Harm reduction experts, LE officials debunk fentanyl exposure myths

"There's a belief that if you touch fentanyl that you could receive a lethal dose or you could get exposed to fentanyl to the skin ... I've never heard of a case of that happening."


By Morgan McKenzie
Greeley Tribune

GREELEY, Colo. — The Greeley Police Department recently reported to the community that two officers were hospitalized due to fentanyl exposure in a September arrest of two suspects.

While Greeley police said both officers experienced "physiological symptoms consistent with fentanyl exposure," the department never shared how the officers became exposed after the Greeley Tribune made attempts to gain more knowledge of the incident.

Across the United States, false information circling the media about the dangers of fentanyl exposure has impacted the timely responses of first responders, endangered the lives of those who use the lethal substance and constructed myths believed by many.

Despite what someone may have heard, research has shown there are no verifiable cases of incidental fentanyl exposure and any secondary contact will not lead to overdose.

Facts

Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. Pharmaceutically, fentanyl is prescribed in patches or lozenges to treat severe pain, typically for advanced cancer pain.

However, fentanyl is also made illegally, which can be attributed to most cases of fentanyl-related harm, overdose and death, according to the Centers for Disease Control and Prevention. Illegal drug markets traffic fentanyl, often mixed with heroin or cocaine, to increase the desired effects.

Counterfeit pills are a common form of fentanyl, which usually contain lethal doses of the drug, the United States Drug Enforcement Administration reports.

But a person can only experience fentanyl exposure if fentanyl is ingested, smoked, snorted or injected, according to Sam Bourdon, Colorado Department of Public Health and Environment Harm Reduction Grant Fund Coordinator. Incidental exposure, such as touching the drug or walking into a room where someone has smoked fentanyl, is not possible.

To date, the American College of Medical Toxicology indicated there have been no reports of "emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids."

Overdose symptoms vs. other types of reactions

Since 2017, incorrect information about fentanyl exposure from casual contact has grown dramatically because of an Ohio police officer developing symptoms attributed to brushing powder off his shirt, according to WTFentanyl. Prior to this incident, the United States Drug Enforcement Administration released messaging about the dangers of fentanyl exposure in 2016.

More recently, Greeley police had their reported run-in with incidental fentanyl exposure. Developing symptoms after exposure to substances on the job is a common report among first responders, particularly law enforcement officers, around the nation.

However, Evans Police Chief Rick Brandt, who has completed opioid exposure education with departments across the state and nation at conferences, reported symptoms such as agitation, increased blood pressure, increased respiration, sense of panic and lightheadedness aren't consistent with incidental exposure.

He said officers having this type of reaction could mean exposure to another illicit drug, or it could be anxiety-related.

Bourdon said symptoms including hyperventilation, panic or disorientation are signs of a panic or anxiety attack. But in many cases, people with symptoms are actually experiencing the so-called "nocebo" effect, which means if they expect adverse consequences or risks, then the body has a physiological reaction as if they were actually experiencing them.

Typical fentanyl and opioid overdose symptoms from consuming the substance through ingestion, smoking snorting or injection include respiratory depression such as decreased breathing, no breathing, noises of struggling to breathe like gurgling, as well as pinpoint pupils, unconsciousness, blue or ashy skin or fingertips and sometimes seizures, according to Bourdon.

Luckily, there is an easily accessible and easily administered treatment to effectively reverse an opioid overdose.

Naloxone, also known by its brand name of Narcan, works by reversing the effects of opioids through either a shot in the muscle or a spray in the nose to someone experiencing an overdose. But it's only needed by those actually experiencing an overdose.

"If someone is conscious, they don't need Naloxone. They don't need an overdose reversal," Bourdon said. "It's when someone becomes unconscious and they start experiencing that respiratory depression."

Even a non-overdose reaction to an opioid among those with substance dependence shows symptoms of lethargy, sleepiness, slowing respiration and slowing heartbeat, as well as pinpoint pupils, Brandt said.

Myths causing harm to overdose victims

In the United States, there were more than 100,000 fatal opioid overdose deaths between 2020 and 2021, according to the CDC.

A 2019 study in the Harm Reduction Journal by Rachel Winograd found that nearly 80% of 200 law enforcement officers interviewed believed people could overdose from touching fentanyl.

Despite what law enforcement reports to the community or what a person reads in the media or on social media, an overdose as a result of just being in the presence of fentanyl is not possible, according to Lewis Nelson, professor and chair of the Department of Emergency Medicine and director of the Division of Medical Toxicology at Rutgers New Jersey Medical School.

To Brandt, one of the most harmful aspects of the numerous reported cases of exposure involving symptoms is how misinformation is making its way into the media. Bourdon agreed, stating the most dangerous myth about incidental exposure is that it can cause an overdose.

"Every couple of months, there's a news article about an officer being exposed and being transported to a hospital ... when the symptoms didn't really match," Bourdon said.

The myths heightened the fear of fentanyl exposure and altered law enforcement and first responders' willingness to respond to people in need of aid.

Hesitancy to approach an overdose victim because of a personal fear of being in close proximity to fentanyl puts these victims at risk of losing their lives, especially since acting in a timely manner to administer Naloxone is critical.

Bourdon explained due to the potency of fentanyl, the processes that cause an overdose happens faster than other substances, such as heroin or morphine. When someone enters respiratory depression as a result of fentanyl, it occurs within zero to two minutes rather than five to 30 minutes.

Bourdon reported a person will also go into cardiac arrest significantly faster.

"So you can imagine if someone is hesitant to enter a space or they're donning unnecessary equipment, their likelihood of responding in a timely fashion is going to be impeded," Bourdon said.

As long as Naloxone is administered quickly, and the overdose victim is given two to three minutes of recuperation and rescue breathing, it should work just as adequately as any other tool and show effectiveness in reversing an opioid overdose, Bourdon said.

No confirmed incidental exposure cases

Bodies of research, including the American College of Medical Toxicology and the American Academy of Clinical Toxicology, have stated that there's very little risk if any secondary exposure, Bourdon said.

Additionally, through Brandt's research and communications with medical experts, he confirmed no cases of inadvertent exposure to law enforcement or first responder in the manner that's been described that we've been seeing in the media — the main myth centered around skin contact.

"There's a myth in law enforcement, and I've spoken at conferences about this as a topic, there's a belief that if you touch fentanyl that you could receive a lethal dose or you could get exposed to fentanyl to the skin," Brandt said. "That is not accurate. I've never heard of a case of that happening."

Even in cases where a person gets fentanyl powder on a cut, the risk of receiving a lethal dose is extremely low, Brandt said.

While there is no proven case of exposure through absorption of skin from powdered fentanyl, crystallized fentanyl or fentanyl pills, Brandt said a prescription fentanyl patch is the only method designed for absorption through the skin

With the pharmaceutical patch, it can take 12-16 hours before a significant blood fentanyl concentration is reached, according to Nelson.

As long as first responders use safety protocols and precautions, the other four methods of exposure — inhalation, ingestion, being stuck by a needle or touching one's eyes, nose or mouth with hands or when illicit drugs come into contact with the eyes, nose or mouth directly — are also unlikely.

The chance of exposure is a very rare occurrence even in situations involving large amounts of fentanyl, where a significant amount of powder is placed in the air, the North Carolina Department of Health and Human Services reported.

Fentanyl doesn't self-aerosolize, according to Bourdon, meaning the substance is not going to combust and create water droplets.

Training and education

Law enforcement protocols for handling unknown substances changed when fentanyl became a more prominent issue in the United States, Brandt said. The change went from field testing controlled substances to stepping up safety by using protective gear, like gloves, eye protection and masks, to collect the substance before packaging it up to send off to the Colorado Bureau of Investigation.

Police are first taught to be "situationally aware" when walking into any situation, according to Brandt. In any case, when a first responder touches an opioid substance, he advises them to not touch any of their mucous membranes and to wash their hands with soap and water as soon as possible.

"I don't want to speak for every state, but I think the general training is ... handle it like a hazardous material," Brandt said about unknown substances. "Don't touch anything. Don't smell anything. Don't taste anything."

Boudron advised the use of nitrile gloves and a regular uniform will provide "adequate protection" from coming into contact with fentanyl.

"You can approach the situation much as you would with a normal overdose," she said.

Know the facts, carry the tools

Brandt has trained more than 225 police departments about administering Naloxone, but first responders aren't the only ones who can carry around the medicine that reverses an overdose.

Bystanders, family and friends are all allowed to carry and administer Naloxone without civil or criminal liability due to legislation passed in Colorado, according to Bourdon. She said "everyone should carry it at this point" to reduce the devastating overdose epidemic.

Bourdon said many organizations and pharmacies are distributing Naloxone and training people on how to use the medicine when responding to an overdose, but she assures administering the drug is an easy task. It also causes no harm if it's administered to a person who's not experiencing an opioid overdose.

Matching Bourdon's knowledge, Brandt said there are no safety threats to administering the life-saving treatment, which can be done with little to no skin contact with a person experiencing overdose symptoms.

"I share your concern that folks are going to be hesitant to help somebody," Brandt said. "But if you are really dealing with somebody who is exposed to a lethal amount of an opioid, if you have Narcan or Calexico, you can safely administer that without really even hardly touching the person except to get them in a safe position. But it's easily administered without any exposure."

When an unknown drug is reported in the media, understandable fears will arise, Bourdon said. But it's critical for people to spread information on the actual risks of overdose, the harms of substances and that there are tools to combat the fentanyl crisis.

"My message to folks in the community: if you don't have Narcan or Calexico on your person, go get some and carry it around with you," Brandt said. "Have it handy because you just never know when you're going to come across one of these."

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