present, is enough to kill is not supported by science. Yet when headlines keep repeating “apparent fentanyl exposure,” they reinforce the belief that proximity alone is fatal. And that belief has consequences. First responders may hesitate before helping someone who has overdosed, because they are afraid that touching the person might poison them. Bystanders may refuse to perform CPR. Parents may panic about a trace of powder on a playground. Hazardous-materials teams may be called out unnecessarily, turning a medical emergency into a scene that requires decontamination rather than rescue. Meanwhile, a person who has actually overdosed is running out of time. What they need is someone to breathe for them and, if available, naloxone—not a cautious distance. Toxicologists have outlined clear safety steps for people who may encounter fentanyl, and they have warned that laws and protocols based on false beliefs about incidental exposure make responders’ jobs harder, not safer. The problem is not that people are trying to be careful. The problem is that the language of certainty, repeated often enough, trains people to fear the wrong thing and neglect the right thing. A death by overdose is tragic enough without adding a second tragedy: a rescuer who stays away because a headline convinced them that help is dangerous.
The same confusion that distorts an emergency scene also distorts national mortality statistics. The International Classification of Diseases, known as ICD-10, uses a code called T40.4 for “synthetic opioids other than methadone.” That code sounds precise, but it is actually a very broad category. It includes pharmaceutical fentanyl prescribed by a doctor, illicitly manufactured fentanyl sold on the street, fentanyl analogs, and even tramadol. It does not distinguish a medication that was taken exactly as prescribed from a powder bought from an unknown seller. It does not establish that fentanyl acted alone, or that it was the cause of death rather than simply present in the body. When federal researchers applied a more conservative calculation that separated some of these categories, the estimated number of prescription-opioid deaths in 2016 fell by 47.3 percent—from 32,445 to 17,087. The actual death toll did not drop. No one who died was brought back to life. What changed was the definition, and the corrected definition told a different story. Yet the old story had already become part of public policy. It had already shaped how lawmakers, doctors, and the public understood the crisis. Behind the abstract numbers are real people: a patient who was prescribed fentanyl after surgery, a person who bought a pill that was actually something else, someone who mixed multiple drugs and died accidentally. They are all placed under the same umbrella, and the umbrella changes how we respond to their deaths. The count was not fabricated. It was incomplete, and an incomplete number, when presented as complete, is a kind of falsehood.
Conflating illicit fentanyl with prescription opioids does not just distort statistics; it distorts public policy. When deaths involving the illicit drug supply are misclassified under broad prescription labels, policymakers respond by restricting legitimate medical prescribing. They impose rigid dose limits or duration limits. They scrutinize clinicians as if every prescription were a potential crime. They pressure stable patients to taper off medications that, for some, have been necessary for years. The Centers for Disease Control and Prevention, in its 2022 prescribing guideline, acknowledged that inflexible applications of earlier guidance had contributed to rapid tapers, abrupt discontinuation, patient abandonment, untreated pain, withdrawal, and psychological distress. Those are clinical terms, but they describe human experiences. A person with chronic pain suddenly loses access to medication that allowed them to work, sleep, and care for their family. A patient is told to reduce their dose, then to stop, with no meaningful alternative. A doctor afraid of regulatory investigations decides to drop patients rather than risk treating them. That person, abandoned by the medical system, may seek relief elsewhere—often on the illicit market, where there is no quality control and no one to call when something goes wrong. The mislabeled number in a federal database has become a wall in a clinic, a locked door, a prescription not written. Meanwhile, the resources that should be used to address the actual crisis are diverted away. The illicit market shifts, fentanyl-contaminated stimulants spread, and the need for naloxone distribution, addiction treatment, mental-health services, and social support grows. But the policy focus remains fixed on the wrong target. The result is that people are harmed by a story the data never actually told.
The confusion deepens because drug categories overlap. A single death involving fentanyl, cocaine, and methamphetamine may be counted in all three drug categories. The CDC has warned that these categories should not be added together, but headlines routinely report that fentanyl “caused” a certain number of deaths when the data only show that fentanyl was involved or detected after death. That is a crucial difference. “Involved” can mean many things: the drug was in the body, it contributed, it was a bystander, it was one of several substances, or it was simply found at the scene. It does not automatically mean the person died because of that one drug. Yet the language of causation fills the gap. And some of the most important drivers of drug deaths remain almost invisible in official statistics. Suicide is one example. Because classifying a drug death as intentional requires affirmative evidence—a note, a documented threat, clear signs of intent—standard reporting often defaults to “accidental” or “undetermined.” Researchers have estimated that true suicides may account for 20 to 30 percent of opioid overdose deaths, but rigid database categories mask that complexity. Chronic pain is another invisible driver. Death certificates rarely record the years of untreated pain, the involuntary taper, the loss of a prescriber, the pharmacy that refused to fill a prescription, the worsening disability, or the moment someone turned to illicit drugs after medical care was disrupted. None of those factors are entered into the database, so they appear not to exist. But absent from a spreadsheet does not mean absent from a life. A veteran who dies of an overdose may be counted as an “accidental poisoning” when the real story includes untreated post-traumatic stress, a lost doctor, and a painful disintegration of support. Responsible reporting means acknowledging these gaps rather than presenting raw mortality data as the whole truth.
Sensational narratives about fentanyl spread because they are frightening, and fear is contagious. Stories of officers collapsing after touching a small amount of powder, warnings about fentanyl-poisoned Halloween candy, and fears of tainted currency all travel quickly across social media. They are rarely supported by evidence, but they do not need to be; they feel true. Illicit fentanyl is genuinely dangerous. It is potent, often unpredictable, and involved in far too many overdose deaths. But unsubstantiated fear-mongering does not make anyone safer. It frightens responders, criminalizes people at overdose scenes, distorts public spending, and penalizes patients while the illicit market continues to rage. Journalists and public officials can do better. They can adopt precise language: “fentanyl was detected” instead of “fentanyl killed.” “The cause remains under investigation” instead of “another deadly overdose.” They can distinguish illicit from pharmaceutical fentanyl when the evidence allows it. They can state clearly what the available data cannot establish. This is not about softening the truth. It is about telling the truth accurately. Uncertainty is not a flaw to be edited out; it is essential to the truth. When incomplete evidence is reported as certainty, policy targets the wrong people, the wrong drugs, and the wrong causes. The reporting error itself becomes part of the crisis. As Lynn R. Webster, a physician and leading expert on pain and addiction, argues, the goal is not to minimize the harms of fentanyl or to dismiss the suffering behind every statistic. The goal is to make sure our response is based on what is real, not on what is merely repeated. The numbers will not save us. But the truth—careful, humble, and complete—can.