Fentanyl Exposure Risks for Law Enforcement and Emergency Response Workers

Fentanyl is a powerful synthetic drug that is similar to morphine and heroin, but is 50 to 100 times more potent. Fentanyl and its analogs, such as carfentanil, can pose a potential hazard to law enforcement, emergency medical personnel, and firefighters who could come into contact with these drugs through the course of their work day. While there are important questions about the risks of different types of exposures (and resultant health effects) that might occur during law enforcement and emergency response activities, workers involved in these types of activities leading to potential exposures should take prudent precautions. NIOSH provides interim recommendations for routine law enforcement activities following an arrest or execution of a search warrant—such as evidence collection—that may lead to potential exposures to fentanyl or related compounds.

Exposure routes are likely to vary based on the form of fentanyl and the circumstances of the event. Exposure through the skin, inhalation, and ingestion are all possible routes of exposure. Inhalation exposures can quickly result in respiratory depression. Recent news reports point to law enforcement officers being exposed to fentanyl through skin absorption while on the job. Additional research is needed to better understand the possible routes of exposure and means to prevent those exposures. Fentanyl and its analogs do not have established occupational exposure limits (OELs).

Standard safe work practices must be applied to all operations where fentanyl or its analogs are known or suspected to be present, just as they are applied to any law enforcement operation involving potential narcotics, such as a methamphetamine lab or heroin. Law enforcement officers should not eat, drink, or smoke in the area of the suspected fentanyl and should wash their hands and inspect clothing for contamination after performing any activity potentially involving fentanyl. It is important that a job hazard analysis be performed to determine the most appropriate level and type of personal protective equipment (PPE) to protect against respiratory and dermal hazards for specific tasks. At a minimum, NIOSH recommends the use of a P-100 half-mask filtering facepiece respirator (or higher), gloves, eye protection, and protective clothing to protect against possible fentanyl exposure. In the event of a large spill or release of fentanyl, NIOSH recommends that law enforcement vacate the area and call a hazardous materials incident response team for support.

The U.S. Drug Enforcement Administration (DEA) recommends that law enforcement do not field test drugs if fentanyl is suspected (https://www.dea.gov/divisions/hq/2016/hq061016.shtml). Wearing the appropriate PPE, the suspected substance should be collected and sent to a laboratory for analysis.

Questions remain about the risks of exposures to fentanyl and its analogs. For example do dermal exposures represent a significant health risk for first responders, should an OEL be established for fentanyl, and are there other activities that would benefit from NIOSH providing best work practices?

Would your workplace benefit from a Health Hazard Evaluation specific to the issues surrounding fentanyl? The NIOSH Health Hazard Evaluation Program has previously conducted research on possible workplace hazards and provided recommendations to law enforcement and emergency responders to protect against possible drug-related exposures other than fentanyl. Below are a few examples of evaluations conducted with law enforcement. For more information on the Health Hazard Evaluation program including how to request an evaluation visit the website.

• 2014-0039-3246 Evaluation of Law Enforcement Agents’ Potential Exposures during a Raid of a Clandestine “Spice” Lab
• 2011-0146-3170 Evaluation of Potential Employee Exposures During Crime and Death Investigations at a County Coroner’s Office
• 2010-0017-3133 Evaluation of Police Officers’ Exposures to Chemicals While Working Inside a Drug Vault
• 99-0252-2831 State of Iowa Division of Narcotics Enforcement

We would like to hear from law enforcement and emergency services personnel about the safety procedures and practices that you use when you suspect the presence of fentanyl or carfentanil. Do you have information on the effectiveness of your safety procedures and practices or other issues related to fentanyl that you’d like to share with the broader law enforcement community? Please provide your input in the comment section below and let us know if you’re interested in hearing more about the NIOSH Health Hazard Evaluation Program.

Jennifer Hornsby-Myers, MS, CIH, is a Senior Certified Industrial Hygienist in the NIOSH Emergency Preparedness and Response Office.

Scott Dotson, PhD, CIH is a Lead Health Scientist in the NIOSH Education and Information Division.

Deborah Hornback, MS, is a Health Communication Specialist in the NIOSH Education and Information Division.