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Police officers hospitalized after incidental exposure to fentanyl. A Florida child fatally overdosed. In communities around the country, such headlines are stoking fears that a momentary brush with a tiny amount of fentanyl powder could prove fatal.

The synthetic opioid, blamed for increasing numbers of overdose deaths across the U.S., is 50 to 100 times more potent than morphine. But experts consulted by STAT said many of the reported incidents appear to be false alarms that run counter to scientific fact and exaggerate the risks.

The American College of Medical Toxicology recently issued a position paper concluding that, based on what’s been publicly released, none of the recent incidents involving first responders is consistent with opioid toxicity. The doctors, who reviewed a handful of cases, said they are not challenging the truthfulness of the officers involved. Rather, they are questioning whether their reports are verified cases of poisonings that carry the hallmarks of opioid exposure.


“A lot of the symptoms are nondescript, such as vague dizziness, that don’t concern opioid poisoning,” said Dr. Andrew Stolbach, a physician at Johns Hopkins Medical Center and lead author of the paper. “And in a lot of the cases, the way that they were exposed doesn’t make sense, like brushing a small amount of powder off a uniform.”

While most of the reports have involved first responders, some have involved young children, including the fatal overdose of a 10-year-old Florida boy who was found to have a mixture of heroin and fentanyl in his body. How he came in contact with opioids remains unknown, although authorities have raised the possibility that he encountered it at a community pool or walking through a neighborhood known to be a hotbed of opioid trafficking.


Establishing the truth in these cases is not just a matter of setting the record straight, but of preventing hysteria and ensuring public safety. While accidental exposure to opioids can take lives, so can undue fear of the risks. For first responders, taking extra precautions could delay lifesaving care for people suffering overdoses and distract from more pressing threats, such as a suspect at a crime scene.

“We want to prevent unintended consequences,” said Dr. Diane Calello, medical director of the New Jersey Poison Information and Education System. “If a law enforcement professional is wearing a lot of unnecessary protective gear in a situation that requires an agile response, that in and of itself is a safety issue.”

Conversely, failing to take proper precautions could also result in harm. So what’s the right balance?

STAT spoke to several toxicologists and law enforcement officials to examine the underlying science of fentanyl exposure and the extent of the risk it poses to first responders and the public.

Can fentanyl poison officers and others through incidental skin contact?

In several incidents, officers have reportedly fallen ill after a powdered form of fentanyl came in contact with their skin or clothing.

Although ingesting a pinch of fentanyl powder can be fatal, several toxicologists said contact with intact skin is extremely unlikely to cause opioid toxicity, which can occur only if the substance enters the bloodstream.

“If you have fentanyl powder on your hand for five or 10 minutes, it’s inconceivable that that would be sufficient to cause you to have an overdose,” said Dr. David Juurlink, a toxicologist at the University of Toronto.

Fentanyl cannot penetrate the skin on its own. It needs moisture. That’s why, in clinical care, patients are given fentanyl patches to aid in absorption and relieve pain. The position paper by the American College of Medical Toxicology reported that, even if a large area of the body were covered with fentanyl patches, it would take 14 minutes to transmit a therapeutic dose of 100 micrograms, let alone an overdose.

“For the fentanyl patch to work, you have to put a lot of fentanyl in the patch. It has to be moist and it has to be in contact with the skin for a long period of time, in a special liquid,” said Stolbach. “Those aren’t the conditions that are going to occur when somebody is incidentally exposed.”

One of the most widely reported incidental overdoses occurred in East Liverpool, Ohio, where officer Chris Green became ill following a traffic stop involving drugs. Green has recovered and returned to work.

The city’s police chief, John Lane, said he believes Green’s illness resulted from opioid exposure, regardless of the questions raised by toxicologists. Lane said a screening test confirmed that Green had opioids in his body, but the exact method of exposure remains unclear.

He said Green collapsed moments after he brushed a small amount of powder off his shirt at the police station, after the traffic stop was over.

“We don’t know if he brushed it off with his hand or rubbed his eye,” Lane said. “We think what may have happened is that he put on that Purel or Germ-X stuff, and that got it wet and maybe he absorbed it that way. We’re not sure. All we know is he overdosed from it.”

The medical toxicologists group specifically warns that alcohol-based hand sanitizers should never be used, because they are ineffective in removing fentanyl and may increase drug absorption. The organization said officers should take basic precautions to prevent the remote risk of poisoning through skin contact, such as wearing nitrile gloves and immediately washing with copious amounts of water if contact does occur.

Can inhaling fentanyl cause an overdose?

Toxicologists said the possibility of accidental inhalation presents a higher risk, especially in poorly ventilated spaces where public safety officials suspect fentanyl is dispersed in the air.

Calello said inhaling fentanyl — or ingesting it — puts it in contact with mucous membranes in the nose or mouth, providing the drug a way into the bloodstream, which can result in poisoning.

She added, however, that such circumstances are unlikely to arise during a traffic stop or in other open-air environments. “Handling an overdose victim is not going to entail a plume of aerosolized drug,” Calello said.

It would take prolonged exposure to a large amount of airborne fentanyl to cause an overdose, according to the medical toxicologists. Their report references safety standards for industrial workers who manufacture fentanyl. “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,” the report states. (100 mcg, or micrograms, is enough to have a therapeutic effect but not enough to cause an overdose.)

“We would expect in an industrial fentanyl production plant there’s going to be more fentanyl in the air than there would be at any crime scene,” Hopkins’s Stolbach said.

Still, in cases where first responders suspect a high concentration of airborne opioids, the medical toxicologists group recommends that officers use a respirator, in addition to wearing water-resistant coveralls to block skin exposure.

Why are so many officers falling ill if the risks of poisoning are so low?

Toxicologists said officers may indeed be getting sick following exposure to fentanyl or other substances, but that does not necessarily mean the drugs are the cause.

The only way to confirm a case of poisoning is to conduct a urine or blood test, or to verify that symptoms were reversed by a dose of naloxone. But such evidence is lacking in many of the cases reported around the country.

“The common theme is that there is no biochemical confirmation,” Stolbach said. In most cases, the media is reporting that officers are being hospitalized, but hospitalization may just be a precaution.

Juurlink said the real culprit in these cases may be a phenomenon known as the nocebo effect, in which the mere suggestion that a substance can be harmful causes people to suffer negative effects after exposure. In medical research, for example, being informed of side effects related to a pill or procedure can bring on real-life symptoms.

“If in a moment of panic, a person sees powder on their skin and they’ve read reports on the internet about people having overdosed, you could see how that might cause someone to at least believe they’ve had an overdose,” Juurlink said.

Indeed, some of the symptoms reportedly suffered by public safety officers, such as a racing heart, dizziness, and anxiety, are more consistent with panic than opioid poisoning. “If anything, people with opioid poisoning would have a slow heart rate,” Stolbach said.

Toxicologists said law enforcement officials should be trained to recognize the objective symptoms of opioid poisoning so they can deliver the opioid antidote naloxone when appropriate. Those symptoms would take hold within a few minutes of exposure. A person would become sleepy and lethargic and start breathing at an abnormally slow rate.

“That’s the typical progression,” Calello said. “From awake to sleepy, to asleep, to unconscious. The things that have been described in the news really are not what we typically see with patients who get opioids.”

  • Let’s say someone had two beers which mean alcohol was in there system. Another person inside a restroom in a room has been smoking fentanyl all night. Would that cause someone to overdose and die? PLEASE I need help figuring this out my friend just passed away and I need answers as to what killed him.

  • Hello I just wanted to say that the Ohio officer that overdosed from a mystery exposure to fentanyl was actually using street fentanyl that he stole while arresting a dealer that had kilos of the stuff. The officer ODed because he actually did too much. He supposedly stole a good amount and got addicted.. Just though you should know.

  • Excellent article. It’s about time someone published or has written about this. The shit going on in this country is absolutely sickening. Everyone has to blame someone or something on something or someone else. Everything is harmful and killing people, everything is exaggerated and blow up way out of proportion, people are soft and weak in this day and age because they are raised and taught to be pussies. Pussies raising pussies. People need to grow up, man up . I’m 53 years old now grew up in the 70’s, early 80’s and loved it. Jumping box bikes, without a helmet,
    skateboarding, roller skating, drinking out of a house, eating dirt as a little kid, etc, etc. And P.S. I’m am still alive!! Did acid, mushrooms, coke, weed, heroin, etc. And a lot of it! So please spare me the BS speech that someone is dropping dead because they pulled someone over and that person had heroin in their car that was cut with fentanyl. Pure BS. The government and media and liberals don’t live in the real world . They all live in this fantasy world where words, history , statues,
    holidays, Christmas songs and good old fashion honesty are offensive and have no place in our country.

  • i keep reading how law enforcement have a reaction to the exposure of fentynal powder. is the reaction the same for when they are exposed the actual hardened pill or pills? or if lets say a cop or anyone for that matter.. a mom about to clean her kids clothes and finds one hardened pill not crushed or broken. a complete pill, will she be at risk of overdose? or having the pill enter the skin of her hand??? is the reaction or risk the same regarding the hard vs. the loose powder exposure?

  • Hello I work in law enforcement and was told if this drug contacted my skin I would be dead in 10 seconds

    • So I would love to know where you work that ur higher ups are spewing this garbage out. Teaching something so far from the truth, I would hate it ifwhat else they are teaching horribly. Like when to fire your weapon. We trust u people to protect and serve and it seems really u guys are a bunch of chatty cathy’s, gossiping on donut breaks and not even bothering to check what ur teaching is correct.

    • I gotta laugh next to buddy as well. Fentynal is a drug… an opiate… and is a type of powder either loose or pressed that ppl either injest. .. sniff up nose or slam it IV style, needle to the vien. …

      fentynal is not a corrosive poison!! If u work in law enforcement then u must have been near or heard of plenty stories or even witnessed the epidemic happening of those losing their lives to this drug… and have a general and what I would think to be a positive and correct insight on how this drug was entered into the body causing death by overdose.

      U gotta ask yerself…. have u ever heard of any one victim to succumb to death from a 10 second physical contact with the substance (fentynal)

      It’s wrong and could be potentially dangerous depending on exactly what incorrect information u are sharing to the public. But Mr. Or Mrs. Claiming to be within law enforcement…

      Cmon now, u know better bud

  • Obviously they haven’t done what was needed to test ( not urine or blood) but hair to eliminate possible drug abuse of the Law enforcement Officer.
    Our tax paid servants are human and can and have addictions. That test would eliminate the abuse that might have ended the issue. Although it would open Pandora’s Box.

  • Has there been any follow up reporting and research in the case of the three nurses in Massillon, Ohio, who had become unconscious and given Narcan for suspected exposure to Fentanyl? This incident took place in the ER of Affinity Medical Center.

    • Powder form must be on skin for quite awhile before enough is absorbed to be felt. When making half grams or gram packages of cocaine it took an hour before hands went numb.

  • This is ridiculous you can not get even near light headed handing this pure form in small doses or large doses unless you hold it to your Nose and breath the in or cut yourself open and rub it in (minor effects) or ingesting it again minor relative to IV. Those that think differently read the news too much. Handling doesn’t even touch the requirements for the drug to be potent and active. It’s not anthrax it’s a drug powder and metabolic pathways via ingestion or intravenous use are the only ways for the compound to enter he blood stream in doses significant enough to provide analgesic effects regardless of purity and strength.

    • It isn’t fentanyl per se, but various fentanyl analogues whose dosage and effects in humans have barely been studied scientifically. These analogues are often sourced from overseas vendors whose quality control and concern for human safety is dubious at best. Some of these analogues are indeed powerful enough to cause acute symptoms from skin contact with quantities a first responder might otherwise be tempted to shrug off as inconsequential. Some are strong enough to cause symptoms from inhalation of minute amount of stray powder disturbed by, say, opening a ziplock bag.

    • Even if they have been drinking and someone in the room has been smoking all night and the person that drank is asleep can that cause any harm..

  • With all due respect, what these alleged ‘experts’ fail to mention is that it is not fentanyl but instead CARfentanil, a synthetic analogue of fentayl which is quite a measure more potent on the order of 10x or more. This is why it is used as a big game tranquilizer. Contact with this agent would certainly be potent enough to cause a toxic level in these individuals precipitating an OD.

    • Wikipedia says that some fentanyl analogs are as much as 10,000 times more potent than morphine. How can amateurs dilute such a potent drug? I suspect that many of the overdose deaths are caused by inadequate dispersal and mixing of the drug in the cut (excipients). Just one lump the size of the period at the end of a sentence would be enough for an overdose.

  • With all due respect to Pharmalot, these “experts” fail to provide one scintilla of evidence to suport their positions. They leave out one of the most important factors in toxicology, body weight. A 110 lb paramedic will react a lot more severly to incidental exposure than a 250 lb cop. And for the record you CAN kill yourself by covering yourself with fentanyl patches. It’s a well known and quite effective means of suicide within the terminal cancer community. When a family friend, reduced to 75 lbs from Stage 4 cancer coverered her self with patches, the dose was more than “therapeutic”. These so called experts illustrate the axiom that opinions are like a**holes; everyone’s got one.

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