SEATTLE — The suspicious letters sent to vote centers and government buildings in six states this month were undeniably scary, some containing traces of fentanyl or white powder, accompanied by not-so-veiled threats and dubious political symbols.

Harkening back to the anthrax attacks that killed five people in 2001, the mailings are prompting election officials already frustrated with ongoing harassment and threats to reach out to local police, fire, and health departments for help stocking up on the overdose reversal medication naloxone.

Even if there’s little risk from incidental contact with the synthetic opioid, having the antidote on hand isn’t a bad idea amid an addiction epidemic that is killing more than 100,000 people in the U.S. every year – and it can provide some assurance for stressed ballot workers, election managers say.

“My team is usually in the direct fire just because we’re opening up thousands of millions of ballots, depending on the election,” said Eldon Miller, who leads the ballot-opening staff at King County Elections in Seattle, which stocked up on naloxone after receiving a fentanyl-laced letter in August. “I always say to my team, ‘Your safety is my utmost importance.’”

The letters were sent this month to vote centers or government buildings in six states: Georgia, Nevada, California, Oregon, Washington, and Kansas. Some were intercepted before they arrived, but others were delivered, prompting evacuations and briefly delaying vote counts in local elections. The FBI and U.S. Postal Inspection Service are investigating.

Some of the letters featured an antifascist symbol, a progress pride flag, and a pentagram. While the symbols have sometimes been associated with leftist politics, they also have been used by conservative figures to label and stereotype the left. The sender’s political leanings were unclear.

Fentanyl, an opioid that can be 50 times as powerful as the same amount of heroin, is driving an overdose crisis as it is pressed into pills or mixed with other drugs. Briefly touching it cannot cause an overdose, and researchers have found the risk of fatal overdose from accidental exposure is low, unlike with powdered anthrax which can float in the air and cause deadly infections when inhaled.

Election workers across the country have been besieged by threats, harassment, and intimidation since former President Donald Trump and his supporters began spreading false election claims after he lost the 2020 election.

“I hope we encourage people to not hurt election officials,” said Anne Dover, the elections director in suburban Atlanta’s Cherokee County, which did not receive a suspicious letter. “A lot of people are leaving the field. It’s not just threats of physical harm. There’s a lot of emotional and psychological abuse.”

Dover reached out this month to fire department officials, who provided Narcan, the nasal spray version of naloxone. Naloxone can be obtained over the counter, given to people of all ages, and does not harm people who do not have opioids in their system.

Her office also is taking new precautions with mail: leaving it in a particular spot and having one person designated to open it wearing gloves and a mask.

Lane County, Oregon, which received a suspicious letter, will provide naloxone kits and train elections staff on administering it. So will Lincoln County, Nevada, which did not get a suspicious letter.

The office of Georgia Secretary of State Brad Raffensperger said this week that it will provide naloxone to any of the state’s 159 counties after a letter intercepted on its way to elections officials in Atlanta’s Fulton County tested positive for opioids.

Condemning the letters, Raffensperger noted one of his sons died of a fentanyl overdose about five years ago: “We know how deadly this stuff is.”

Some of the letters, including ones sent to King and Pierce counties in Washington state, bore striking similarities to the one King County received while counting votes in this year’s August primary. The incident prompted King County Elections to procure naloxone, though the antidote was not needed then nor when its Renton office received a second fentanyl-laced letter this month.

“We felt like it was just a good idea to have on hand for all kinds of scenarios these days,” King County Elections spokeswoman Halei Watkins said. “We have it in a few spots in the building, and include it with the first aid and emergency kits that go to our off-site vote centers.”

Maya Doe-Simkins, co-director of Remedy Alliance/For The People, which launched last year to provide low-cost or free naloxone to community-based, harm-reduction programs, said governments should be more focused on providing the antidote to those who work with people likely to overdose.

There is no shortage of naloxone, which is available online and at some pharmacies, but its distribution leaves something to be desired, Doe-Simkins said.

“It is an absolute gross misuse of resources to spend money on ensuring that election officials have naloxone,” Doe-Simkins said, especially because “the actual appropriate and evidence-based intervention for naloxone distribution is underfunded and under-resourced.”

Chris Anderson, the elections supervisor in Seminole County, Florida, said his office hasn’t received any envelopes containing fentanyl in the mail but obtained several doses of Narcan this month from the fire department, which said it had plenty of supply.

“We can immediately save a life with those,” Anderson said. “I appreciate the advice given to us from medical professionals, and we certainly will do everything we can not to have to use Narcan, but in that one instance where it’s needed, I’d rather have and not need than need and not have.”

In Tacoma, Washington, Pierce County Auditor Linda Farmer said her office obtained naloxone after neighboring King County’s experience in August. The office received a threatening letter this month containing baking soda and took the occasion to reemphasize that naloxone is available.

“We reminded staff last week of where to find it,” Farmer said.

Associated Press writers Ken Ritter in Las Vegas; Jeff Amy in Atlanta; David Fischer in Miami; and John Hanna in Topeka, Kansas, contributed to this report

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