How are First Responders to know if they have an occupational exposure to Fentanyl, Carfentanyl, which is orders of magnitude more dangerous, or some new but undocumented designer drug that is even worse? It is reasonable to assume the worst case scenario in an unknown situation, and prepare accordingly.
1
@Bubba
You did not understand the article.
There is no danger. They aren't going to "come into contact with..."
the only precaution they need to take is to not touch any apparent drugs with bare hands or skin not that that would have any effect on them if they did.
7
@magicisnotreal I am not limiting my definition of "contact" to dermal uptake. In the 1990s I contracted with DEA for testing their evidence labs. Some DEA employees were getting an occupational exposure to drugs they were testing as a result of the drugs being aerosolized during testing. As a result of this, they risked failing a drug test that was a requirement of their employment, and immediate firing. The various Fentanyl drugs that First Responders may come into contact with today are far more dangerous than the drugs DEA was testing back then.
1
Trump, misinformation and drugs. I was asked by a friend who is in charge of vaccine marketing for Latin America for one of the largest pharmaceutical companies in the world to name as many drug dealers as I could. My friend is from Guadalajara, Mexico. I said Pablo Escobar and El Chapo. He said that's enough. Now name 1 US drug dealer. I could not. He said that is what he expected me to say. He also said, perhaps I could explain how all those drugs which cross the US/Mexico border get to NY, Chicago, Miami, New England and Seattle without US versions of Escobar and El Chapo. I invite anyone who reads this column to explain this apparent dichotomy.
14
During my my major illnesses both of which involved extensive surgery and the first of which nearly did me in - and a certain unfortunate iatrogenic situation when an unhappy poorly trained gastroenterologist perforated my colon- I would have done myself in had it not been for the genius of the fentanyl transdermal patch. When it becomes impossible or medically unadvised to swallow a pill, that patch is a godsend. It would be truly inhumane to ban these drugs for the circumstances where they're truly needed because of irrational misinformed hysteria. And no, I am not addicted to the stuff. I want my pain meds actually to work when I need them - which means never using them for non-medical experiences.
30
I suffer from chronic pain due to medical malpractice. Before the cause of my pain was determined, my pain was off the charts. I was prescribed fentanyl and was told it was 100 times more effective than morphine. It wasn’t. In fact, I periodically experienced no pain relief at all. Delivery of pain relief was inconsistent.
Medically prescribed fentanyl is administered through the skin in patches. Placement is critical. On the upper chest is optimal, but the upper back also works, the instructions say, if the patient is demented and likely to tear the patches off. Patches come in different doses and last three days.
A day after my patch was placed on my chest, I developed weeping sores around and near the patch, an obvious allergy. Too cheap to throw away $150 for three patches (I was uninsured), I used medical tape around the edges of the patch and Benadryl.
Perhaps fentanyl provides many times the pain relief if it is injected, but it was less potent than Oxycodone for me.
13
So now some anecdotal information has gotten into the mainstream media and given credence. It reminds me of the fake autism/vaccine study which led to millions of idiotic parents not vaccinating their children. NYT please do a front page piece on the value of opiods and proper handling. Addicts will overdose on anything drugs, food, alcohol, kitchen products. That is no reason to demonize anything that can kill if taken in mass quantities.
22
Meanwhile money used to purchase unnecessary protective gear is not going where it's needed--into addiction treatment. Only 10% of addicts get treatment, even though they all need it. Relapse is common, partly due to brain adaptation to drugs and alcohol. Treatment may be needed more than once and for prolonged periods before it "takes."
8
80% of illegal fentanyl comes from China.
They make Russia look like your saintly Grandmother.
This important editorial containing very vital information must be distributed to the producers are writers of both TV and motion pictures so that they do not perpetuate the inaccuracies of fentanyl exposure that leads to nocebo effect attacks among first responders. Additionally, it should be distributed to the first responders themselves.
An excellent, much needed journalistic effort!
2
Thank you!! As an ER MD I watched as this country panicked over something COMPLETELY untrue!
Naloxone (Narcan) works to reverse a narcotic overdose because Narcan IS an opioid! Only it’s not potent in any way. Our bodies have “opioid receptors.” The narcotic binds to these receptors giving us pain relief or euphoria.
Narcan kicks these opioids out and bind themselves. Soit’s important to keep giving Narcan IV until the narcotics leave the body via the kidneys and metabolized in the liver.
That First guy who “got fentanyl powder on his hands then touched his face” panicked and went down. As they took him to the ER in panic they kept giving him vial after vial of Narcan...no help! The ER doctor said “It HAS to be something else!” And it was.
But the stories spread and an episode of “Code Black” with Rob Lowe as an army doctor working with paramedics in the field showed this ridiculous scare. An entire team of SWAT and DEA stormed a drug house, powder was EVERYWHERE and they all went down...even a first year resident in the ER picked up a fanny pack, got dusted, went down and died! In the middle of the trauma room!
That show’s gone, but the panic continued.
When a patient comes in unconscious, at times an OD isn’t obvious (no needle in arm) you give glucose-sugar in case of insulin shock in diabetics, then Narcan. No help? LOOK FOR OTHER REASONS. To keep giving a dozen vials of Narcan is crazy.
Get the word out--this does NOT happen...ever!
24
@Nuschler Thank you. As a 30 year pacu rn I administer fentanyl to post operative patients frequently. On the rare occasion I've had a topical exposure. Simply washing the skin with soap and water takes care of that. I'd be much more concerned about contact from topical nitro ointment or scopolamine in the eye.
7
Misinformation is indeed hazardous. The Editorial Board, through this piece, is guilty. Though perhaps correct about fentanyl, the Board fails in not taking into account reasonable fear of chemical derivatives of fentanyl that orders of magnitude more potent and toxic. The derivatives do in fact pose a risk, those on the front line should shoe over-abundance of caution. Please do your research.
1
Well, Karl, if you know about these even-more-dangerous "derivatives," perhaps you could identify them for us and point us to information regarding the danger and the real-world risk of exposure.
4
Funny, there never was a Times editorial questioning the wildly exaggerated claims of harm from breast implants, Johnson's Baby Powder, Roundup or numerous other substances litigated against by the Plaintiff's Bar.. It's only when defending drug addicts and dealers against the police do you fret about "hysteria" regarding the danger from chemicals!
2
Opioids should be treated as a potential health abuse problem akin to alcohol and tobacco. Legalization would lead to taxation, regulation and education.
Unless and until that happens all opioid makers and dealers and users should be treated the same. Beginning with prosecuting and locking up the Sackler family behind Purdue Pharma in a maximum security prison.
2
The entire "Opioid Crisis" is a panic about misinformation, with persecution of the innocent, cheering for the guilty, obfuscation of the causes, and doubling down on absurd, ineffective policy.
The "Opioid Crisis" is an inevitable result of our dysfunctional health care policy, fear of the 'other' and failure to recognize how social problems are interrelated.
Facts:
Health insurer's profits are a % of the total cost. Their profits grow when costs grow.
Primary care and mental health lower the total cost of health care.
Health insurers disfavor primary care and mental health-specialties that treat psychiatric problems.
Primary care and mental health are in short supply.
75%+ of opioid abusers have severe, long term psychiatric disorders. Opioids give some relief. (Cicero&Ellis.)
Most people with mental disorders can't get treated.
Rural and poor areas have especially short supply.
Rural and poor areas are especially hard-hit by the 'opioid crisis.'
Countries with functional health care systems and drug decriminalization (Kristof/Portugal) have minimal opioid problems.
Most people in prison (80%) have severe mental disorders.
The US has ~2,200,000 people in prison/jail, costing $80-180Bn/yr, or $35-80,000/person/yr.
Buprenorphine treatment costs about $2,000/yr.
........
Decriminalization, amnesty, expand primary care and buprenorphine access, jobs, social services.
Stop treating symptoms and ignoring the real problems.
6
@DataDrivenFP Y If this is a "panic about misinformation, with persecution of the innocent" then you must think we are panicked about Big Tobacco & Boeing. Reality check: Big Pharma, specifically Purdue & the Sackler Family knew very early in the game of the dangers of opioid addiction/death. Another quote you offer, "75% of opioid abusers have severe, long term psychiatric disorders". Let's look at the numbers - depression affects 16 -18 million Americans. 13% of Americans say they take anti-depressants. Most have jobs, raise kids, attend school, are high functioning. When they are prescribed opioids by Big Pharma via their doctor/pain clinic & become addicted, is it irrelevant because they suffer from mental illness? Doctors/pain clinics/hospitals/Big Pharma and those who fund Big Pharma (Sacklers) have literally created a population of addicts. To suggest that it's no big deal because people are either depressed or because it's a small number is akin to saying that "every so often the US executes an innocent person but the number is so low, it's no biggie." 10% of the population carries an addiction gene or has a propensity for addiction. They have the potential of becoming addicted/ dying simply because after wisdom tooth surgery or a broken arm, a doc convinces them that Oxy is perfectly safe. Do the math. Still think people are panicking?
1
After reading "Opinion - Fear, Loathing and Fentanyl Exposure"
If skin contact with Fentanyl is slow/possible contaminant culprit but mucus membranes are critically vulnerable; all mucous membranes shall be protected. It is obvious that shaking off Fentanyl from a garment in close proximity would send air-born Fentanyl particles into immediate breathing living environments. A prevention clause shall be included into Fentanyl's a "Hazardous Materials Handling Internal Safety Document and Training Materials".
All senses shall be protected also: Eyes, Nose, Mouth.
Most corrosive environment(s) such as chemical(s) and semiconductor manufacturing and clean room fabrication facilities follow strict quality assurance guidelines.
"Risk and Quality Control play paramount roles in safe use of any process and/or system(s).
"Risk and Quality Control play paramount roles in the safety of use of any process and/or system(s) interactions".
These unfortunate events have a parallel with recent Ethiopian and Malaysia Airplane(s) calamities; although sources, outcomes and ratios are different: sensor & software vs. cleansing process followed, 100's perished to less than 10 seriously affected.
In a century afflicted by gender, political, and environmental turmoil, no human being earning a decent living should live in fear of any work place interaction, tool or environment.
>>> "In a century afflicted by gender, political, and environmental turmoil, no human being earning a decent living should live in fear of any work place interaction, tool or environment."
Meanwhile, back in the real world . . .
2
I think the real problem we have in America today is the problem of so many people living fear based lives.
Fear is the most destructive thing to humanity and rational thought.
Yet we have allowed it to become the accepted basis for use of deadly force by police!
Why don't we all start being rational again?
“Only Thing We Have to Fear Is Fear Itself”
That is not a joke, he was dead serious. Fear is what took the ecobomy down in 29 and kept it down until FDR started taking actions to rebuild it.
11
I think some of this may also be part of police culture to try to instill false fear about things they don't want people doing regardless of whether or not it is legal.
This also helps feed the unnecessary prosecution and persecution industry.
4
It wasn't too long ago that some people refused to shake hands with an individual diagnosed with HIV.
7
@WmC
Exactly what I was thinking.
The special people among us are always looking for "justifiable" excuses to exercise prejudice.
5
I'm the primary care giver for my 90 year old father and he's been prescribed fentanyl now for about 4 years. Every 72 hours I replace his patches for him and it's nearly impossible to do this without coming in contact with the sticky portion or the part that actually delivers the drug to my dad. I hate to tell the fearful, but I'm still quite alive. I haven't even come close to dying from it.
Now, my dad, on the other hand get scared almost daily from the non-stop scare propaganda put out by uninformed media types. Myself, my sister (a registered nurse) and his doctor have had to repeatedly reassure him the patches are safe for him to use.
What really scares me is if legislators get really stupid over this and move to completely ban fentanyl patches. This would undoubtedly push my father towards acute withdraw from fentanyl which in turn will likely kill him.
Another myth often perpetuated is that nobody ever died from acute withdraw from opiates.
I went through withdraw in my younger days from mere heroin and had I had the same heart problems back then I probably would have died from heart failure. My father will die eventually, but I'm going to do everything in my power to make sure it's not from acute opiate withdraw.
9
Good article: Reefer Madness, Part Two.
6
@Cooofnj
To be fair the actors in that movie were portraying the very real long term effects of cocaine and methedrine abuse that took place during the 1920's. We don;t hear much about it because we didn't have any nanny state laws about drugs other than alcohol then.
It was an intentional mislead on the part of the producers.
>>> "To be fair the actors in that movie were portraying the very real long term effects of cocaine and methedrine abuse that took place during the 1920's."
No, they were not. "Reefer Madness was a 1936 propaganda film about the alleged dangers of *marijuana* -- thus the title.
1
@Douglas
EReally. How'd I miss that. :\
So much for evidence-based practice.
This is a training problem, plain and simple. And yet, I went to a meeting/training a couple of months ago, and the chair of the group, in charge of training, took a 20 minute slot to give a purportedly authoritative talk on incidental fentanyl overdose. The group was on the verge of adopting pretty draconian measures and ordering unnecessary BSI before it was stopped and debunked.
There has been a report available from the American College of Medical Toxicology and the American Academy of Clinical Toxicology for going on two years now that debunks this whole thing with evidence, measurement, and calculations. The way medicine is supposed to be done. That the panic continues is tribute to the fact that medicine has "leaders" who aren't really at the top of their fields, and who are anything but impartial to patients they are prejudiced against.
Here's the report:
https://www.oklahomapoison.org/images/Fentanyl_Position_Statement_2017.pdf
11
How is this an important editorial issue? How is this an important medical issue? Some cops got scared?? How about informing the public how to deal with overdoses?
>>> "How is this an important medical issue? Some cops got scared??"
Scared cops and other responders are likely to act in ways not helpful to the people they are supposed to be . . . helping.
Maybe read the editorial again.
4
Hysteria is an essential part of the government's management of drug addiction issues.
It's essential for more money for law enforcement...just think of all the great hysterias propagated by law enforcement and bottom dwelling media reports, from reefer madness to crack to fentanyl. Hysteria governs the response and likely may even make things worse.
But it all makes sense if you want more money for ongoing development of the American police state.
19
How to distinguish a panic attack from an opioid overdose:
Panic Attack: (Closely resembles Opioid Withdrawal)
Your sympathetic side of the Central Nervous System is engaged. Think tigers and the fight-or-flight syndrome. Heart rate is abnormally high (above 100 beats per minute). Breathing rate is abnormally high (above 20 breaths per minute.) You may feel your heart pounding (thinking you're having a heart attack is common.) Lightheaded or dizzy (your heart may be beating so fast that it's not pumping efficiently--less oxygen in the blood=dizzy.) Fear (that's your adrenaline talking, plus all these scary symptoms). Pupils may be dilated.
vs
Opioid Overdose from fentanyl, heroin, etc:
Your parasympathetic CNS system is engaged, the opposite of above. (You're somewhere in the feed or breed continuum, as opposed to fight or flight--zenned out if it's benign, heading towards unconsciousness if not).
Heart rate is abnormally low (less than 60) and maybe headed south. Breathing is abnormally low, (less than 12) and maybe headed south. You aren't worried, generally, though maybe you should be. (You aren't likely to or capable of giving yourself Narcan.) Pupils may be pinpoint.
If you're in panic attack status, you haven't inhaled fentanyl.
13
So over this entire topic, junkies will be junkies and most Americans have less and less sympathy for them as time goes on.
They are expensive and they rarely recover .
2
Personally, I have less and less sympathy, as time goes on, for people who don't have sympathy for others.
9
A society that is skeptical of the truth and readily believes liars is a society that has mass panics. It is mostly a society of "uninformed and proud of it" people.
15
"Misinformation is itself a hazardous substance."
I'm still reading, but I'm expecting that to be the best sentence in today's paper. Great editorial.
15
If you find your teen with alot of "paper cuts" and using up the bandaids beware.
@Alan Einstoss Beware of what?
2
We are far overdue for a proper scientific re-evaluation of various drugs and medicines. Dealing with the misinformation out there will be an extra benefit.
3
On the other hand, as long as the risk is plausible though minimal, and given that some persons are extremely or even irrationally risk averse (perhaps its own disordered condition), nocebo effects will persist until, possibly, that plausible risk no longer exists.
1
Our ENTIRE opiate problem is due to the prohibition of opiates and our insane war on drugs. In a few years time we'll look back at the bright idea of legally prohibiting drugs as being counterproductive, cruel and disastrous. We'll look back at the war on drugs and ALL its attendant stupidities way we look back at segregation, anti-gay bigotry, and other moral panics. You watch... D.A., J.D. NYC
15
The stuff kills. Whats wrong with people avoiding contact with it?
5
@MoneyRules,
Oxygen kills; water kills; fir kills. Or they save lives. It's all a matter of dosage.
6
@RRnot with Fentanyl - you've been listening to the wrong voices. It is NOT a matter of dosage - it's "when". educate yourself.
This is absurd. Doctors, nurses, pharmacists, patients, and family caregivers in the cancer and hospice worlds have been handling fentanyl in it's various forms for years with no special protective equipment. I did a physical exam recently where I made a point of locating where the patient was wearing their Fentanyl patch, checking whether it was adhered properly, and whether there was any adjacent skin irritation. I'm pretty sure the patient's spouse routinely assisted them in applying and removing the patches. All of us with (clean) bare hands and no gas masks! Is there some magic protective force field around us but not first responders?
144
@S
When black and brown folks were making, using and dealing drugs it was a crime wave.
Now that the makers, dealers and users are white there is " crisis" and an " epidemic" requiring compassion, empathy and treatment.
Lock them up
2
@Blackmamba I could not agree more. When it was blacks and c rack it was "...take back the streets..." and "...Suburbs Ho!...".
N w that it is white people, it's a different song.
1
“...many of them were given Narcan in response, even when their symptoms were more consistent with a panic attack than with an opioid overdose.”
Sounds like a day in the life of an American hero, walking that thin blue line to preserve life, liberty, and skittishness.
By the time an individual might require Narcan to resuscitate them, they’re not going to be walking around worried about incidental exposure to a drug that frightens them.
They would be on the verge of death. That’s why Narcan exists.
10
Why are we so prone to dubious memes and panic? It’s pathetic.
9
@trblmkr - Because seeking the truth is too difficult for most people to do. And the internet does not help those who want to seek the truth, because anyone can post anything and call it true. Because when you don't take information at face value, you are branded a cynic or a trouble maker, even if all you do is ask questions.
We have become (maybe we have always been) a nation of people who believe what we want, whether or not it is the truth. We dismiss facts that do not jibe with our world view. That is why we are in the state we are in today.
1
Cops can’t get a disability pension unless something bad happens. So whatever happens has to be bad enough. If not physical at least PTSD.
3
The subtitle of this article is nearly as misleading as the misinformation that it decries. It is nearly impossible to overdose from fentanyl only if one doesn’t already use drugs recreationally or otherwise. The qualification is absolutely crucial. As a harm reduction worker in Rhode Island, I can readily attest to the presence of fentanyl in club drugs, cocaine, and fake prescription pills in Providence and likely elsewhere. A quick glance at this peice might give an impression to the contrary. It is certainly possible to accidentally overdose from fentanyl outside the context of heroin use but in the case of other drugs.
4
Apparently, the mere thought of drugs makes some people's rational thinking go completely haywire. I've seen it happened with even relatively benign drugs like marijuana. Drug hysteria is real.
11
Thank you for the article. I am so sick of law enforcement and EMTs fear mongering and blatantly lying about their exposure. Actually I'm so sick of EVERYONE always trying to stir up panic, and spread false information to pursue an agenda.
12
Minimal risk is only minimal until you're the one at risk.
6
@John D., read the 2017 paper by the ACMT/AACT. Minimal risk here means cannot happen unless you are in a processing facility with massive exposure. In short, on the street it means no risk.
14
@John D.
Imaginary risk is still not risk.
10
Is there something in the water in the United States that makes part of a population more than normally susceptible to mass panic? Every few months it seems that a "something scare" floods "fantasyland". And then there are the long-haul boogeymen: Witches, Reds, Vaccinations, Mexican rapists, etc. etc. that might be bad jokes except that real people get really hurt by the reactions to them. Yes, there are real threats but the "scare-of-the-month" over-reactions may actually exacerbate these --- since throwing expensive resources against minimal dangers makes reasonable measures against the real threats less effective. Two things that come to mind quickly are climate change and white supremacist terrorism.
16
@jprfrog, sorry to disappoint, this is not the "scare of the month", it's been a scare that's been going on for several years now.
1
@jprfrog
Exactly right! I'm 68 years old and use a concept I call BTI (Before the Internet) that I use with my grown children and grandchildren to explain how the world actually works. I think that most of the mass panic situations can only occur because of the multiplying factor of the internet. Sure, this stuff happened BTI but never on the ridiculous scale it does today.
And spot on about climate change and white supremacist terrorism.
1
Forcing addicts to resort to using street drugs that could be laced with unknown contents is akin to making them play Russian Roulette. If society truly wanted to help addicts and those who come to their aid, the best thing would be to them access to their stimulant or depressant of choice, certified free of deadly contaminants. Too obvious?
4
We can add this to Crack Babies. There is a huge effort in this country to keep everyone scared of everything.
It makes the Police State seem comfortable.
18
This was a needed correction to the ideas I'd had about the risks of passive exposure. Though I consider myself a level-headed, often cynical, consumer of information, I'd taken the reports of first responder overdoses at face value. My monthly subscription to the NYT pays off daily.
19
Of all the myths spread in the irrational war on pain management, those involving medical practitioners are the most pernicious.
According to the US National Library of Medicine/National Institutes of Health: "Many current assumptions about opioid analgesics are ill-founded. Illicit fentanyl and heroin, not opioid prescribing, now fuel the current opioid overdose epidemic. National discussion has often neglected the potentially devastating effects of uncontrolled chronic pain. Opioid analgesic prescribing and related overdoses are in decline, at great cost to patients with pain who have benefited or may benefit from, but cannot access, opioid analgesic therapy." https://www.ncbi.nlm.nih.gov/pubmed/28402482
And yet this "Banquo's Ghost" keeps materializing in new forms.
https://emcphd.wordpress.com
8
Someone writing an opinion on opioids who is actually not hysterical and has common sense. Will wonders never cease?
Actually transdermal patches of fentanyl are quite safe and a good way to administer pain medicaton for chronic pain while ensuring a steady state dosage.NO highs and lows from pills or one time injections.
The pain patients who are regulated by competent physicians are not the problem here- it is the thrill seekers who take drugs for illcit purposes, yet the chronic pain patients are the ones who now suffer, due to the hysteria of the crowd, or as they say on South Park "rabble, rabble rabb!e". Enough.
10
@Pat Nixon
Not entirely true.
In the presence of a fever, the rate of transdermal transport increases to the point that death from an overdose of fentanyl has occurred.
I think that this editorial misses the fact that we aren't just dealing with fentanyl. They are dealing with Lofentanil, Thiafentanil, and Carfentanil. All of these are analogues that are literally 100 times more potent then fentanyl, which puts them at around 10,000 times as potent as morphine. We are talking about doses in the micrograms. It doesn't need to be aerosolized with a propellant at this point. A bag of powder with enough movement in the air to carry a fraction of a single milligram is enough to represent an overdose level exposure. (Like when you open a bag of flour, and it gets into the air.)
11
@John Moltzen
The Russians used an aerosolized agent in a hostage situation in the Dubrovka Theater in 2002. At least 170 people (mostly hostages) died. The agent is believed to have been one of the fentanyl derivatives you cite.
Not to say that the thrust of the editorial may not be true, just to add a word of caution.
8
Yes, it was probably fentynl they used. But...
Most of those deaths at Nord Est play in Moscow were uninformed ambulance guys stacking what they thought were dead bodies in the ambulances. They weren't dead when they left the play but suffocated in the ambulances.
@John Moltzen
OK, but those are different drugs from fentanyl. There could always be an unknown dangerous substance at an emergency scene - there could be a brand new designer drug or chemical weapon that's never been seen before, there could be measles in the air, there could be a carbon monoxide leak into the room... The question is how common any of these threats are, how likely that a random otherwise ordinary-seeming scene would contain them, and therefore how much fear or $$ or change in procedures are they worth. I doubt very much that the especially dangerous synthetic opioids you mention are actually common enough to warrant this level of panic.
While there is confusion about being near opioids and being in danger from accidental ingestion, the larger problem is the number of people addicted to these drugs.
The treatment for addiction is expensive, most often not covered by insurance, and long. That's were the concern should lie and solutions found. It would solve both problems.
4
It's not fentanyl in its medication form (patches, etc.) that's worrying everyone. It's the uncut form that arrives in suitcases which drug addicts then shoot up that's scaring them. 2 milligrams is the lethal dose of fentanyl. Gloves and facemasks are hardly unreasonable for any first responder. And for police officers who are taking down a drug den, some form of body protection in case of massive exposure is not so much to ask.
Now, if we're talking about level 4 biohazard gear with an independent air supply, that is probably going a bit overboard.
10
@Liz
Gloves certainly should be used by first responders to overdose scenes - to protect them from bodily fluids. And facemasks if they're getting up close to the victim or items/surfaces in the room, for the same reason. If they weren't already doing that, they have much bigger problems. If they are, great, fentanyl exposure risk more than solved.
Not to perpetuate the myth of passive overdose outlined in the editorial but fentanyl is NOT the most potent opioid known to man. Sufentanil is 5-10x more potent than fentanyl and and oral formulation was recently approved by the fda (brand name Dsuvia) for post operative pain. Remifentanil (used in general anaesthesia in humans) and Carfentanil (large game tranquilizer) are both approximately 100x more potent than fentanyl.
17
“Several states are planning to spend tens of millions of dollars on protective gear and screening equipment that most toxicologists say are unnecessary.”
As in most cases follow the money.
Spreading fear and panic is one of the best salesmen known to mankind.
91
@mlb4ever
What kind of gear? What kind of equipment? Perhaps we should look over what they're actually asking for before we say they don't need it.
@mlb4ever
A good question to ask in terms of state purchases of almost anything is who is doing the selling and which politicians depend on those individuals for campaign contributions or who's a friend of whom. Face masks and latex gloves should be pretty cheap.
Fentanyl is a great medication in palliative and hospice care only.
Full stop.
Opioids are not needed.
NSAIDrugs
In doses high enough will assuage pain.
Pediatric IV Tylenol / Acetaminophen.
works for post surgical pain in adults.
Some folk have adverse effects post surgery ,vomiting from class 2 narcotics.
Street cred for use of these substances is for desperate folk needing inpatient facilities.
We as s nation fall short in response to this crisis over again many times.
3
@nurseJackie: Yes, and NSAIDs in high enough doses over a long enough time, used for severe post-herpetic neuralgia (nerve pain) will also do a pretty darn good job of damaging your kidneys, as well. Ask me.
Opioids are not needed? I guess everybody has an opinion. Opioids have their place, and not just in “palliative or hospice care”. Obviously you have never experienced pain so severe that you thought life wasn’t worth living. Drunks driving cars kill too many people every day, but I bet you aren’t campaigning to ban cars because of the actions of a segment of the population who, for whatever reason, cannot control themselves when it comes to alcohol and driving. The same reasoning can also apply to opioids. They need to be handled with the greatest of respect and control, but the point is, they CAN be handled by most of us with intractable pain that nothing else will help. We don’t want to be on these drugs, but what else would you suggest? I have been stable on my original small dose of methadone for over ten years. It has never occurred to me to either misuse or abuse my medication. And I am quite sure there are many stories like mine out there. Would you prefer that I be disabled from the pain and be a burden on society instead of being stable on my meds and holding down a full time job, plus my own small business, plus occasional volunteer work, all in my mid-60s, contributing to society on a daily basis? Overdoses make the news, people like me don’t.
63
@nurseJacki@ Talk to me after you've lived with chronic pain for more than 10 years, trying to function on five to six hours per night of broken sleep
Anyone who claims "opioids are not needed" has never dealt with the agony of a damaged body that doesn't respond to NSAIDS, physical therapy, "pain acceptance" or New Age treatments like massage and acupuncture.
Some injuries can't be healed and some illnesses can't be cured. Why should chronic pain patients be condemned to never-ending suffering because others enjoy the "high" opioids provide?
54
@nurseJacki@
That is nonsense.
NSAIDs do immense damage to kidneys and stomachs and have high acute toxic potential as well.
9
I had both chemotherapy and radiation at the same time (for cancer). I also had Fentanyl patches prescribed by an oncologist. Most of the patches are in a baggie still unused or I disposed of them properly. Opioid users picked the wrong drug. I'm part of the solution, not the problem. Pain is not fun. Neither is being addicted to anything. Whether it be fentanyl or other opioids or cigarettes or alcohol.
11
The most frustrating aspect of being human is that we all posses minds that are run on emotion and logic, but emotion is like dark money in our political system- we do not recognize its affect on our own deductive processes when we feel certain we are being completely logical.
Join these emotionally driven minds into groups and you have governments that constantly behave illogically. This makes it impossible to rationally and efficiently deal with problems like the fentanyl crisis, where we waste resources chasing the rabbits of irrational fear, such as inadvertent overdose.
Same thing happened after 9-ll when trillions were wasted on wars that did nothing to make us safer and completely destabilized the Mid-East. Even Homeland Security squandered vast sums on projects based more on fear than reason.
And then there is the constant battle between political parties whose members tend to feel certain that they are the only ones operating logically.
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@alan haigh
Nice metaphor: "emotion is like dark money."
1
About your "those patches are still very slow and inefficient," you are thinking of Fentanyl patches, but you said it in a context that makes it sound as if it's true for all medications, and that's not the case.
I use lidocaine patches to control chronic leg pains. They work pretty much instantly, and when taken as directed the lidocaine doesn't accumulate and spread through the body.
If it weren't for lidocaine patches, I'd be taking opiates every day, but the opiates I've been prescribed in the past either weren't strong enough to work or made me impossibly groggy.
I would hate for anyone to be dissuaded from trying lidocaine patches by what you said.
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@Brian Harvey
Lidocaine patches are also great for Herpes Zoster attacks.
Prescription fentanyl is a world apart from the illicit type that arrives on U.S. soil from China.
It can be safely handled as such with no fear of passive toxicity.
Personally I received a large amount (200mcg) in patch form that needed to be replaced every 48 hours without any inherent complications for years.
For those like myself who truly had no other options, fentanyl can be something of a life saving medication.
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I had a transdermal fentanyl patch for my dog who was dying of bone cancer (to be applied if the pain became too much when the time came to take the long, final trip to vet). The vet I got it from gave me all kinds of scary instructions about handling the patch when It came time to apply it. The veterinary nurse (who is the one who actually handles the patches regularly in the vet hospital), told me to discount most of what I had been told. What she said made sense. If the patches were as deadly as the vet said, why would they be used on humans (and animals) who were already in a compromised state? They are designed to kill pain, not people (or dogs).
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"And addiction specialists are worried that health care providers will hesitate or outright refuse to treat people who are overdosing, just as doctors and dentists denied care to H.I.V.-positive patients during the early days of the AIDS epidemic."
There is a vast difference between irrational panic over fentanyl exposure, and the very real possibility of contracting AIDs by health care providers.
I recall the panic of my friends and relatives who were medical students or residents. These young people were absolutely terrified of catching AIDS. They worked in hospitals in New York where there were high populations of AIDs patients, and would panic when they were splattered with blood during surgeries, or stuck themselves with needles, accidentally, following which they would have to wait a certain amount of time until they could know if they had infected themselves with AIDS. They started doubling and tripling on surgical gloves.
One cousin withdrew from a coveted orthopedic surgery residency spot ,fled New York for his native Ohio, and switched specialties and patient populations that reduced his exposure to AIDs.
These young people weren't prejudiced, They were terrified that they were going to become infected with AIDs, & infect their spouses and babies with AIDs.
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I probably received a few dozen surgical needle sticks during my surgical career, one during a case on an AIDs patient. I never received post incident preventative treatment. I operated on a number of other HIV carriers. I also operated on a large number of artificial kidney patients who have a lot of hepatitis C, which is far more worrisome. I am free of both AIDs and hepatitis.
These sticks were with solid surgical needles. Nurses have far more exposure to hollow injection needles; sticks with those are much more likely to transmit disease, but I never knew a nurse to refuse to treat an HIV or Hep C carrier. I never saw the kind of panic among nurses that some doctors and prospective doctors showed.
It is best for both would-be doctors and their future patients if students worried about the very small risk of contracting a serious disease from a patient choose another profession.
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@DJS
Sad - and all your relatives reactions were caused by fear - what we later learned to be irrational fear
The whole point of fear-mongering is to create panic and interfere with rational thought and response. The recent Ebola scare led to widespread marketing and purchasing of protective equipment by many communities, healthcare systems and other public agencies. Expensive, rarely used, now approaching the printed expiration date. At the risk of sounding flippant, can't the worried workers and responders be allowed to use that same protective equipment that was purchased and is now languishing nationwide?
25
Yup.
I make my living as an anesthesiologist in an inner city hospital where the treatment of community acquired self administered drug overdose is common. In my 40 year career I have seen zero cases of accidental narcotic toxicity in first responders or healthcare providers. Zero. I have seen zero cases of accidential narcotic effect in first responders or healthcare providers. Zero.
I handle commercially available fentanyl every day, am randomly drug screened, and even though I occasionally get fentanyl on my skin have never had so much as a positive drug screen.
Comparisons of fentanyl to morphine as described in the lay press are misleading. Yes, fentanyl is "50 to 100 times more potent than morphine." But the concentration of commercially available versions is proportionately reduced. Fentanyl commonly is produced in a 2 cc, 50 mcg/cc vial. Morphine is produced in 4mg, 10 mg, and 15 mg one cc vials. Since 1000 mcg = 1 mg, these are equi-potent, equi-volume formulations.
Science reveals the truth and the truth shall set you free.
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For the most part EMTs in small cities and rural areas are volunteers with training in acute care medicine.
They have not been handling fentanyl and the far more potent derivative that is used in veterinary medicine as part of their regular lives.
If supplying them with equipment that eases what the experts say is irrational fear but helps them to more quickly administer aid to an OD victim why denigrate the EMTs and police?
They are trying to help people who caused their own near deaths.
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@Edward B. Blau
There is a much better way to spend scarce resources than on unneeded, expensive, protective equipment.
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@Edward B. Blau
1. Learning actual facts and legitimate procedures would make the process even faster than providing expensive security blankets to cover themselves with.
2. Treating the thing as if it's dangerous makes the nocebo effect more intense. First responders may have fewer panic attacks if you provide them unnecessary equipment, but the ones who still do have a panic attack - especially the ones who have one because of a failure of said equipment - will be sicker/more uncomfortable.
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@Edward B. Blau
I thought the same thing. What's the value in criticizing and/or diminishing their concerns? It is they who are on the line so to speak; meanwhile the Editorial Board opines from the safety of its NYC tower.
4
Thank you for publishing this information. All first responders to overdoses deserve accurate information on their risks. CDC's NIOSH recently released a video aimed at police first responders that was full of misinformation. Assault charges and police fear of overdose scenes are real concerns in some areas.
8
Ebola was a serious disease. A few people infected with the disease came to the US died of it. The small urgent care I worked at bought expensive protective gear and questioned people whether they had been in west Africa recently. Panic is a very serious real reaction. Fentanyl has become a plaque on the country. It is highly addictive and deadly. The opioid crisis, largely caused by outrageous misbehavior by the pharmaceutical providers, led drug seekers in a tragic search to feed their habits. Fentanyl arrived and killed remorselessly. Now the public has taken the most irrational response.
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@c harris
As a doctor myself, please add my fellow physicians overprescribing as part of the cause. Pharma is bad but it takes 2 to tango
3
@E
Arguably, as our only protectors from Pharma, I'd say doctors were leading the tango. Don't worry. They are on most people's list.
When any substance, or contagion is very dangerous, or deadly, it is easier for misinformation to be the norm. This was the case with the HIV, and aids epidemic, that was initially a death sentence. As the medical community became involved for treatment, it has become a chronic, long term disease, so unfortunately, the nature of the human animal is to ignore safe sex. Our country, and the world has a very high rate of STDs', which can cause infertility, and are mostly treatable if one knows they have one. However, with measles, it spreads easily, so each type of exposure, should be communicated to the public daily on the news media, so the public knows exactly what the risk is, to become aware, and have accurate information. It matters little whether it is edibles with high doses of THC for children, serious, but not deadly, to alcohol, cocaine, fentanyl, heroin, meth, pain killers, etc. Each of them have degrees of danger, from alcohol, which cause drunk drivers to kill, and injure many each day across the country, to those drugs that children, or anyone can get high on, or become violent. The degree of harm can be slight, serious, or deadly, depending on the substance, the amount, and whether it is a child or adult.
6