Fentanyl Is So Deadly That It’s Changing How First Responders Do Their Jobs

As the number of fentanyl overdoses in America climbed last fall, the New Hampshire State Police Forensic Laboratory released a photo to highlight the drug’s particular dangers. The photo showed two vials. One showed how big a lethal dose of heroin might be: 30 milligrams, a small scoop. The second showed the equivalent for fentanyl: 3 milligrams, a bare sprinkle.

It was a warning to potential users, but also a visual reminder that fentanyl is so potent that it is dangerous even for people might accidentally touch or breath a tiny amount of it. People like police, EMTs, forensic labs technicians, and even funeral directors. A puff of fentanyl from closing a plastic bag is enough to send a full-grown man to the emergency room, as a police officer from New Jersey described in a Drug Enforcement Agency video last fall. The DEA made the video as part of an official warning to law enforcement about the dangers of handling fentanyl.

The unprecedented rise of fentanyl has forced police and crime labs to change how they work. Police departments are using protective gear like Tyvek suits and respirators. Crime labs are looking for new ways to detect fentanyl without opening the bag. And both have stocked up on naloxone, the drug that reverses overdoses, for their employees.

Fentanyl first took off in North America in British Columbia, which declared the drug a public-health emergency in spring 2016. In response, the Justice Institute of British Columbia organized workshops for first responders and created a website: fentanylsafety.com. As fentanyl spread through the U.S., the website kept gaining relevance in new places. “The website has been accessed through all the world,” says Steve Schnitzer, director of the institute’s police academy. “We get inquiries from places all the time.”

Last fall, 11 SWAT officers in Hartford, CT,  became ill after raiding a stash house. Their flash-bang grenade blasted heroin and fentanyl into air, and they came out dizzy and vomiting—symptoms of an overdose. Thomas Davoren, police chief in Groton, CT, says his department now bring respirators, eye protection, and Tyvek suits to raids if they suspect fentanyl or other synthetic opioids.

Groton, like several other police departments since the DEA warning, has also stopped testing suspected opioids in the field. Officers used to do something called a colorimetric test: Scoop a bit of the suspected drug in plastic pouch with liquid reagents, and it would change color indicating this drug or that. That very act of scooping is now dangerous if it’s fentanyl. Since field tests are preliminary anyways, officers now just send it directly to a crime lab.

Some departments use a device called TruNarc, which shines a laser at a substance in a plastic bag. The problem with this approach, says Amber Burns,the  forensic supervisor at the Maryland State Police, is that it doesn’t work well with heroin. Testing heroin with the device still requires a separate kit, in which a scoop of the drug has to be added to a vial of ethanol, in which case you have the danger of opening the bag again.

That’s why Burns and her lab are now in talks with the National Institute of Standard and Technology to test techniques that require only swiping the outside of a closed bag—similar to technology the TSA uses to look for traces of explosives. NIST scientists published a recent paper showing that two technologies, called IMS and DART-MS, can both be used to detect traces of fentanyl. That gets away from the problem of handling a “bulk amount of fentanyl,” says Ed Sisco, a research chemist at NIST. By bulk, he just means milligrams, essentially enough to be visible. IMS requires a $30,000 portable device about the size of a microwave that could be taken into the field; DART-MS is a little more sensitive, but also requires a bigger device, so it’s more suitable in a lab.

Burns says the techniques could also help in preliminary tests in the lab. If workers in forensics labs could rule out fentanyl or another synthetic opioid, they might not have to take extra precautions like working in a fume hood, which sucks any vapors or dust out of the room. She says it can take about an extra hour to set up to work in a hood. Her lab has also stockpiled naloxone. Timothy Pifer, director of the New Hampshire State Police Forensic Laboratory, says the same thing: His lab had added more doses of naloxone since fentanyl became common, one for every chemist station now.

Comparing the size of lethal doses of heroin, fentanyl, and carfentanil. The vials here contain an artificial sweetener for illustration. (New Hampshire State Police Forensic Laboratory)

The other advantage of the IMS and DART-MS systems is that they can detect other synthetic opioids. One of the particular challenges of the opioid crisis is that exact drugs keep changing. First it was heroin, then fentanyl. Now certain areas are seeing more overdoses of carfentanil, a drug originally used as an elephant tranquilizer that is an estimated 100 times even more potent than fentanyl. (It’s unclear though because it’s not really been tested in humans.) There are also reports of acrylfentanyl, which is resistant to naloxone. Who knows what’s next.

When I first contacted Pifer for this story, he mentioned they had updated their photo of lethal heroin and fentanyl doses with a vial representing carfentanil. “Hopefully we won’t have to update it again,” he says.

Powered by WPeMatico

eBay