Questions About Illicit Opioid Decontamination
The illicit opioid problem isn’t new, but the staggering increase in the number of overdoses is. Translated, that means these drugs are out there and responders are encountering them more frequently. Further, given the toxicity it takes very little to cause significant injury or death to those trying to help (Grain of Salt.) By 2015, the CDC saw nearly a six-fold increase in the number of illicit opioid deaths. The trend continues into 2017 with the number of fatalities doubling from 9,945 to 20,145 between 2016 and 2017. (report)
In May of 2017, I released some thoughts on the basics of Carfentantil response in an article of the same name. The intent was to bring the concept into the open as there had been an increase in incidents involving this class of drugs (fentanyls) and very little written about them in the HazMat community. A month later, the DEA published their “Briefing Guide for First Responders” to provide guidance for Police, Fire, EMS, and special operations units on how to handle these incidents. (They are fusion incidents, involving the coordinated efforts of multiple agencies.) Additionally, numerous studies and articles have been written on response and significance of the problem. Debates have stirred on social media regarding various methodologies and opinions on how to handle these incidents, including CPC, detection, and decontamination.
I’ll cover the first two briefly. These drugs are extremely toxic, so CPC selection should be made through risk assessment of the situation. There are numerous recommendations and these are based on the scene findings. Detection has also advanced, nearly to the point where a simple “paper” test will be able to determine the presence (or absence) of these drugs. Both of these are backed not only by relevant application of the technologies but also scientific testing, with appropriate documentation by government and/or third-party labs.
Decontamination however, has been more elusive with several technologies nearly immediately flooding the marketplace this year. Many have found their way to the response units, ultimately to the field personnel relying on these technologies to keep them safe. The purpose here is not to provide names nor any debunking evidence of any of the decontamination technologies, but rather to serve as a discussion point when making decisions about personal safety. One important consideration that is not often raised is the type of fentanyl that is suspected, as there are significant differences between fentanyl citrate (pharmacological version) and fentanyl HCl (illicit version.) We hear the term “fentanyl” and naturally assume that there is only one type, but this isn’t true. Addressing decontamination without taking into consideration the specific type of fentanyl is dangerous to our responders directly (in that it can cause injury) and also indirectly (false sense of protection AND potential for secondary contamination.)
It is unlikely that many (if any) reading this would purchase equipment that has a life-death variable (for example, CPC or instrumentation) without adequate research. The concerning part about fentanyl decontamination right now, is that there is a lot of advertising and marketing, and not a lot of unbiased evaluative data. Why? Business. Arriving first to the marketplace often affords significant advantage to the company that is first. Unfortunately, in this case the cost is potentially personal safety. By no means I am I stating or implying that ANY product on the market is a hoax or doesn’t work, HOWEVER I am saying that there is a product-support mismatch that we ALL need to consider when making purchasing evaluations. Research concepts and then research the validation process and be sure that the solution meets your needs and expectations (does it REALLY do what they say it does.) Also be aware that there are different kinds of synthetic opioids, street and illicit, as well as numerous structures (fentanyl, acrylfentanyl, carfentanil, etc.) that all play a role in the decision-making process for a decontamination method. Be informed. Ask questions. Be sure you are getting what is advertised.
Be safe and be smart.