Thread by @EMPoisonPharmD

We wrote this case of #fentanyl exposure w/ NO clinical effects (bit.ly/3k7I1dF) to help realign fentanyl exposure risk perception.

I thought it was one of the only confirmed cases...turns out there are quite a few.

A 🧵on NIOSH health hazard evaluations
#MedEd

If someone is concerned that hazards are interfering with their job function, NIOSH can get called in to do a field evaluation.

They review exposures, med records, forensics, and write public reports.

They have QUITE a few confirmed fentanyl reports.

cdc.gov/niosh/hhe/defa…

Like this one, where a law enforcement officer had CONFIRMED methamphetamine/fentanyl blown all over them, rubbed sanitizer on it (don't do that), felt dizzy, had hypertension, were alert, breathing normally. No Opioid effects. Back to normal in a few hrs.
cdc.gov/niosh/hhe/repo…

Or this review of 16 officer exposures, some d/t powder blowing in their face or "potentially" mucous membranes. 🔟CONFIRMED fentanyl. None experienced opioid toxicity, signs of lethargy, or other indications of central nervous system depression. cdc.gov/niosh/hhe/repo…

Or this one where forensic chemists/workers were CONFIRMED to be breathing in fentanyl and getting it on hands regularly, yet 0/24 had symptoms.
cdc.gov/niosh/hhe/repo…

No urine tested, who knows if absorbing at all, shows even when confirmed, dose may not be enough to cause sx

Coincidentally this study of fentanyl manufacturers found that workers did often urinate fentanyl from work place exposure. NONE had symptoms, even when absorbing enough to be detected... (academic.oup.com/annweh/article…)

Interestingly their model showed dermal hand fentanyl correlated best w/ urinary fentanyl excretion, however total dermal exposure had weaker correlation. To me this suggests hand to mouth as the biggest route of exposure, even when exposed...but this is off topic...

Lets look at this incident where an officer opened a metal box 📦 and inhaled a PLUME of powder that erupted from it. They had confusion and difficulty breathing. Received naloxone which per report had a positive effect. The box substances were tested and SHOWED...

THC, Alprazolam, Meth, Cocaine. No fentanyl or other opioids. Remember, naloxone can be given to anyone. And assessing the effect is highly subjective, especially for non medically trained staff. Just receiving naloxone DOES not confirm exposure cdc.gov/niosh/hhe/repo…

Or this time 9⃣ first responders went into a room where a "pill party" was going on. They saved some lives (👏). Someone saw a white powder was nearby, completely undisturbed. Then 8 of them felt weakness, confusion, palpitations, nausea, and lightheadedness...

NONE had objective signs of opioid toxicity. As with all these reports "The etiology of health effects could not be definitively identified." Responders were monitored in the ED for several hours. Symptoms improved over that time without intervention. 🤨 cdc.gov/niosh/hhe/repo…

These reports are just a few examples, there are many more.

A big problem with the media stories of 1st responder fentanyl exposure is no testing, no medical results, and no confirmation of exposure, coupled with blind attribution of all effects being to fentanyl.

These critical analyses done by NIOSH of confirmed fentanyl exposures showing no opioid symptoms developed even when "inhalation/mucous membrane" route involved should help 1st responders feel better

Recognize media reports do not do this fact checking, and many are not real.

Anxiety symptoms from exposure ARE real.

In confirmed skin/inhalation/mucous exposures, no opioid toxidromes in ANY reports.

Wear PPE, be safe, decon if exposed, BUT don't believe the media hype.

@threadreaderapp unroll