Occupational Fentanyl Exposure in Emergency Responders
Date First Published:
July 26, 2024
Last Updated:
July 26, 2024
Report by:
Andrew N. Wechsler MD; Matthew Singh MD, EM senior resident, EM core faculty (Corewell Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI)
Search checked by:
Jeffrey S. Jones MD, Corewell Health - Michigan State University Emergency Medicine Residency Program, Grand Rapids, MI
Three-Part Question:
Are [emergency responders] with [unintentional skin exposure to fentanyl] at risk for [adverse effects]?
Clinical Scenario:
A 40-year-old police officer is exposed to a white powder after apprehending a suspect. He is concerned that he was exposed to fentanyl so he self-dosed with Naloxone and came to the Emergency Department. He is observed for 1 hour and discharged home.
Search Strategy:
Medline 1966-07/24 using PubMed, Cochrane Library (2024), and Embase
Search Details:
[occupational exposure (All Fields) AND fentanyl (All Fields)]
Outcome:
33 papers were found, one recent systematic review was relevant to the study question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Does occupational exposure to fentanyl cause illness? A systematic review. Adams A, Maloy C, Warrick BJ. Sep-23 USA | 12 observational studies of first responders (N=438) possibly exposed to fentanyl or fentanyl analogs | Systematic review | Any clinical signs/symptoms after dermal fentanyl exposure | 27 individuals reported subjective symptoms that were inconsistent with fentanyl effects | Possible publication bias; analytical confirmation was available in only six studies; possible exposure to subtoxic doses of fentanyl; quality of data is poor; there may have been exposure cases that were simply clinically managed in emergency departments and not reported or written as case reports. |
| Hospitalization or deaths after fentanyl exposure | 3 persons, none displayed definitive signs of the opioid toxidrome | ||||
| Naloxone administration after fentanyl exposure |
Author Commentary:
In September of 2016, the US drug enforcement administration (DEA) released a warning in response to several media reports of incidental fentanyl overdose due to second hand exposure by first responders. The warning stated “fentanyl can be absorbed through the skin" and advised that first responders should not touch substances thought to be fentanyl. The American College of Medical Toxicology (ACMT) released a position statement that unintentional fentanyl exposure is highly unlikely and that donning full personal protective equipment leads to delays in treatments of critically ill patients. However, misinformation about overdose risk from accidentally touching fentanyl is widespread among police officers. It is important to encourage evidence-based decision-making among first responders. This includes the ability to rapidly recognize the opioid toxidrome, education on personal protective actions, and training in medical management of individuals experiencing an opioid overdose
Bottom Line:
There is insufficient evidence that unintentional dermal fentanyl exposure leads to overdose or adverse effects. Understanding the risk perceptions and knowledge of first responders regarding fentanyl can help identify training gaps.
References:
- Adams A, Maloy C, Warrick BJ. . Does occupational exposure to fentanyl cause illness? A systematic review.