Environmental Risks

The drug fentanyl and its equivalents are a possible hazard to a number of responders who might come in contact with the opioids in the course of their work.

The National Institute for Occupational Safety and Health (NIOSH) indicates that responders are most likely to come across illegally-manufactured fentanyl in powder, tablet and liquid form through:

• Inhalation
• Mucous membrane contact
• Ingestion
• Skin exposure such as needlestick.

Any of those exposure routes can possibly quickly result in life-threatening respiratory depression.

While brief skin contact with fentanyl or its equivalents aren’t expected to result in toxic effects if visible contamination is rapidly removed, skin contact with large volumes of highly concentrated powder over an extended period of time is a potential exposure route.

NIOSH identifies four job categories where responders may come in contact with fentanyl and its equivalents:

• Pre-hospital patient care 

Emergency medical services (EMS) providers, including first responders, fire department and private companies, may attend to persons with suspected fentanyl overdose. Drugs may be on or near the individual.

• Law enforcement

Officers might encounter fentanyl during day-to-day activities including traffic stops, responding to fentanyl overdose calls and detaining and searching individuals.

• Investigation and evidence handling

Anyone in law enforcement who conducts fentanyl investigations are at risk of potentially encountering fentanyl. This may include executing search warrants and collecting, transporting and storing evidence.

Evidence collection might aerosolize fentanyl powder. Anyone handling evidence in the chain of custody may come in contact with fentanyl unless procedures are in place to prevent exposures.

• Special operations and decontamination

Workers performing special operations who are expected to come into contact with a large amount of fentanyl are potentially at risk.This includes hazardous material incident response teams responding to a spill or release and law enforcement officers executing search warrants on opioid distribution sites or other tactical operations. These activities may also aerosolize fentanyl.

• Working dogs

Working dogs, particularly police K-9s executing detection activities are also potentially at risk of exposure to fentanyl and its equivalents. If dogs are exposed, residual powder may remain on the dog’s body. Working dogs should be removed from an area with suspected or known fentanyl.

What can you do to protect yourself against fentanyl and its equivalents?

NIOSH identifies a number of standard safe operating procedures. When you first arrive on scene, analyze the situation, assess the risks for hazards and determine if fentanyl or other drugs are expected to be present. If so:

• Do not eat, drink, smoke or use the bathroom while working in an area with suspected or known fentanyl.
• Do not touch your eyes, mouth and nose after touching any surface that might be contaminated with fentanyl.
• Wash your hands with soap and water immediately after a potential exposure and after leaving a scene with suspected or known fentanyl. Do not use hand sanitizers or bleach solutions.
• Do not perform tasks or operations that might aerosolize fentanyl unless you are appropriately trained with higher levels of personal protective equipment (PPE).
• Do not perform field testing of fentanyl or its equivalents unless you are appropriately trained and have developed an incident-specific plan to perform field testing in the appropriate PPE.

The following table from NIOSH provides PPE recommendations for protection against fentanyl and its equivalents:

 Source: https://www.cdc.gov/niosh/topics/fentanyl/risk.html

For more information on preventing occupational fentanyl exposure to emergency responders, visit the NIOSH website.