The New York Times has published many articles about the “opioid crisis” that follow the usual unchecked assumptions around opioids, so I’m glad this opinion piece by the “top guns” of the Times finally explains the problems posed by fentanyl: it’s super potent, but not by accidental skin exposure or “breathing fumes”.
As baseless public health scares go, the one about police officers and nurses purportedly overdosing from passive fentanyl exposure should have been easy to dispel.
Emergency workers across the country have reported dozens of such incidents in recent years, but their symptoms are often inconsistent with opioid poisoning.
In some cases, officers have administered the overdose-reversal drug Narcan to themselves — a feat that would be impossible in the midst of an actual overdose.
In 2017, the nation’s two leading toxicological societies published a joint statement explaining that for emergency medical workers, the risk of accidental opioid ingestion is “extremely low.” Gloves almost always provide enough protection; masks are necessary only in exceptional cases.
Fentanyl is indeed one of the most powerful opioids ever created.
And it’s true that even very small doses can be fatal. But merely touching the substance is not dangerous.
If it were, all the drug dealers and end-users handling the stuff would be dead.
Opioids have to enter the bloodstream to exert an effect, and not even the strongest ones can penetrate the skin quickly enough or in sufficient quantity for that to happen — if they could, people who are addicted to opioids would have no use for needles.
The risk of accidental inhalation is only slightly more plausible: Fentanyl can enter the bloodstream through the mucous membranes of the nose and mouth, but it is not easily aerosolized.
According to the toxicologists’ joint statement, at the highest airborne concentrations found in industrial production facilities, an unprotected worker would need more than two hours to passively ingest even a medical dose of fentanyl, let alone a toxic one.
But so far, those facts have not stemmed the growing panic. Several states are planning to spend tens of millions of dollars on protective gear and screening equipment that most toxicologists say are unnecessary.
And addiction specialists are worried that health care providers will hesitate or outright refuse to treat people who are overdosing, just as doctors and dentists denied care to H.I.V.-positive patients during the early days of the AIDS epidemic.
It has not helped that federal agencies seem divided over — or perhaps confused by — the issue. The Drug Enforcement Administration has repeatedly warned that any contact with fentanyl can put an officer’s life in danger.
But safety recommendations published by an interagency committee (of which the D.E.A. was a part) echo toxicologists’ assurances that such incidental exposure poses only a minimal risk.
So, even the DEA knows agents cannot overdose (or get any dose) of fentanyl during their “raids”. But this truth remains well hidden so that it doesn’t interfere with the “drug hysteria” they’re trying to keep going.
It must be tough when their desired scare tactics run into the truth. Then again, honesty has never been a priority in the agencies waging the drug-war.
Doctors and toxicologists who have studied the issue say that most of the cases reported so far are best explained by the so-called nocebo effect, a phenomenon whereby people who believe they have encountered a toxic substance experience the expected symptoms of that exposure.
Misinformation is itself a hazardous substance.
If care is delayed as a result of irrational fear, or stigma exacerbated, or resources diverted from needed treatments to unnecessary hazmat responses, more lives will be lost.