May 21, 2019

AIHce Speakers Focus on Industrial Hygienists' Role in the Opioid Crisis

​By Kay Bechtold

Minneapolis Convention Center (May 21, 2019)—Industrial hygienists and environmental health and safety professionals have the ability to make worthwhile contributions to combat the opioid crisis, even as daily attention at the national, state, and local levels remains high, members of AIHA’s Opioids Responder Working Group stressed at an AIHce EXP 2019 session focused on emergency preparedness and training for workers at risk of exposure to opioids. IHs and EHS professionals’ analytical skills and interactions across diverse work groups position them to communicate important information to both workers and the public, said Peter B. Harnett, MS, MPH, CIH, CSP, current chair of the working group. On Monday, May 20, he discussed the group’s initial focus on addressing the health and safety of American workers who are involved in emergency response to opioid-related incidents, including those involved in responding to illicit operations and healthcare workers providing treatment.

The working group comprises members with diverse experiences, including many who have existing expertise with opioids through education and their work. For example, several members have worked for or with pharmaceutical companies. Others have experience assessing opioid-contaminated sites, including residences, or are involved with the validation of decontamination efficiency, clearance levels for re-occupancy, and workplace health hazard evaluations. The working group also includes individuals affiliated with EPA, Department of Homeland Security/Customs and Border Patrol, and NIOSH. Working group members are able to share real-time information about what sort of drugs are showing up at U.S. borders and in the nation’s post offices. Harnett noted that this rapid information sharing has helped the group understand the “polydrug” nature of street products, which now contain as many as four active ingredients.

Working group members have given numerous presentations and participated in outreach and training efforts, including responding to a NIOSH request for input on a fentanyl wipe procedure. The group has also compiled a resource list of important websites and documents relevant to opioid response and has developed an opioid response card template for first responders. The template developed by the Opioids Responder Working Group was used as a starting point for the New York City Police Department’s fentanyl response card. Now, Harnett said, more than 50,000 police officers and staff have access to this information.

“As a professional association, we can move important communications to the public more quickly than state or federal agencies that typically must move through several additional hoops,” he said.

Harnett also touched on recent media reports of police officers requiring naloxone for opioid exposure. He discussed the “nocebo effect,” in which people believe exposure occurred and indicate symptoms that may be consistent with exposure. An opinion piece published in The New York Times last month posits that misinformation about fentanyl exposure has “triggered a panic about the risks.” The article states that “[f]entanyl can enter the bloodstream through the mucous membranes of the nose and mouth, but it is not easily aerosolized.” Harnett said that the article minimizes both the potential for inhalation exposure and the concern for dermal exposure.

NIOSH guidance for preventing occupational exposure to emergency responders lists inhalation, mucous membrane contact, ingestion, and percutaneous exposure as the potential exposure routes of greatest concern.

Jonathan Rosen, MS, CIH, spoke next about the National Institute for Environmental Health Sciences Worker Training Program, which has developed a four-hour, awareness-level training program for workers in occupations with potential for occupational exposure to fentanyl and other opioids. Rosen, who works for the National Clearinghouse for Worker Safety and Health Training, which is funded by the NIEHS Worker Training Program, provided an overview of the program. The tool is in PowerPoint format and includes three small-group activities to help teach workers how to recognize occupations with exposure potential, describe signs and symptoms, explain the use of control measures for worker protection, and detail methods for decontamination and cleanup. Rosen noted that organizations should tailor the training to their own policies, procedures, and available personal protective equipment.

In Rosen’s view, one of the challenges in this area is that police and responders often don’t know how much visible drug material is there until they arrive at the scene; much of the time, dispatchers won’t necessarily know that information. It would be difficult for responders to change their level of protection on arrival, he explained.

Regarding routes of occupational exposure, Rosen noted that leading science organizations have advised that incidental skin contact with dry products is not likely to cause overdoses. But one of the problems with this guidance is that NIOSH has not had the opportunity to do real-time monitoring, he said. None of the agency’s health hazard evaluations have been able to determine exactly how people were exposed.

“This is one of the gaps in our knowledge right now,” Rosen said. “Some of the powder could have been aerosolized. They could have gotten it on their hands and then touched [their faces].”

Rosen advocates for a public health approach to prevention, which includes primary, secondary, and tertiary approaches. The primary approach involves eliminating hazards to begin with—before pain, injury, and opioid use. The secondary approach, which comes into play at the time of injury, involves support for injured workers to avoid opioid misuse. This could include providing people information or materials so they can advocate for themselves with their healthcare provider. For example, patients could ask about alternative pain treatments such as physical therapy or chiropractic care. The tertiary approach includes dealing with substance abuse programs in the workplace. Rosen highlighted the need to reform workplace policies and culture to encourage workers to come forward and access treatment and recovery resources.

“[This is] a major concern because if people have a substance abuse problem in the workplace, we want them to feel comfortable coming forward to talk with organization leadership,” Rosen stressed. “[There’s a] whole realm of work where I feel IHs should be at the table working to help reform these programs, getting people to talk about [the opioid crisis], and into treatment.”

Kay Bechtold is senior editor of The Synergist.

View more Synergist coverage of the conference on the AIHce Daily page.