#FentanylFactsNotFear

The position of the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology, is as follows:

Fentanyl and its analogs are potent opioid receptor agonists, but the risk of clinically significant exposure to emergency responders is extremely low. To date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids. Incidental dermal absorption is unlikely to cause opioid toxicity.

Why is this Important?

“Misinformation encourages stigmatization and medically unfounded stereotypes, along with harmful policies.” – Eliza Wheeler, Harm Reduction Coalition

Stories about inadvertent overdoses create hysteria, which creates the potential for delays in treatment of people who are sick from drugs. In the event of an overdose, every second counts. We need our bystanders, family, friends, first responders to be empowered and equipped to act in case they witness an overdose. We hope through education, we can change this harmful narrative and encourage more people to act in time of crisis.
TOUCH DOESNT KILL

Fentanyl Myths Broken Down

Fentanyl powder is essentially not absorbed through skin, and would take massive amounts over long time to cause an overdose.

“Skin contact is also a potential exposure route, but is not likely to lead to overdose unless exposures are to liquid or to a powder over an extended period of time. Brief skin contact with illicit fentanyl is not expected to lead to toxic effects if any visible contamination is promptly removed.”
CDC on Fentanyl Exposure Prevention

“Incidental dermal absorption is unlikely to cause opioid toxicity. If bilateral palmar surfaces were covered with fentanyl patches, it would take approximately 14 minutes to receive 100 mcg of fentanyl [using a body surface area of 17,000 cm2, palm surface area of 0.5% [26], and fentanyl absorption of 2.5 mcg/cm2/h [24]. This extreme example illustrates that even a high dose of fentanyl prepared for transdermal administration cannot rapidly deliver a high dose.”
American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) Official Position Statement

Dermal precautions

  • For routine handling of these drugs, nitrile gloves provide sufficient protection.
  • Incidental dermal exposures should immediately be washed with copious amounts of water. Alcohol based hand sanitizers should not be used for decontamination as they do not wash opioids off the skin and may increase dermal drug absorption.

This would only be an issue in settings with extreme air movement as powdered opioids do not aerosolize.

“Industrial producers of fentanyl use time-weighted average occupational exposure limits (OEL-TWA) for alfentanil (1mcg/m3), fentanyl (0.1 mcg/m3), and sufentanil (0.032 mcg/m3) to limit exposure [17]. At the highest airborne concentration encountered by workers, an unprotected individual would require nearly 200 minutes of exposure to reach a dose of 100 mcg of fentanyl. The vapor pressure of fentanyl is very low (4.6 x 10-6 Pa) suggesting that evaporation of standing product into a gaseous phase is not a practical concern [18].”
American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) Official Position Statement

Respiratory precautions

  • In the unusual circumstance of significant airborne suspension of powdered opioids, a properly fitted N95 respirator or P100 mask is likely to provide reasonable respiratory protection. Mucous Membrane/Splash Exposure
  • OSHA-approved protection for eyes and face should be used during tasks where there exists possibility of splash to the face.

Even extremely potent analogs like carfentanil behave the same as fentanyl in passive exposure

“The fentanyl in the illicit drug supply comes in powder or solid form, and must have direct contact with mucous membranes or the bloodstream via snorting (inhalation), smoking, or injection to take effect. Yes, even carfentanil”
Harm Reduction Coalition

General Precautions and Management of Exposure

  • Workers who may encounter fentanyl or fentanyl analogs should be trained to recognize the symptoms and objective signs of opioid intoxication, have naloxone readily available, and be trained to administer naloxone.
  • For opioid toxicity to occur the drug must enter the blood and brain from the environment. Toxicity cannot occur from simply being in proximity to the drug.
  • Toxicity may occur in canines utilized to detect drug. The risks are not equivalent to those in humans given the distinct contact that dogs, and not humans, have with the local environment.

Dermal precautions

  • For routine handling of these drugs, nitrile gloves provide sufficient protection.
  • Incidental dermal exposures should immediately be washed with copious amounts of water. Alcohol based hand sanitizers should not be used for decontamination as they do not wash opioids off the skin and may increase dermal drug absorption.

Respiratory precautions

  • In the unusual circumstance of significant airborne suspension of powdered opioids, a properly fitted N95 respirator or P100 mask is likely to provide reasonable respiratory protection. Mucous Membrane/Splash Exposure
  • OSHA-approved protection for eyes and face should be used during tasks where there exists possibility of splash to the face.

Naloxone Administration and Airway Management

  • Naloxone should be administered to those with objective signs of hypoventilation from opioid intoxication.
  • If hypoventilation persists following initial naloxone dose and personnel with advanced airway training are not available, repeat naloxone until reversal is seen or 10 mg is administered.
  • Personnel with advanced airway training should provide airway support for patients who are in extremis or those who do not improve with naloxone.

Long-term Sequelae of Exposure

  • In the absence of prolonged hypoxia, no persistent effects are expected following fentanyl or fentanyl analog exposures. Those with small subclinical exposures and those who awaken normally following naloxone administration will not experience long-term effects.

Video of Touching Fentanyl - Demonstration

Need more?

Here is Chad Sabora, a former prosecuting attorney and harm reduction activist in St. Louis, in a video holding heroin cut with fentanyl and carfentanil (a more potent synthetic opioid) – he certainly is not overdosing.

His full video can be found HERE.

Need more?

Here is Chad Sabora, a former prosecuting attorney and harm reduction activist in St. Louis, in a video holding heroin cut with fentanyl and carfentanil (a more potent synthetic opioid) – he certainly is not overdosing.

His full video can be found HERE.

RESEARCH

“ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders The position of the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT), is as follows:

Fentanyl and its analogs are potent opioid receptor agonists, but the risk of clinically significant exposure to emergency responders is extremely low. To date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids. Incidental dermal absorption is unlikely to cause opioid toxicity.

For routine handling of drug, nitrile gloves provide sufficient dermal protection. In exceptional circumstances where there are drug particles or droplets suspended in the air, an N95 respirator provides sufficient protection. Workers who may encounter fentanyl or fentanyl analogs should be trained to recognize the signs and symptoms of opioid intoxication, have naloxone readily available, and be trained to administer naloxone and provide active medical assistance.

In the unlikely event of poisoning, naloxone should be administered to those with objective signs of hypoventilation or a depressed level of consciousness, and not for vague concerns such as dizziness or anxiety. In the absence of prolonged hypoxia, no persistent effects are expected following fentanyl or fentanyl analog exposures. Those with small subclinical exposures and those who awaken normally following naloxone administration will not experience long-term effects.

While individual practitioners may differ, these are the positions of American College of Medical Toxicology and American Academy of Clinical Toxicology at the time written, after a review of the issue and scientific literature.

Dermal Exposure Risk for Fentanyl and Fentanyl Analogs

Incidental dermal absorption is unlikely to cause opioid toxicity. If bilateral palmar surfaces were covered with fentanyl patches, it would take approximately 14 minutes to receive 100 mcg of fentanyl [using a body surface area of 17,000 cm2, palm surface area of 0.5% [26], and fentanyl absorption of 2.5 mcg/cm2/h [24]. This extreme example illustrates that even a high dose of fentanyl prepared for transdermal administration cannot rapidly deliver a high dose.

Inhalation Exposure Risk for Fentanyl and Fentanyl Analogs

Industrial producers of fentanyl use time-weighted average occupational exposure limits (OEL-TWA) for alfentanil (1mcg/m3), fentanyl (0.1 mcg/m3), and sufentanil (0.032 mcg/m3) to limit exposure [17]. At the highest airborne concentration encountered by workers, an unprotected individual would require nearly 200 minutes of exposure to reach a dose of 100 mcg of fentanyl. The vapor pressure of fentanyl is very low (4.6 x 10-6 Pa) suggesting that evaporation of standing product into a gaseous phase is not a practical concern [18].”

READ FULL REPORT HERE

“Opioid toxicity (i.e., “overdose” or respiratory depression) from transdermal and airborne exposure to Illicitly Manufactured Fentanyl (IMF) is a near scientific impossibility. This is explained in a recent position paper by the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology.

Incidents where responders were treated for alleged “exposure” were exhibiting symptoms of what appear to be anxiety or panic: dizziness, rapid heartbeat, sweating, even fainting – which are not symptoms of fentanyl overdose. There are other stories where officers exhibit no symptoms and yet were “treated” as a precaution. There have been stories of officers administering it to themselves, an impossible task if one is actually experiencing fentanyl-related overdose. There have been cases where naloxone was administered to first responders who were not exhibiting any signs of opioid toxicity, and when they “felt better,” it was attributed to the naloxone, a misinterpretation of the event.

Common sense also invalidates the possibility of casual exposure to fentanyl resulting in overdose. People who use, sell and transport drugs often come into environmental contact with fentanyl without incident. The authors of this op-ed provide services in the Bay Area; we interact with people at syringe exchange programs and encampments where fentanyl is present, in some cases touch samples of fentanyl the drug ourselves – all without incident.

Fentanyl has been used by the medical system for treatment of pain and anesthesia since 1968. There are some formulations of fentanyl that are specifically designed for transdermal absorption (patches), yet there is technology involved in changing the drug to be absorbed this way, and even handling transdermal patches does not cause overdose. The fentanyl in the illicit drug supply comes in powder or solid form, and must have direct contact with mucous membranes or the bloodstream via snorting (inhalation), smoking, or injection to take effect. Yes, even carfentanil. IMF is handled with bare skin throughout much of its travels to the end user, and by the end users themselves, causing no adverse reaction until the drug is ingested via the above-mentioned routes—and even then, fentanyl and fentanyl analogs are used routinely and do not always result in overdose….

Media accounts that are not based in evidence and journalists who fail to do their due diligence to ensure accurate reporting further perpetuate this dangerous misinformation. These stories cause very real harm—they perpetuate fear and stigma against people who use drugs resulting in negligent care, isolation, and diversion of resources toward law enforcement and away from life-saving programs.

We have been here before: In the late 1980s, doctors refused to treat HIV patients out of fear of contracting the disease, even once they knew contagion via casual contact was impossible. This shameful history is now mirrored in the reports of cases where first responders are refusing to treat overdosing people before they secure hazmat suits. This is unnecessary, fear-based, and should be considered criminal neglect. Media has the responsibility to report this story accurately and ensure that we not repeat the mistakes of the past.

As two people who spend our lives focused on preventing overdose and increasing access to naloxone in our communities, we are concerned and frustrated by the perpetuating of this stigmatizing, inaccurate story. People with lived experience with drug use and allies who work in Harm Reduction, public health, and substance-use treatment programs have much work to do with limited resources. Unfortunately, an incredible amount of our time and energy is spent refuting inaccurate and fear-based messaging, taking away from the life-saving work that needs to be done.

Our programs in San Francisco and Alameda Counties have distributed naloxone to community members who have collectively reversed 1,502 overdoses just last year alone. We operate on limited budgets to ensure widespread naloxone access for people who use drugs, as well as their friends, family, and providers who serve them. It is more effective and humane to fund naloxone distribution programs, harm reduction services, and evidence-based substance-use treatment than to spend untold amounts of money training first responders to handle the “bioterrorism threat” of fentanyl and scaling up the War on Drugs. Yet, we are watching as money pours into the coffers of law enforcement to help protect themselves and increase criminalization and interdiction efforts, which have been wholly ineffective at curbing drug use or reducing related harms.”

By Savannah O’Neill and Eliza Wheeler

Savannah O’Neill is the Overdose Prevention Education and Naloxone Distribution (OPEND) Project Coordinator at the HIV Education Prevention Project of Alameda County located in Oakland. This project operates a County wide naloxone access, technical assistance and training program. Savannah is a Social Worker and Certified Addiction Treatment Counselor who has been providing treatment and harm reduction services for the past 12 years in the Bay Area. Contact Savannah at HEPPAC, soneill [a] casasegura.org

Eliza Wheeler is the Overdose Response Strategist for the national Harm Reduction Coalition whose West Coast office is located in Downtown Oakland. In addition to providing training, technical assistance and policy work nationally, Harm Reduction Coalition operates a large naloxone distribution program in San Francisco called the Drug Overdose Prevention and Education (DOPE) Project. Eliza has been providing access to naloxone and working with people who use drugs for 17 years in Massachusetts and the Bay Area. Contact Eliza at the Harm Reduction Coalition, wheeler [a] harmreduction.org

READ MORE

COVERAGE OF THE MYTHS

ALWAYS TEST YOUR SUBSTANCES IF YOU USE ANY

Transdermal (overdosing via short term skin contact) fentanyl rumors aside – if you are using substances of any kind, please test them for Fentanyl. It can be found in any drug these days including opioids, cocaine, MDMA and can even be laced with Xanax and other benzodiazepines. Fentanyl is responsible for over half of all Opioid related overdoses (National Institute on Drug Abuse).

 

We provide free fentanyl test strips confidentially to anyone in need. Reality is, with fentanyl so widespread, if you are using any drugs at all please test them. It takes extremely small amounts of fentanyl to cause a fatal overdose. Message our confidential hotline 479-222-0532 to get these, free Naloxone Opioid Overdose Reversal Kits and other harm reduction materials.

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