30 Jan Illicit Synthetic Opioids
EHSB has recently established a working group which is intended to assist the branch with implementing directives from the task force on illicit synthetic opioids being chaired by the Chief Medical Officer of Health. The working group is composed of representatives from the EHSB,OAPC, MAC, OBHG, and Toronto Paramedic Services.
The primary focus of the first meeting of the working group was tracking of opioid related calls and PPE requirements for paramedics dealing with patients suffering from the effects of illicit synthetic opioids and/or patients exposed to illicit synthetic opioids. The evidence reviewed at the meeting was that universal precautions utilizing a N95 mask are sufficient for the majority of these patients.
Further information will be issued shortly, in the interim the Ontario Poison Center has a section on their website specific to opioid overdose management available at the attached link.
If you have any questions please contact Chief Greg Sage (Greg.Sage@Halton.ca) or Deputy Chief Brian Gibson (Brian.Gibson@PeelRegion.ca).
Opioid Facts and Myths Retrieved from: http://www.ontariopoisoncentre.ca/health-care-porfessionals/Opioid-Management/opioid-management.aspx
Facts:
Fentanyl and its analogues can be absorbed through mucous membranes.
Many users have snorted the drugs and have become overdose victims. In the medical literature, there was a single report of a veterinarian mistakenly splashing himself in the eye with carfentanil which required a dose of an antidote to resuscitate him.
There is some evidence that carfentanil was one of the incapacitating agents used to stop the Chechen takeover of the Dubrovka theatre in 2002. In this instance, carfentanil was delivered as a gas into the theatre and would have been absorbed through the lungs. In the media, there are two videos of police officers, who inhaled carfentanil powder developing symptoms.
Fentanyl and analogues are absorbed from the GI tract.
These drugs, as contaminants, are often taken by mouth in pill form. Absorption might be slightly slower but the overdose effect is the same once absorbed.
Carfentanil is potent enough to sedate an elephant. Special protection must be worn at all times.
Large animal veterinarians do use these potent fentanyl analogues to sedate or anaesthetize animals. Individuals protect themselves by wearing gloves, long sleeves and eye protection when handling the drugs. Border security personnel and post office staff, when opening suspicious packages, are using similar protection but also open these exhibits under a fume hood.
Suspected drug labs are particularly dangerous.
When entering a drug lab where illicit opioids are being manufactured, the powders of fentanyl or its analogues may be free to be inhaled. The US Drug Enforcement Administration recommends that individuals entering suspected drug lab and pill pressing facilities are appropriately protected using Hazmat gear. Field testing substances is NOT recommended as equipment will NOT have many of the new analogues in the library so will give false positive or negative results. Police wear a mask to double seal an exhibit.
Myths:
Fentanyl powder and its analogues can poison you if touched.
The lay press and even some government publications have sensationalized the issue to state that fentanyl powder and/or its analogues can poison you if touched. This is not the case. Inadvertent dermal exposure to the powder will not cause toxicity. If however, powdered drug remains on the skin, (e.g. on your hand) and subsequent oral contact is made (e.g. hand goes in mouth), absorption might occur through mucous membranes.
Rescuers may succumb to opioid overdose when helping victims.
Although very small doses of fentanyl and its analogues can be dangerous, there are no reports of rescuers succumbing to opioid overdoses when helping victims. There are no reports of peers, EMS workers or hospital staff getting ill by providing basic lifesaving care to these victims. Universal precautions should be followed as per usual.