Fentanyl is a potent opioid analgesic and has been the center of the opioid and overdose epidemic. As an illicit agent, fentanyl is often in the form of a powder, which is then either insufflated (the fancy medical term for snorting) or dissolved in water and injected intravenously. It is fifty to one-hundred times more potent than heroin, the drug it replaced as the illicit opioid of choice. It can cause significant euphoria and analgesia, which is why it is so widely used. It can also cause respiratory depression or complete respiratory arrest, the reason it can be so deadly. It is readily absorbed when insufflated or injected and the actions are almost immediate. These are the facts.
These are some additional facts about fentanyl. Fentanyl, in the form of a powder, is not absorbed through the skin. Simply washing with soap and water can remove fentanyl powder from the skin. In fact, very few powders are absorbed through the skin, due in part to their molecular size and make-up. Fentanyl in powder form is not aerosolized when a package is opened and doesn’t stay suspended in air. It is therefore not likely to be inhaled simply when the packaging is opened.
There is no data to support that any special decontamination is required to clean a surface that was in contact with fentanyl beyond standard cleaning or any evidence that clothing requires disposal or incineration after exposure. There is certainly no data that a vehicle that contained intact packaging requires special decontamination or destruction. Yet as a result of ongoing media reports, this is exactly what is happening.
The Harms of Hysteria
It is important to know the facts because how we respond to a crisis, an emergency or an epidemic need to be fact based to prevent harm. Hysteria, from Greek for hysterika (which translates to uterus, a topic for a whole separate blog) can occur when facts are either misconstrued or inaccurate. Hysteria can be detrimental because it can cause unnecessary fears or harms. It can result in enacting inaccurate policy and pointless spending.
Propagating hysteria and the ensuing fear that accompanies it can occur through an array of conduits, and in today’s rapid dissemination of media, especially through unregulated social media, this can occur rapidly. It is even worse when it is coming from authoritative sources like the Drug Enforcement Agency as well as the more formal media outlets.
Inaccurate reporting of misinformation that can lead to hysteria, fear, and rapid dissemination of misinformation. This has unfortunately been the case with exposure to fentanyl by public safety officers. There have been a growing number of reports of first responders, mostly police officers, who were exposed to fentanyl and who then required emergency care for “symptoms related to fentanyl exposure”. This has ranged from vehicle stops where packaged fentanyl was present in the vehicle, to officers exposed after opening a package for field testing. This has created a degree of hysteria that has led to wide-spread misinformation about the risk of exposure.
The Dangers of Misinformation
While safety is certainly of utmost concern, there are some real dangers to this inaccurate information. One issue is arresting individuals who are in possession of personal use quantities of fentanyl. These “end-users” are at the greatest risk and often have co-morbid mental health and substance use disorders. While it is illegal to possess this drug, it is clear that arresting individuals with substance use disorder is a detriment to those individuals and to the legal system itself.
There is mounting data to suggest that the most appropriate intervention is not arrest, but referral to treatment. But arrests are being made. In a recent case in Needham, Mass., two individuals were charged with drug-related crimes after officers were “exposed” to possession amounts of fentanyl. The fentanyl in this case was in a closed container and according to reports, officers never actually handled the container or the drug. Instead of treatment, these individuals will face fines or possibly incarceration, both of which can impede any progress towards recovery.
In one case in New Hampshire, a man was arrested and charged with assault with a deadly weapon after officers responding to his home reported they were exposed to fentanyl. This is a charge that carries up to five years in prison. The charges were later dropped, but not after one and a half years of investigative and legal costs.
This also creates a possible reluctance for first responders to provide appropriate medical care that includes rescue breathing and naloxone. When someone is not breathing, seconds count. If first responders are reluctant to provide this care, the outcome can be deadly. Misinformation about the risks of exposure can lead to death, not of the responder, but of the person who is in the midst of acute overdose.
Profiting from Fear
Building on this fear, there are several companies that are selling either courses or kits to “protect” public safety providers from the danger of fentanyl. These courses and kits are unnecessary and are costing public safety agencies thousands if not tens of thousands of dollars. One such course costs $595 per person, which can be cost-intensive for even moderately sized agencies.
Courses of this nature are unnecessary. The risk of exposure is quite low and most information is available from reliable sources on-line for free. Similarly, “opioid exposure kits” are being advertised that contain respirators and Tyvek coveralls among other supplies, that go well beyond the necessary protections needed and at a steep cost.
Propagating this misinformation through these types of courses results in other costs, including excessive responses to clean-up. HAZMAT teams have been brought in to clean up even small amounts of powder suspected to be fentanyl, and in one case, an officer’s uniform was incinerated after a reported exposure to fentanyl powder. This is an avoidable use of valuable resources and expense.
The cost that comes from these courses or the level of response that they are teaching could be better spent on appropriate training, naloxone or other interventions that are more beneficial to the public safety provider and those afflicted with substance use disorder.
A Call to Listen to the Science
Fentanyl is a potent and often lethal drug when it is used as an illicit drug by those afflicted with substance use disorder. The data on the risk to first responders is clear, simple measures like using gloves, washing with soap and water and avoiding contact with mucous membranes are very effective. Harms propagated by misinformation are aplenty and come at both a financial and societal cost. Policy and media reports need to be concordant with the science, rather than sensationalized. Media outlets in particular should be held to a high standard to report the facts accurately and held accountable when they fail to do so. There is already enough harm from this tragedy, neither the government or media should be adding to it.