In 2020, more than 90,000 people in the United States died of a drug overdose. Nearly two-thirds of those deaths involved synthetic opioids such as fentanyl and its analogues, often collectively referred to as “ultra-potent” opioids because they can be anywhere from tens to thousands of times stronger than morphine or heroin. As the overdose crisis has grown, the role of law enforcement officers has expanded into the public health arena. Beyond policing the trafficking and sales of illicit drugs, officers are now front-line responders on overdose calls, providing patient care in situations for which they may not be accurately informed, sufficiently trained or adequately prepared.

These situations increase the likelihood that officers could come into close, direct contact with unidentified substances—leading to a rise in concerns about exposure to ultra-potent opioids and subsequent risks to officer safety. These worries have been perpetuated by mainstream news outlets, social media channels and even professional organizations. While law enforcement officers and other first responders have legitimate safety concerns on many calls, when it comes to on-the-job exposure to ultra-potent opioids, the science is clear: first responders are extremely unlikely to encounter situations that put them at risk for overdose.

Exposure misinformation through mainstream media

Nonetheless, lack of relevant training from credible sources leaves individuals vulnerable to media-perpetuated misinformation, which breeds further panic and exacerbates stress. In fact, the stresses of responding to the opioid epidemic topped the list of priorities at a 2018 event hosted by the National Institute of Justice in partnership with the Police Executive Research Forum. Indeed, early warnings about the risks of transdermal and aerosolized exposures came from trusted sources. In 2015, public safety officials and the Drug Enforcement Agency (DEA) announced a new, nationwide public safety and health threat: illicit fentanyl and its analogues. The organization released a video warning law enforcement officers to use caution in field-testing, and recommended expensive, excessive personal protective equipment (PPE) to prevent potentially lethal outcomes. This video was later retracted, but the message persists. By 2017, unconfirmed reports of law enforcement overdose from briefly touching fentanyl began to circulate in the news, on Facebook and through other social channels. Such accounts—often in the form of videos—continue to emerge and circulate today, perpetuating unsubstantiated concerns for officer safety.

Unverified accounts of officer overdose, officer demands for unnecessary PPE and a heightened concern for public safety prompted the medical community to weigh in. After a substantial review of the phenomenon of first responder illness or opioid toxicity stemming from casual contact with fentanyl and its analogues, scientists with the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) determined that it was extremely unlikely that first responders could overdose from secondhand exposure to ultra-potent opioids. An additional review of two exposure incidents reported to the National Institute for Occupational Safety and Health (NIOSH) found that self-reports of suspected opioid overdose were not confirmed by laboratory tests, nor were symptoms—elevated blood pressure and respiration—consistent with those of a fentanyl overdose or “severe opioid toxicity.” Rather, the reported symptoms (nausea, dizziness and a sense of doom) are more consistent with anxiety or exposure to low levels of opioids and other drugs.

This persistent misinformation shapes first responder perceptions of risk such that, despite the growing body of scientific evidence and official statements from experts, many law enforcement officers still mistakenly believe that transdermal and casual exposure to fentanyl is potentially fatal. However, evidence-based education and training can change that.

Evidence-based education and training

Relevant training led by a credible expert can increase the accuracy of first responders’ knowledge about the risks associated with overdose response and, specifically, potential exposures to synthetic opioids. In one study, a 10-minute “presentation and discussion” led by an emergency department physician cut the number of law enforcement and security officers who incorrectly believed they could overdose by touching fentanyl from 94 (83.2 percent) to 21 (18.6 percent). Given the dynamic nature of the current drug market, trainings should be ongoing, based on the most current research and, where possible, tailored to local circumstances.

A medically informed approach allows officers to make smart in-the-moment decisions, navigating the line between no risk and little risk and weighing potential consequences to their communities. For example, the ACMT and AACT urge against taking the time to don unnecessary PPE in virtually risk-free overdose responses. However, they acknowledge that while there have been no documented cases of opioid-related toxicity resulting from lengthy exposures to large volumes of ultra-potent opioids via trafficking or manufacturing interdiction, these situations may theoretically increase risk. As such, they note that properly fitting N95 or P100 respirator masks could offer additional protection without inhibiting quality and timeliness of response. The organizations’ simple, five-point, evidence-based strategies for interacting with suspected samples of ultra-potent opioids can provide a useful framework and substantially reduce law enforcement’s safety concerns when responding to calls related to the opioid epidemic.

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