Experts say you can’t overdose by just being near it
In December 2016, police responded to a call about a suspicious person at a Green Island Dunkin’ Donuts. When they arrived, they found a man surrounded by drugs and needles on the floor of the public restroom.
“We immediately had a reaction,” one of the responding officers told a local news station. “I started getting dizzy. I wasn’t talking right for a couple minutes.”
The other officer, from nearby Watervliet, said it felt like his throat was going numb. The two were taken to a local hospital, where their symptoms faded, and released later that day.
The culprit of the mysterious symptoms seemed to be fentanyl, a synthetic opioid created in the 1960s and used for medicinal and veterinary purposes, that very recently started popping up in local and national heroin supplies and killing people at far higher rates than heroin alone. Fentanyl is up to 100 times stronger than morphine and up to 50 times stronger than heroin, so someone overdosing on fentanyl is much harder to revive than someone overdosing on heroin. Just a few milligrams can be deadly.
But deadly how? To inject? Snort? Touch? Look at?
No one quite knew, and stories like Green Island’s began circulating in small towns nationwide. In the most famous incident, a police officer in Ohio was said to have overdosed last summer after he brushed a small amount of white powder he believed was fentanyl off of his uniform. He was given three doses of Narcan, a drug that reverses an opioid overdose, and recovered.
The story went viral, and toxicologists had an immediate reaction: That just isn’t possible.
Fentanyl can be deadly when injected, ingested or inhaled. But it’s highly unlikely if not impossible, they said, to overdose or experience toxic effects from merely touching it. Even airborne exposure — accidentally breathing in an aerosolized form of the powder — is unlikely to cause much of an effect unless “vigorous sniffing” is involved, they said.
The American College of Medical Toxicology and American Academy of Clinical Toxicology had been in the process of drafting a position paper on fentanyl exposure — one that would debunk the growing lore around skin and airborne exposure — when the Ohio story broke. The symptoms that police in towns across the nation seemed to be experiencing, medical professionals said, were more consistent with panic attack than opioid overdose.
The CDC last summer even had to update its web page on fentanyl, which previously stated that skin absorption could be deadly. Now the CDC, under a post titled Preventing Occupational Exposure to Emergency Responders, states:
“Responders are most likely to encounter illicitly manufactured fentanyl and its analogues in powder, tablet, and liquid form. Potential exposure routes of greatest concern include inhalation, mucous membrane contact, ingestion, and percutaneous exposure (e.g., needlestick). Any of these exposure routes can potentially result in a variety of symptoms that can include the rapid onset of life-threatening respiratory depression. Skin contact is also a potential exposure route, but is not likely to lead to overdose unless large volumes of highly concentrated powder are encountered over an extended period of time. Brief skin contact with fentanyl or its analogues is not expected to lead to toxic effects if any visible contamination is promptly removed.”
Unfortunately, many EMTs and paramedics had already received misinformation about exposure routes in the form of public health and safety advisories, said Daniel Gilmore, director of operations at Mohawk Ambulance Service. That matters, he said, because first responders change their safety precautions based on what they expect to encounter at any given scene. A drug that’s toxic to touch or even breathe near would require much more involved safety measures than a drug that’s toxic only to ingest.
The misinformation and hysteria surrounding fentanyl has reminded some public health experts and first responders of another public health crisis. Gilmore worked as a firefighter, EMT and paramedic throughout the HIV/AIDS crisis of the 1980s and 1990s, and said it took time for accurate information about exposure and transmission to trickle down to first responders, let alone the general public.
“It was a lot of hype,” he said. “We didn’t understand it, we didn’t know how it was transmitted, and I think we’re seeing the same thing here. But the reality is, the initial scares about exposure to this drug just have not panned out.”
While the misinformation was ultimately corrected, he said, some worry the damage may already have been done.
If first responders are worried they might get sick or overdose by accidentally touching or being near fentanyl, they may take longer to suit up and respond to a scene, said Keith Brown, director of health and harm reduction at the Katal Center for Health, Equity and Justice, a nonprofit that advocates for a public health approach to drug use over criminalization.
“By causing fear and panic among such key partners in responding to the overdose crisis, we’re putting people’s lives at further risk and adding to the stigma around drug use,” he said.
When someone overdoses on opioids, their breathing slows and eventually stops. The brain starts dying after four to six minutes without “good oxygenated blood,” Gilmore said. After eight to 10 minutes, their chance of being resuscitated drops dramatically.
CDC guidelines currently recommend nitrile gloves for first responders who suspect that fentanyl may be present at the scene, and suggest adding a disposable facepiece respirator if small amounts are visible.
Such measures are unlikely to slow down first responders, Gilmore said. It’s when the scene involves guns or some other criminal element that first responders are often slowed down, he said, because it must first be cleared by the lead law enforcement agency.
To his knowledge, none of the 220 EMTs and 60 paramedics who work for Mohawk Ambulance have ever experienced symptoms after encountering fentanyl at the scene. The ambulance company serves municipalities in Albany, Rensselaer and Schenectady counties, where opioid overdoses have risen along with every other county in the state.
The company has responded at least once, Gilmore said, to a local police department to evaluate and treat several officers who believed they might have been exposed to fentanyl. Their symptoms, he said, were not consistent with an opioid overdose.
“You hear all this bad stuff about a drug and now you’re a police officer who realizes he has potentially exposed himself to something that can be very, very bad for you? Of course you become concerned for your well being,” he said. “It’s not surprising they end up with symptoms.”
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