May 30, 2019

Not Just Police: "Fentanyl Epidemic" a Concern for Several Occupational Groups

By Ed Rutkowski

Skyrocketing demand for fentanyl and its analogues among drug users has cultivated an illicit international trade in these opioids that potentially endangers several occupational groups, according to an industrial hygiene consultant who delivered a presentation about fentanyl’s occupational hazards at AIHce EXP 2019 last week in Minneapolis. John Murphy, PhD, CIH, ROH, founder of Resource Environmental Associates, told conference attendees at the Minneapolis Convention Center that a “fentanyl epidemic” is underway and suggested that media attention to accidental exposures to law enforcement officers obscures the larger truth that other workers need protection, too.

According to CDC, opioids were involved in nearly 68 percent of the 70,237 drug overdose deaths that occurred in the U.S. in 2017. Fentanyl has recently become a central figure in the opioid crisis. Murphy cited statistics from the Centers for Disease Control and Prevention that show fentanyl’s contribution to overdose deaths increasing 500 percent in the last ten years.

Synthesized by the Dutch company Janssen Pharmaceutica in 1959, fentanyl was originally intended as an alternative to morphine for use as an anesthetic in surgeries, Murphy said. Fentanyl was approved as a post-surgery pain killer in North America in the mid-1960s. Eventually it became available in many forms, including patches, lozenges, drops, sprays, and tablets. Increasing availability and over-prescription of opioids in recent years have been cited by many observers as contributing factors in the opioid crisis.

Janssen Pharmaceutica also created carfentanil, a fentanyl analogue, in the early 1960s. Hundreds of times more potent than fentanyl, carfentanil was primarily used as an animal tranquilizer. Its current popularity among drug dealers is primarily due to the fact that tiny amounts of carfentanil can produce significant effects in users, Murphy said. In recent years, seizures of illicit drugs by law enforcement officers have revealed that dealers are mixing fentanyl and carfentanil with other drugs, including heroin and cocaine.

Because a little goes a long way, fentanyl and carfentanil are relatively easy to transport undetected. Murphy explained that much of the fentanyl and carfentanil in North America originates in China. Manufacturers take orders online and deliver the drugs direct to users. Sometimes doses are disguised as urine test strips, which can be blotted against the mouth. Chinese manufacturers also ship fentanyl’s precursor chemicals—industrial chemicals used in the plastics industry—to clandestine labs in North America, which synthesize fentanyl directly, a process that takes two to three weeks and requires little expertise, Murphy said.

The transportation of the drugs across international boundaries presents a risk of exposure for customs and border services personnel and postal employees, Murphy said. Other occupational groups with high potential for exposure are paramedics, nurses, and people who work in social services. Landlords can also be exposed through accidental discovery of opioids in rental properties.

Law enforcement officers have been at the center of much of the reporting on occupational exposures to opioids. Over the last few years, Murphy said, he found approximately 300 reports in Canadian and American media of encounters with opioid users or dealers that resulted in police experiencing one or more symptoms of opioid exposure, including confusion, delirium, mood swings, nausea or vomiting, and pinpoint pupils. These stories have elicited many counter-reports expressing doubt that such encounters could lead to adverse health effects.

Murphy conducted his own review of anecdotal case reports and concluded that transdermal exposure to fentanyl from a traffic stop or similar encounter was not likely to be a concern for police. But it’s a different story for carfentanil, which can produce effects within minutes if absorbed through abraded skin, Murphy said. And exposures to the eyes and sinuses, as well as inhalation, are plausible concerns for police who encounter powdered fentanyl and carfentanil, depending on the purity of the powder.

Ed Rutkowski is editor in chief of The Synergist.

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