ST. PAUL, Minn. – Fentanyl. It is a major factor in the opioid epidemic and considered to be one of the deadliest illicit drugs on the market. From the singer Prince to teens in small towns, fentanyl has been linked to many drug overdoses and deaths. For first responders like police officers and paramedics, accidental fentanyl exposure can prove to be quite harmful.
As a member of law enforcement who may routinely conduct drug raids, drug arrests, respond to potential opioid overdoses and other situations where drugs such as fentanyl may be present, it is crucial that you take the necessary precautions to protect your body from the effects of fentanyl exposure. You should understand the potential risks as well as the personal protective equipment available to help prevent accidental fentanyl exposure.
What Exactly is Fentanyl?
Fentanyl was originally developed as a rapid-acting synthetic opioid to be used as a prescription medication for severe pain. When prescribed for pain relief, fentanyl, and its analogues, generally come in the form of a transdermal patch worn by patients. This patch allows the drug to provide immediate relief through skin contact, but it is also slowly released and absorbed through the body over the course of several days since the drug is so powerful. According to the Food and Drug Administration (FDA), fentanyl is about 50 to 100 times more potent than heroin or morphine.
However, it is the recreational use of this potent drug that is rapidly creating a hazard from small towns to large cities. There is a growing illegal market in which individuals buy large amounts of the drug in a powder form and compress it into tablets to be sold illicitly. Law enforcement around the country are reporting coming into contact with fentanyl in powder, tablet or liquid form.
Likewise, law enforcement professionals are also reporting a spike in seeing fentanyl analogues as part of drug trafficking busts. Take for instance, Carfentanil, which is only a few molecules different from fentanyl, but is even more potent and dangerous. Carfentanil is often up to 10,000 times more powerful than morphine. It is traditionally used to tranquilize large animals like elephants, but is also increasingly found being made and distributed on the illegal market.
What Effects Occur Due to Exposure to Fentanyl?
Inhalation of the powder form is a likely exposure route for modified-illicit fentanyl. A small amount of fentanyl that has been aerosolized can affect a person quickly. Potential exposure routes of greatest concern typically include inhalation, interaction with the eyes or nose (mucous membrane contact), ingestion or from a needlestick.
Exposure can cause an onset of adverse health effects such as:
More importantly, according the U.S. Drug Enforcement Agency (DEA), respiratory distress or cardiac arrest can occur within minutes of exposure from as small a dose as 2 milligrams.
The following PPE recommendations, provided by the U.S. Centers for Disease Control (CDC) and the National Institute of Occupational Health and Safety (NIOSH), apply to routine activities after an arrest or search warrant execution, such as evidence collection activities. This guidance applies to powder, pill, and liquid forms of fentanyl or its analogs that may be present during the evidence collection phase of law enforcement operations.
NIOSH recommends that law enforcement personnel assess the specific risks of each situation and exposure level with regards to fentanyl in order to determine the appropriate personal protective equipment (PPE) to protect against respiratory and/or dermal hazards, including accidental inhalation or skin exposure.
The following serves as a general discussion of potential PPE options. To learn more about what specific PPE products and models can be used to help protect law enforcement from fentanyl depending on the exposure level conditions, please download our whitepaper.
Safety goggles should be worn for eye protection. For instance, an indirect vented goggle with a high performance anti-fog coating can help officers who need a clear field of vision to analyze the scene and avoid exposure. The vented portion of this type of goggle is designed so that no direct straight-line passage from the exterior to the interior of the goggle exists. The purpose of the indirect venting is to limit or prevent the passage of liquid splash and dust into the goggle, which can help avoid fentanyl exposure when it has been aerosolized, vaporized or part of a liquid mix.
Respiratory PPE Choices
Depending on the level of exposure, there are different types of respiratory protection options that may be used to protect against accidental fentanyl exposure. These NIOSH-approved respiratory options include:
- A NIOSH-approved filtering facepiece respirator, in which case eye protection should also be worn
- A tight-fitting half or full face reusable air-purifying respirator with particulate filters
- Chemical, biological, radiological, and nuclear (CBRN) canisters with full face respirators
- Powered air-purifying respirators (PAPRs) with high-efficiency particulate air (HEPA) filters
- A self-contained breathing apparatus (SCBA)
All respirators administered to law enforcement need to be part of an OSHA respirator program and each kind must be fit tested to everyone individually who will be wearing these forms of respiratory PPE.
Skin contact is also a potential exposure route, but is not likely to lead to overdose unless large volumes of concentrated powder are encountered over an extended period of time. If visible contamination is promptly removed via soap and water, brief skin contact is not expected to lead to toxic effects.
First responders who are performing any task that would potentially aerosolize Fentanyl, such as sweeping or “burping” bags to remove air, should wear dermal protection that covers their arms and legs. Again, the level of exposure to fentanyl or its analogues, will determine which level of full body PPE may be needed for protection.
In moderate and high exposure situations, coveralls or disposable protective sleeves will help shield law enforcement personnel. In these exposure settings, disposable boot covers and head covers are also recommended to reduce the spread of contamination.
No matter what the exposure level situation, nitrile gloves are suggested when there is a risk of handling anything that has come into contact with fentanyl-related compounds. While the permeation rate of fentanyl through nitrile is unknown, nitrile generally shows low permeability to other hazardous drug compounds.
Nitrile gloves should be purchased with a minimum thickness of 5 mil (0.127 mm). Powder-free nitrile gloves are recommended since particulates from the glove may absorb the narcotic compounds, which may increase the potential for dermal contact/absorption during doffing and spread contaminants to unintended surfaces. See NIOSH suggestions for specifics on sizing, replacement and double gloving procedures.
First, follow your own department’s decontamination procedures set up at your facility. Next, it is advised as a best practice by the CDC that law enforcement and first responder personnel should immediately wash hands with soap and water after a potential exposure, including after leaving a scene where fentanyl is known or suspected to be present to avoid potential exposure and to avoid cross-contamination. It is important to note that hand sanitizers or bleach solutions should not be used to clean contaminated skin as they can facilitate skin absorption.
Decontamination of reusable PPE and equipment should be done according to the manufacturer’s recommendations. Contaminated single use PPE should be placed in labeled durable 6 mil polyethylene bags and disposed of appropriately.
We encourage you to review your agency guidance and download this helpful whitepaper today to learn more about the dangers of accidental exposure to fentanyl and the specific PPE that can help you in these situations.