Can You Overdose From Touching Fentanyl?
NO!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711758/
Cool. Now that we've dispelled this rumor let's dive in a bit deeper. I'm sure at one point or another you've experienced overdose training. I am also sure that during one of these trainings, usually in a crowded training room that smells of chicken wings and okay pizza, you have been told that you need to be careful on overdose calls, because touching fentanyl will cause you to overdose. As a new EMT, this was something I was taught and was basically gospel to all the first responders in my community. This is wrong information. Let me be clear, you cannot overdose from simply touching powdered fentanyl.
Fentanyl is scary. It's potent, powerful, and available. Fentanyl is the Aliens to Heroin's Alien. One of those bastards was a handful and killed a shit-ton of people, imagine what more of them could do. Sci-fi movie analogies aside, fentanyl is much more common today than when I first started in EMS. For those not in the know, fentanyl is an opiate, the same as heroin or oxycodone. What sets fentanyl apart is its potency. Heroin and fentanyl have different molecular structures. They both "hug" the opiate receptors in your brain. Unfortunately, Fentanyl is quite the hugger and requires more naloxone than usual to "kick" them off those receptors. Put simply, it takes less fentanyl to cause an opiate overdose than heroin.
"But Ryan!" You may scream into the void from behind your keyboard. "I watched this cool bodycam footage where some police officers got powdered fentanyl on them and overdoses. They even narcaned them!" (Looking at you San Diego Sheriffs.) Well for starters I would ask you to put on your cynicism caps. How many calls have you been on where a police officer has pushed Narcan on a non-overdosing patient? I would wager a penny that this has happened to you at least once. My point is, police officers aren't the greatest at recognizing if a patient is overdosing and are, quite frankly, a bit jumpy on the Narcan. I'm not saying this is necessarily a bad thing, countless lives have no doubt been saved by police officers pushing Narcan before EMS arrival. However the point still stands, cops like to push this stuff, and are trained to push this stuff, often.
What I believe happened from watching the body camera footage, is that the officers on scene came into contact with some powdered substance. Due to their training, they recognized that this substance could indeed be fentanyl, leading to one officer believing he may have ingested some of it. I think this caused a panic attack to occur, resulting in his eventual narcanning. This is just my personal opinion. What is not my personal opinion are the joint statements listed above from our friends over at the American College of Medical Toxicology (ACMT) and the American Academy of Clinical Toxicology (AACT.) In short, they state that "fentanyl and its analogs are potent opioid receptor agonists, but the risk of clinically significant exposure to emergency responders is extremely low." Fun stuff!
As a career field, we have a long way to go in terms of overdose education. Make no mistake, fentanyl is deadly. Overdosing can and will kill you, but it doesn't happen by chance. Be careful out there, ventilate your OD patients and remember, touching fentanyl will not cause you to overdose!