It May Not Be Cocaine: Fentanyl in White Powder in King County

The numbers are hard to stomach this year. When the final review of fatal overdoses is completed in the upcoming weeks, 2022 will set another heartbreaking record for fatal overdoses in King County – more than doubling the number of lives lost compared to just three years ago in 2019.

What might people not know about fentanyl circulating right now?

We are seeing an increase in fatal overdoses involving fentanyl in the form of white powder, even though fentanyl in pills remains the most common form. White powder fentanyl could easily be mistaken for other drugs, like cocaine, or pressed to look like rock cocaine. From our 2022 overdose report, among the overdose deaths where a fentanyl-substance was identified, the majority (64%) were linked to pills, but almost a quarter (23%) were linked to powders. Fentanyl is an extremely powerful opioid.

“We have spoken with family members of loved ones who have died, and tragically, we are seeing more and more fentanyl overdoses that occur after taking what was believed to be white powder cocaine,” said Dr. Nicole Yarid, Associate Medical Examiner, King County Medical Examiner’s Office. “Fentanyl test strips are one tool to help prevent overdoses in this environment where fentanyl is so prevalent and deadly.”

We have also received information from first responders (EMS) that patients treated for non-fatal opioid overdose thought they were using cocaine.

How the rise in fentanyl is leading to unprecedented risk

In short, the rise in fentanyl nationally and locally over the past few years has led to a much more dangerous drug supply. Fentanyl has increased the risk of overdose and death, even from taking one pill or using a small amount of powder. Fentanyl is now involved in 70% of King County overdose deaths to date in 2022.

The variation in the amount of fentanyl, from pill to pill, or powder to powder, can vary—leading to greater risk for overdose.

Fentanyl is a powerful opioid that is a depressant. The drug suppresses the brain signals that help tell the body to breathe. When someone is experiencing an overdose from fentanyl, their breathing becomes so suppressed that the body doesn’t receive enough oxygen to stay alive. Overdose starts as a deep sleep. Naloxone (Narcan) is a medication that can reverse the effects of the overdose and help restore breathing temporarily. That’s why it’s so critical that people don’t use alone and that someone nearby has naloxone on-hand.

Everyone can get naloxone without a prescription at pharmacies, which most health insurance plans cover. You can also get free naloxone at needle exchange programs and by mail. Find naloxone near you at

How to take care of one another around the holidays

Check-in and show support for the people in our lives. Many folks are struggling and may not show it. Substance use disorder is not a moral failing; it’s a treatable health condition.

  • For those that may use occasionally, it’s important to know that white powder may, in fact, be fentanyl. Do not use alone, and make sure to have naloxone on-hand.
  • The safest thing to do is not to use. And our community has several access points to help those start on a path of recovery. Substance use disorder is a treatable health condition. If you have substance use disorder or are looking for support for someone you know, you can learn about treatment options and choose the option that feels best. Find a treatment provider at the Washington Recovery Helpline
  • Fentanyl test strips are available to help people test their drugs. Order educational materials and fentanyl test strips at  
  • Have naloxone ready. Everyone can get naloxone without a prescription at pharmacies, which most health insurance plans cover. You can also get free naloxone at needle exchange programs and by mail. Find naloxone near you at
  • In response to the increasing incidents of overdose attributed to fentanyl in white powder, Public Health has been distributing posters around the community. If you see the posters, point them out. It’s not always easy to talk about drug use, but a non-judgmental conversation can help reduce the risk of overdose.
Warning: White powders containing deadly fentanyl are circulating in Seattle/King County. Fentanyl is also commonly found in blue pills (called 'Blues', 'Percs", 'M30s'. Reduce overdose risk. Avoid using alone. Take turns with others and "watch and wait" between hits. Avoid mixing drugs. Have Narcon ready. Call 911 if you suspect an overdose. Sign up for drug alerts: king

Wishing our community a healthy and safe 2023.

Originally posted on 12/27/22