Alberta prison guards probably didn’t overdose just by touching fentanyl

Reports of law enforcement officers overdosing on duty from fentanyl they accidentally came into contact with is being met with skepticism from toxicologists, who say simply touching potent synthetic opioids won’t cause an overdose.

Earlier this year, the story of an Ohio cop who claimed he almost died after brushing what was believed to be fentanyl off his shirt went viral — only to be decried as “nonsense” by medical experts.

The latest report comes from Canada, where, according to a local union, seven prison guards in Alberta were exposed to fentanyl during routine searches in July. At least two of them had to be sent to hospital after touching fentanyl while sorting through the mail, and another guard was hospitalized after inhaling a substance believed to be fentanyl while searching a car.

“Wind caught the material, airborne, went into somebody’s face,” Ryan DeBack, the vice-president of the Union of Canadian Correctional Officers told CBC’s Calgary Eyeopener about the car search. Lab tests are still confirming what exactly the substance was. DeBack is calling on the government to implement practices to better protect guards from substances like fentanyl.

In the other incident, six officers at an Edmonton prison touched fentanyl that fell out of the incoming mail for inmates. Two of those officers had to be hospitalized and given the opioid overdose antidote naloxone. “Through subsequent touching and handling of the substance, we had six people exposed, two of them went down almost immediately,” DeBeck explained. “This stuff absorbs through skin.”

But medical experts have raised doubts about similar incidents, saying that fentanyl overdoses are unlikely caused just by touching the drug.

David Juurlink, a doctor and toxicologist at the University of Toronto, said that inhaling fentanyl is cause for concern if it’s dispersed in the air one’s breathing. “Walking past fentanyl powder won’t make you sick,” said Juurlink in an interview. “But fentanyl that’s made it into the air in the context of a struggle or a broken bag, or something like that, could be quite dangerous.”

When it comes to touching fentanyl and its analogues, Juurlink says there’s very little evidence to suggest that would cause harmful side effects or an overdose. “It’s just not absorbed anywhere near quickly enough to cause toxicity by that mechanism,” he explained. Fentanyl and its related compounds can kill you, but they have to be injected, or ingested orally, or inhaled.

Juurlink and other toxicologists raised similar thoughts in a recent Slate article that debunked the story from May about the Ohio cop who said he nearly died from a fentanyl overdose after touching it with his hands. Chris Green, a patrolman in Liverpool, recalled finding white powder believed to be fentanyl coating the inside of the car belonging to two suspected drug dealers. When Green got back to the station, another officer noticed the powder on his shirt and he wiped it off with his fingers. That’s when he says he got sick and felt his body shutting down.

The Slate article entitled, The Viral Story About the Cop Who Overdosed By Touching Fentanyl Is Nonsense, and written by emergency physician and Harvard Medical School teaching affiliate Jeremy Faust, goes on to pick apart Green’s story and says that, if true, it would be the first ever reported overdose caused solely by unintentional skin contact with an opioid.

“Perhaps when he [Green] moved to brush the substance off his shirt, some of it stuck to his fingers and he later inhaled it, or accidentally ingested it,” writes Faust. “But the amount that could have transferred from the car to the shirt to the fingers to the mouth or nose would not be a clinically significant quantity, even accounting for fentanyl’s potency.”

DeBack, the prison guard spokesperson, told VICE News that while there is no scientific evidence to definitively prove the guards who touched the fentanyl experienced overdoses, the fact is that they were experiencing symptoms such as dizziness and increased heart rates, and multiple naloxone doses were used. And when it comes to questions around whether touching fentanyl is the cause, he said that’s better left to the experts. For now, the union will continue to treat the incidents as health emergencies. “Our biggest concern is that whatever we’ve being exposed to … it’s never happened before,” said DeBack.

The Centers for Disease Control and Prevention changed its previously published guidelines for first responders that warned that merely touching fentanyl and similar opioids could kill.

Instead of saying that “skin absorption can be deadly,” the CDC webpage was updated last month to say that “while dermal absorption of fentanyl commonly occurs through prescribed use of the drug, inhalation of powder is the most likely exposure route for illicitly manufactured fentanyl.”

Juurlink and the other medical experts are quick to say that there’s nothing to suggest that these first responders are being untruthful, but that patients can sometimes believe they are experiencing certain medical symptoms in dramatic circumstances.

“I don’t doubt that a police officer who’s felt unwell after casual skin contact might believe he or she was poisoned,” said Juurlink. “But I think it’s much more likely to represent the ‘nocebo effect’ — the idea there is that people will develop symptoms if they think they’ve been exposed to something.”

He added it’s important to dispel unnecessary panic around touching fentanyl and its analogues, so that first responders can do their jobs properly.

“My worry with the media perpetuating the belief of some officers and some first responders that casual skin contact is dangerous is that somewhere out there a patient is going to be deprived of timely emergency care by somebody who thinks they need to put a hazmat suit on,” he said. “All I can do is try to minimize the hysteria around it and reassure people that if you brushed a little bit on your arm, you’re not going to die. People will sometimes develop what they perceive as symptoms nevertheless, very often those symptoms are not those of an opioid.”