Fentanyl

Congress Is Racing To Address a Fentanyl Problem That Fentanyl Experts Say Probably Doesn't Exist

You can’t overdose on fentanyl simply by touching it.

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Congress is racing to address a problem toxicologists say probably doesn't exist: the dangers to emergency responders of incidental exposure to the powerful drug fentanyl.

A bill introduced by Reps. Conor Lamb (D–Pa.), David Joyce (R–Ohio), and David Trone (D–Md.) would use federal money to fund local police purchases of portable drug screening devices. Front and center in much of the advocacy for the bill is the alleged risk of the synthetic opiate fentanyl to police and emergency medical responders who come in contact with it at drug busts and overdose scenes.

Thus the Toledo Blade editorial board calls for passing the bill at once, saying "police, firefighters, and other first responders are in jeopardy if they come into contact with even a minute trace of the drug."

An NPR station in upstate New York spoke to John Anton, police chief of DeWitt, New York, who is haunted by fears of his officers accidentally overdosing. "Fentanyl is just so deadly they'll just go unconscious, and then CPR has to be administered," Anton told NPR. "And I worry about them every day getting exposed to fentanyl, getting it on their clothes, bringing it home to their families, getting it on their boots and so forth."

Anton's worry is most likely misplaced. Fentanyl, a powerful drug, is at the center of a wave of thousands of overdose deaths. Even so, experts have been trying for years to calm fears that it poses any significant risk to first responders, notwithstanding viral stories to the contrary.

Perhaps the most-circulated story of this sort took place in 2017 after a fentanyl bust in which an officer in East Liverpool, Ohio, had used gloves to handle a white powder. Later, with ungloved hand, he absently brushed some dust off his shirt. Soon thereafter he lay unconscious. He described himself as "in total shock… No way I'm overdosing." Colleagues attempted to revive him with naloxone, but he did not wake up until after four doses, a remarkable quantity. The terrifying story was widely publicized in national media.

Writing in Slate shortly thereafter, Harvard Medical School professor and emergency room physician Jeremy Samuel Faust offered a reason to be skeptical. Every toxicologist he spoke to agreed that skin contact from brushing a shirt, even if complicated by bringing fingers to mouth or some similar misstep afterward, would not cause such symptoms. The very detail that made the episode so riveting—that it took an enormous quantity of naloxone (four doses) before he woke up—undercuts rather than reinforces the story.

"When a medication with well-established and consistent efficacy such as naloxone does not work at its usual dose, it's usually because we are treating the wrong illness—we've made a diagnostic error—not because the known treatment is flawed." If a therapy that has been well established as reliably treating opiate overdose did not work, even at escalating dosages, it's because opiate overdose is most likely not what he was suffering from.

Many of the bipartisan sponsors and supporters of H.R. 2070 seem unaware that any doubt lingers over the panic stories.

"We must make sure our first responders, who are on the front lines of this epidemic, are protected from exposure to deadly substances like fentanyl," Trone declared in a press release. "Providing resources like screening devices to state and local entities is a no brainer."

"Police officers, paramedics, and other first responders face tremendous danger when responding to scenes where fentanyl and other dangerous substances are present," says another sponsor, Sen. Edward Markey (D–Mass.) "Shielding these brave men and women in Massachusetts and across the country from these dangers as they serve and protect our communities should be our top priority."

Interestingly, while the Fraternal Order of Police union supports the bill, its letter of endorsement from national president Chuck Canterbury refrains from making any arguments based on officer safety. Instead, it advances other reasons for supporting the equipment bill, based on making drug investigations more effective.

Elected officials would do well to follow its lead. Unfounded fears of rescuer overdose can do real harm by fostering hesitation and needless preliminaries at overdose scenes where every moment counts in resuscitating a victim.

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23 responses to “Congress Is Racing To Address a Fentanyl Problem That Fentanyl Experts Say Probably Doesn't Exist

  1. The scary stories about dangerous drugs to touch that I have heard mentioned carfentanyl, which is supposed to be way more potent than fentanyl and potentially dangerous in quantities that can be inhaled or absorbed trough skin.
    I don’t know if that is a legitimate fear either, or how often drugs like that actually make it to the opioid black market, but it seems more plausible anyway.

    1. I’ve heard the same thing about fentanyl though.

  2. “Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies.” — Groucho Marx

  3. I’ve always called BS on the fentanyl stuff. If it were as totally dangerous as they say, all the dealers, junkies and cops that dealt with it would be dead. It’s basically Reefer Madness all over again because it’s easier to trample over rights when you have a crisis.

  4. Fentanyl does absorb through the skin which is why it is used medically as a transdermal patch.

    1. Isn’t it mixed with a carrier agent?

      1. Actually you are right. It is water soluble but to really get it through the skin it needs a lipid base which the patch uses. Some users will take the patches and dissolve the fentanyl back into water solution for injecting.

        So getting some powder on your hands it would probably not do much if you knew it was there and removed it. If you accidently got it in your mouth or respiratory system you would get a dose. It is sometimes snorted by users.

        Overall I think the detectors are a good idea for people who have to deal with this stuff. As has been pointed out there are even more potent analogues like carfentanyl and you don’t know what you are dealing with.

        1. Another interesting thing.

          Heroin is of course highly variable, however the buzz users want is long lasting so users need to use it less often.

          Fentanyl has been a mainstay in medicine for good reasons. As prepared it is easy to control standard dose and titrations. It has been considered short acting which is not quite true.

          It has both sedative and analgesic effects and pairs well with midazolam, which often is also considered shorter acting. If you need to move to higher doses you are probably better off with a little more Fentanyl since that is more easy to reverse.

          I am talking short term like surgery or moderate sedation. In expert hands it is an excellent drug. Wake up and your colonoscopy or liver biopsy is over. Anesthesia is a wonderful thing.

          It was also expanded to include other uses. Drips for post op pain as an alternative to morphine, breakthrough pain for cancer or other patients in various forms including spinal catheters. Again with very good results in controlled conditions and expert hands. It was never a drug of abuse. Until…

          So the secret as always happens got out. The illegal drug dealers invested and chemists learned to make it. It is synthetic, you don’t need poppy growers.

          The thing is heroin users did not ask for this, it was foisted upon them. They just wanted good quality heroin. The stuff was cheap, easy to transport and supply, you could cut your supply with it and make much more.

          So fentanyl is not really short acting. The buzz does not last as long because it redistributes to fat and muscle tissue more quickly. It is then slowly released into the bloodstream. The user wants another dose, then another. The chance of overdose increases with each.

          I do not know if there is a libertarian solution to all of this. Prison is obviously not a solution at all. Some think that buying pure heroin and fentanyl from Susie at wal mart is better. I am not so sure.

          1. Sounds to me like the problem was caused by prohibition. Let’s stop doing that and see if it gets better. or at least stops getting worse. because banning shit isn’t helping.

          2. I do not know if there is a libertarian solution to all of this. Prison is obviously not a solution at all. Some think that buying pure heroin and fentanyl from Susie at wal mart is better. I am not so sure.

            I’m curious as to why you think the commercial version wouldn’t be better. It would almost certainly be regulated by FDA, which of course isn’t the pure libertarian solution, but we shouldn’t allow perfect to be the enemy of the good.

            Even if it were an unregulated market (the libertopian solution), I suppose that you’d see a drastic reduction in overdoses as people go to the safer commercial version of these drugs. No respectable drug company would purposely open themselves up to the lawsuits that would come with tampering with their products.

            1. Certainly it would. There are places in Europe, Denmark I believe, where heroin addicts can get pharm grade heroin which is injected under supervision. I think that is a good idea. It is not libertarian exactly and street heroin still exists.

              Methadone is available here and effective for many people.

              But none of that is what I think people mean by ending prohibition and a totally unregulated market. Even alcohol is still highly regulated. Prohibition never really ended.

              The argument could be made that opiate addiction is not a “problem” requiring a “solution”. That sort of ends the debate but it would be a hard sell to the general public.

    2. transdermal patches work by mixing the active ingredient with a carrier that carries the active ingredient throughg the skin barrier.

  5. Fentanyl? Almost certainly not. Carfentanil, at 100x stronger than fentanyl, yeah it might be possible to absorb, either transdermally or aerosolized particulate from disturbing powder, the lethal dose which is around 0.02mg.

    But a couple mitigating factors; first, it’s rarely pure, what the illegal lab in China claims notwithstanding. Second, anyone who gets it near pure is someone who likely knows what they’re doing, and likely has some tolerance to opioids, which will quickly up the lethal dose by orders of magnitude. Responders are likely to encounter end users or lower level dealers with highly diluted forms.

    It also has a higher binding affinity for the mu-opioid receptor, so I don’t recall the specific values offhand but it’s entirely possible that it, or other fentanyl analogs, can outcompete naloxone and thus require a much higher dose to reverse, certainly moreso than plain old fentanyl, which seems to be all the toxicologists were talking about. What some might be more familiar with that’s a similar situation, if you take buprenorphine while on other opiates, it leads to precipitated withdrawal, because bupe has a higher affinity than heroin/morphine/oxycodone but does not activate the receptor as much; but 3-4x the normal regular opiate dosage can then break through that and stop the precipitated withdrawal by completely flooding the receptors.

    1. None of the fentanyl analogues with Ki values published are going to “outcompete” naloxone. Even the opioids with super high affinity (i.e. sufentanil & carfentanil) can eventually be displaced by enough naloxone.

    2. “Fentanyl? Almost certainly not. Carfentanil, at 100x stronger than fentanyl, yeah it might be possible to absorb, either transdermally or aerosolized particulate from disturbing powder, the lethal dose which is around 0.02mg.”

      This is why you read the Comments at Reason, not the articles.

      Nowhere in the article is there any assertion of just how much fentanyl you would need to get on you for it to be a problem.

      Clown Magazine.

  6. If only there were a way to allow people to buy drugs from actual chemists instead of black-market chemists people might actually know what and how much of a substance they’re putting into their bodies and they might be able to do it much more safely. And cops wouldn’t have to touch the substance or get into gunfights with dealers because it would all be legal.

    1. Would be a pretty hard sell.

      Can’t even get people to agree to injecting sites. Not even here.

      The Portugal model is one way to go. It is not what you are talking about but they are not busting down doors and putting users in jail. It has had good results.

      1. No it didn’t!

        In Portugal, somewhere, someone is having fun!

      2. What we can learn from the Portugal experiment is that decriminalization doesn’t lead to some huge increase in drug use. Link

        The problem is that I don’t think decriminalization alone would work in the US. It doesn’t solve the problem of distribution among the black market. So you don’t really know what you’re getting when you still have to buy it from the corner dealer. The real solution to overdoses is to ensure transparency at the point of sale, which I think means you need over the counter drug sales. You’re right, though. It will not happen anytime soon here.

        1. Overdoses happen all the time even with prescriptions.

          But why make utilitarian arguments at all?

          Once you do that it just becomes an if…then discussion and debate about which statistics you believe.

  7. […] Congress is racing to address a problem toxicologists say probably doesn’t exist: the dangers to police and emergency medical technicians of incidental exposure to the powerful drug fentanyl. I explain in a new piece at Reason. […]

  8. The problem isn’t physically touching fentanyl. It’s the fact that if you’re touching it, you could very well be inhaling it as well.

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