ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders

Moss, Michael J.; Warrick, Brandon J.; Nelson, Lewis S.; McKay, Charles; Dubé, Pierre; Gosselin, Sophie; Palmer, R.B.; Stolbach, Andrew

doi:10.1007/s13181-017-0628-2

Cited by 26 publications

(36 citation statements)

References 26 publications

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“…Potential routes of occupational exposure to drugs include inhalation, mucous membrane absorption, ingestion, absorption through the skin, or a combination. Brief skin contact with powdered fentanyl or its analogues is not expected to lead to toxic effects if visible contamination is promptly removed . In these two investigations, all these routes of exposure were possible.…”

Section: Discussionmentioning

confidence: 99%

Health effects from unintentional occupational exposure to opioids among law enforcement officers: Two case investigations

Chiu

Hornsby-Myers

Perio

et al. 2019

American J Industrial Med

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Recent increases in the rate of drug overdose-related deaths, the emergence of potent opioids such as carfentanil, and media reports of incidents have raised concerns about the potential for work-related exposure to a variety of illicit drugs among law enforcement officers (LEOs), other emergency responders, and other workers in the United States. To characterize the risk associated with unintentional occupational exposure to drugs, we retrospectively investigated two incidents that occurred in 2017 and 2018 where LEOs were exposed to opioid and stimulant drugs and experienced health effects. We interviewed five affected LEOs and others. We reviewed records, including emergency department documentation, incident reports, forensic laboratory results, and when available, body camera footage. Multiple drug types, including opioids and nonopioids, were present at each incident. Potential routes of exposure varied among LEOs and were difficult to characterize with certainty. Health effects were not consistent with severe, life-threatening opioid toxicity, but temporarily precluded affected LEOs from performing their essential job duties. While health risks from occupational exposure to drugs during law enforcement activities cannot currently be fully characterized with certainty, steps to prevent such exposures should be implemented now. The creation and implementation of appropriate controls plus education and training are both important to protecting first responders from these hazardous agents. To more fully characterize potential exposures, timely prospective toxicological evaluation of affected responders is recommended.

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Section: Discussionmentioning

confidence: 99%

Health effects from unintentional occupational exposure to opioids among law enforcement officers: Two case investigations

Chiu

Hornsby-Myers

Perio

et al. 2019

American J Industrial Med

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“…This may also be true for carfentanil as animal studies suggest that the relative lethality of carfentanil compared with fentanyl is equivalent. 47 In fact, a recent position statement by the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) suggests that doses of naloxone beyond 10 mg are unlikely to be helpful. 47 Furthermore, 13 lgÁkg -1 of naloxone (equivalent to 1 mg of naloxone administered to an 80 kg male) is sufficient to occupy 50% of brain mu-opioid receptors and is often enough to restore respiratory drive.…”

Section: Management Of Carfentanil Exposurementioning

confidence: 99%

“…47 In fact, a recent position statement by the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology (AACT) suggests that doses of naloxone beyond 10 mg are unlikely to be helpful. 47 Furthermore, 13 lgÁkg -1 of naloxone (equivalent to 1 mg of naloxone administered to an 80 kg male) is sufficient to occupy 50% of brain mu-opioid receptors and is often enough to restore respiratory drive. 48 If the probability of carfentanil exposure is high, a reasonable starting dose is 2 mg iv.…”

Section: Management Of Carfentanil Exposurementioning

confidence: 99%

“…Contact with mucous membranes via inhalation, eye exposure, or oral exposure has a higher risk; nevertheless, the exposure would have to be prolonged and the dose significant to cause an overdose. 47 Basic level personal protective equipment (PPE) most commonly consists of nitrile gloves, safety glasses, N95 mask, disposable paper suit or coveralls, and shoe covers. 52 Depending on the potential degree of exposure, level A, B, or C PPE consisting of full chemical resistant suits and a respirator or breathing apparatus can be worn.…”

Section: Provider Safetymentioning

confidence: 99%

“…52,53 The ACMT and AACT state that nitrile gloves and an N95 respirator provide sufficient protection for potential dermal and respiratory exposures. 47 Further emphasis is placed on training workers to recognize opioid intoxication and a ready access to naloxone, including the ability to administer it if there are clear objective signs of hypoventilation or a depressed level of consciousness. These are consistent with DEA 52 and National Institute for Occupational Safety and Health 53 recommendations for first responders, which include maintenance of an individual basic PPE kit that also includes a naloxone injector(s).…”

Section: Provider Safetymentioning

confidence: 99%

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