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

Abstract

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.

Evaluation of health symptoms after a law enforcement operation.

“…After a multiagency operation, Agency officials became concerned because a large proportion of LEOs who participated became ill over the course of several days. The types of symptoms and the timing of symptom onset were not consistent with symptoms reported after illicit drug exposure in other recent HHEs [Chiu et al 2019] or symptoms reported from exposures to other substances identified in the residence. While almost one third of symptomatic LEOs met the case definition for influenza-like illness, the group of symptomatic LEOs most likely had more than one type of illness.…”

Media Reports of Unintentional Opioid Exposure of Public Safety First Responders in North America

“…The consensus of the scientific community remains that illness from unintentional exposures is extremely unlikely, because opioids are not efficiently absorbed through the skin and are unlikely to be carried in the air [8]. In a rare case report of law enforcement officer opioid exposure in a peer-reviewed literature, clinical manifestations were not consistent with opioids, and none of the law enforcement officers tested was positive for opioid metabolites [9]. In other words, the phenomenon of first responder opioid exposure that seemed to be frequently reported in news media has not been confirmed scientifically.…”

Development of Novel Video-Based First Responder Opioid Hazard Refresher Training

“…9 With each encounter, the lives of first responders are put at risk, as exposure is a serious threat that requires training to ensure that personnel are protected. 10,11 In addition, guidance for first responders during the COVID-19 pandemic may conflict or complicate guidelines for responding to opioid exposure incidents. For example, although the use of hand sanitizer is recommended as a countermeasure against SARS-CoV-2, it is not recommended when opioids may be present, as it can increase the absorption of opioids through the skin.…”