Four years ago, three police officers were dispatched to a 911 call from a hotel in Fredericksburg, Virginia for a potential overdose.
When they arrived, they said they saw syringes, electronic scales, loose white and tan powders, and claimed they heard a person in the bathroom flushing the toilet repeatedly. There was, in fact, no overdose victim in the room, but one person showed signs of drug intoxication.
However, after arriving, all three officers -- and one more who handled materials from the scene back at headquarters -- reported symptoms of drug exposure, including dizziness and difficulty breathing. Fellow officers said at least one of the officers was experiencing signs of an overdose after being in the presence of the suspected drugs, including fentanyl, according to on the website of CDC's National Institute for Occupational Safety and Health (NIOSH).
The problem? Many experts say that this was likely not an overdose at all, and that symptoms weren't due to fentanyl exposure. They also charge that it misrepresents the risk of toxic exposure from fentanyl for officers on the job.
"No one has explained exactly what's happened in that video, it's all conjecture," said Brandon del Pozo, PhD, a drug policy and public health researcher at Brown University and former police chief. "It is surprising to see something with such a basis in conjecture being presented by an agency that has a commitment to science."
The NIOSH video provides little evidence confirming how these officers were exposed to the drugs, and no real explanation of the health effects that it aims to prevent, experts told 鶹ý. Drug researchers and scientists say that the video inflates law enforcement officers' risk of overdose, incites fear within the police force, and ultimately, causes harm to people who use drugs.
A History of Misinformation
Fentanyl, which has been implicated in the majority of recent overdose deaths in the U.S., is approximately 50 times more potent than heroin and 100 times more potent than morphine. The synthetic opioid was responsible for around , according to CDC data.
Over the years, the media has covered reports where law enforcement or members of the public said they overdosed or experienced health issues after fentanyl came in contact with their skin or clothing.
Additionally, the Drug Enforcement Administration (DEA) issued a warning to police officers in 2016 that "fentanyl exposure kills." The agency cited the risk of overdose by skin absorption -- a path of exposure that scientists have deemed impossible. It has since removed this notice from its website.
"It's so laughingly wrong, that it's kind of scary," said Jon Zibbell, PhD, a public health analyst at RTI International in North Carolina. "Think about how many overdoses we would have if every dealer that ever touched it or every user that touched it overdosed."
A from the American College of Medical Toxicology (ACMT) and the American Academy of Clinical Toxicology (AACT) published in 2017 stated that "fentanyl and its analogs are potent opioid receptor agonists, but the risk of clinically significant exposure to emergency responders is extremely low."
The organizations added that, "to date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids."
Likelihood of Overdose in NIOSH Video "Slim"
NIOSH stated in the video that potential routes of exposure for illicit drugs including fentanyl are through the eyes, nose, or mouth, as well as inhalation.
The officers in Fredericksburg protected themselves against these potential routes of exposure during the arrest, wearing goggles, gloves, and P100 respirators. But between 25 and 90 minutes after they entered the hotel room, the officers began experiencing symptoms.
One of the officers in the video developed dizziness and blurry vision. "At this point, I think he is overdosing," another officer said in the video. The officer slumped down in the hallway, and his partner administered naloxone while they waited for medical personnel.
Asked to comment on the evidence for exposure and overdose in the video, Stephanie Stevens, a spokesperson for NIOSH, told 鶹ý in an email that she could not answer specific questions about the individuals involved in this incident because the agency is unable to give out personal health information. However, Stevens noted that the CDC conducted of the incident, which included medical reports for the officers involved.
The officers' symptoms included blurry vision, dizziness, a feeling of warmth, weakness, and feeling "drunk," the CDC report stated. The report also stated that the potential route of exposure for all officers was unclear.
"None of the evidence in the report supports the idea that officers were exposed to fentanyl," del Pozo said. He noted that the urine screens – which came back negative for all substances – suggest that fentanyl exposure is highly unlikely.
Ryan Marino, MD, an emergency physician who specializes in medical toxicology at University Hospitals in Cleveland, stated that as published in the ACMT/AACT statement, "nonspecific symptoms like lightheadedness, dizziness, tingling, etc., are not symptoms of opioid exposure or toxicity, and specifically would not be expected from fentanyl."
The inconclusive results about the route of exposure in this incident also makes the situation less clear, the experts said. While fentanyl exposure is possible through mucous membrane contact or inhalation, Zibbell said, these exposure pathways are unlikely to cause toxic effects for law enforcement officers if they take appropriate precautions, such as wearing gloves and not touching their face.
The amount of a drug that causes an overdose will differ from person to person, Zibbell said. It is plausible that a police officer who touched the drug could then rub their eyes, nose, or mouth and expose themselves to fentanyl. But in situations where emergency responders or even researchers are exposed to fentanyl, the evidence that these exposures are low-risk is overwhelming, he added.
"If you take the proper precautions, fentanyl is not dangerous," Zibbell said. "It is a controllable situation."
Inhalation is also highly unlikely, as fentanyl and other similar synthetic drugs do not aerosolize easily, Marino said. "You'd literally have to be blowing the powder into the air, which again, just isn't something that would happen, and wouldn't happen in sufficient quantities."
The ACMT/AACT statement said that at the "highest airborne concentration encountered by workers, an unprotected individual would require nearly 200 minutes of exposure to reach a dose of 100 mcg of fentanyl."
In the unlikely event of an exposure, the organizations said that naloxone should be administered to those with "objective signs of hypoventilation or a depressed level of consciousness, and not for vague concerns such as dizziness or anxiety."
Misinfo May "Chill" Overdose Response
It is not impossible for law enforcement officers to come into contact with illicit drugs such as fentanyl on the job, experts said. However, overstating the risk is likely to result in a culture of fear that prohibits police officers from effectively doing their jobs, del Pozo stated.
"It stresses officers out," del Pozo said. "It gives them an outsized sense of risk, it stigmatizes people who possess drugs, and it chills overdose response."
Del Pozo added that officers believe they are at risk of overdose because trusted voices – including NIOSH, the DEA, the Department of Justice, police associations, and others – have communicated this information to them.
"Officers aren't crazy, they are reacting to information they have received from very credible sources," he added. "They have a very human reaction and think they have an overdose."
The information portrayed in the NIOSH video may contribute to that culture of fear, and could cause a psychosomatic reaction among officers in stressful situations involving illicit drugs, experts said. Zibbell said it's critical to give law enforcement officers accurate knowledge so that they can control a situation.
"This information does the opposite," he said.
"Instead of giving them the power to control a situation, this says you have no control. Fentanyl is like the boogeyman, it's ubiquitous, it's everywhere. It'll creep in your mask, and there's nothing you can do," Zibbell said. "It couldn't be further from the truth."