Incidental fentanyl exposure a myth, say researchers

Dec 24, 2020

December 24, 2020 — The synthetic opioid fentanyl is a huge problem in the US right now, according to Sheriff Matt Kendall, who sees some of the social effects first-hand. “It is the biggest problem,” he says, because fentanyl is so much cheaper than methamphetamine or heroin to make. “I believe there’s more fentanyl on the streets right now than heroin,” he added. “This is going to be the new epidemic.”

It’s a scary substance. In 2018, the CDC, in partnership with the National Institute of Occupational Safety and Health, put out a video from police body cams that purported to show police officers in Virginia being accidentally exposed to fentanyl.

Closer to home, the sheriff reported earlier this month that a deputy at the jail had  accidentally been exposed to the drug while cleaning a cell where an inmate had suffered a severe overdose from fentanyl that had somehow been smuggled in. The deputy started feeling woozy, received a dose of Narcan, and was taken to the hospital for observation. He was wearing PPE, including a mask, gloves, and long sleeves. He was also wearing eyeglasses, but not protective goggles. Kendall says it’s impossible to be exposed to fentanyl through the skin, but he thinks the deputy may have been affected by powder that got into a cut on his skin, into his eyes, or by inhaling it.

But Dr. Rachel Winograd, a clinical psychologist who works as an associate research professor at the University of Missouri St. Louis, the Missouri Institute of Mental Health, says that sounds impossible. Her work revolves around the role of opioids in what she and others in the field call “the worsening poisoning crisis.” She’s especially concerned with effective, equitable treatments for addiction. In August of this year, she led a team that researched and published an article on misinformation about the risks of accidental fentanyl contact. ”I suppose if you walked into a cloud of fentanyl dust in the air, then technically when you breathe it in, it would get into your system,” she conceded. But typically, getting affected by the drug requires something much more intentional. Users inject it, snort it, insert it rectally, or apply a fentanyl patch, which last is the most common legal use.

Kendall says the substance that was found in the inmate’s cell, including on the bed sheets, had preliminary tests done on it before it was shipped off to the California Department of Justice for a full analysis, which has not come back yet. Any toxicology tests that may have been performed on the deputy would be privileged medical information.

“You’ll notice that in all the anecdotal reports and accounts of first responders falling ill to overdose from incidental fentanyl exposure, there are zero reports of toxicology that match the anecdote,” Winograd says. “It’s not what’s happening. Something else might be happening, maybe more related to some panic, or nerves, fear, anxiety...but it’s not an overdose.”

In a  2017 position paper on incidental fentanyl exposure to first responders, the American College of Medical Toxicology and the American Academy of Clinical Toxicology agree that “the risk of clinically significant exposure to emergency responders is extremely low.” The paper goes on to say that, while terrorists in Russia killed 125 people with a weaponized aerosolized carfentanil mixture, an unprotected individual exposed to “the highest airborne concentration encountered by workers” would require 200 minutes of such exposure to reach a dangerous dose. Absorption of liquid fentanyl does increase with broken skin. The paper cites a veterinarian who was quickly affected after being splashed in the eyes and mouth with a dart containing a mixture of carfentanil and xylazine, but says that facial contact with liquid or powder opioids is unlikely.

Winograd’s team has started incorporating accurate information about the hazards of incidental exposure, or lack thereof, into a law enforcement training program. She says lives could be on the line.

“By the end of our training, we had pretty overwhelming results that we were able to bust this myth in the minds of those who attended our trainings,” she reported. “And the idea there, why that matters, is that if first responders are really scared that they are going to overdose themselves, or put themselves in harm’s way when they go to save someone’s life from an overdose, then that’s going to deter them from doing it...or it will at least slow them down if they feel like they need to put on a bunch of protective equipment...if you take an extra two minutes  to don a bunch of PPE, that could cost someone their life.”