Earlier this month, the San Diego County Sheriff's Department released body camera footage of an officer overdosing after coming into contact with fentanyl. They called it a “public safety video.” A group of 400+ doctors and experts called it misinformation.
After the release of the body cam footage, the news and video were picked up by trade publications (including Forensic) and mainstream media alike, including CNN, Fox News and the Los Angeles Times. Once the story went viral, drug experts like Ryan Marino, MD, and Lucas Hill, PharmD, BCPS, BCACP, stepped in.
Marino is an assistant professor at Case Western Reserve University School of Medicine and the medical director of toxicology & addiction medicine at University Hospitals Cleveland Medical Center. Hill is clinical assistant professor at the University of Texas at Austin College of Pharmacy and the director of the Pharmacy Addictions Research & Medicine program at the university.
Together, they issued a media retraction request that was signed by more than 400 health professionals, first responders, public health researchers, drug journalists, and people with lived experience.
“We are writing to request a retraction and correction of your recent article which perpetuates a myth: that casual contact with potent synthetic opioids such as fentanyl poses a health risk to first responders,” reads the letter. “This is dangerous misinformation that can cause harm both to people who use opioids and to members of the law enforcement community.”
While this is believed to be the first expert retraction letter regarding fentanyl exposure, the myth of overdose-by-contact has lived within media outlets and the broader law enforcement community for years.
Marino told The Wrap that when he first saw news reports claiming someone had overdosed from skin contact with fentanyl, he found them comical because he knew it was implausible. But, as the stories gained traction, he noticed real-world consequences.
“At some point, either in 2017 or 2018, I actually witnessed firsthand an overdose patient not being resuscitated as people kind of backed away and tried to seal off the room,” Marino told The Wrap. “I’ve seen those incidents play out repeatedly. That was very disconcerting to me, which made me think that maybe this wasn’t just something to kind of laugh about.”
The perpetuating of the myth is highlighted in a study released in June by researchers at RTI International. The study, based on qualitative interviews of law enforcement officers from five diverse agencies across the U.S., found that nearly all officers falsely believe skin exposure to fentanyl on-scene is deadly. Although the law enforcement officers interviewed were able to point to stories through word of mouth or in the news of on-duty officers or first responders who allegedly overdosed on-scene from touching fentanyl, in some instances requiring naloxone to revive them, the researchers say there are no confirmed cases of fentanyl overdoses through the skin.
The study authors also found that agencies were spending large amounts of funding on “extreme” personal protective equipment, like hazmat suits, to eliminate the possibility of dermal fentanyl exposure—something the authors and other experts say is unnecessary.
“This money would be better spent elsewhere,” said Peter Davidson, a researcher at the University of California San Diego and co-author of the article.
The CDC’s current guidelines recommend nitrile gloves and respiratory protection when powdered illicit drugs are visible or suspected. However, the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) say an N95 respirator is only needed in “exceptional circumstances” where drug particles or droplets are suspended in the air.
The agencies included PPE guidelines in their 2017 joint position statement regarding fentanyl and fentanyl analog exposure. Published in The Journal of Medical Toxicology, the statement acknowledges the potential of fentanyl for dermal absorption, but cites previous literature, expert opinion and clinical experience when they write that “incidental dermal absorption is unlikely to cause opioid toxicity” and the “risk of clinically significant exposure to emergency responders is extremely low.”
Photo credit: DEA.