• 
• 

Three Part Question

Are [emergency responders] with [unintentional skin exposure to fentanyl] at risk for [adverse effects]?

Clinical Scenario

A 40-year-old police officer is exposed to a white powder after apprehending a suspect. He is concerned that he was exposed to fentanyl so he self-dosed with Naloxone and came to the Emergency Department. He is observed for 1 hour and discharged home.

Search Strategy

Medline 1966-07/24 using PubMed, Cochrane Library (2024), and Embase
[occupational exposure (All Fields) AND fentanyl (All Fields)]

Search Outcome

33 papers were found, one recent systematic review was relevant to the study question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Adams A, et al. September 2023 USA	12 observational studies of first responders (N=438) possibly exposed to fentanyl or fentanyl analogs	Systematic review	Any clinical signs/symptoms after dermal fentanyl exposure	27 individuals reported subjective symptoms that were inconsistent with fentanyl effects	Possible publication bias; analytical confirmation was available in only six studies; possible exposure to subtoxic doses of fentanyl; quality of data is poor; there may have been exposure cases that were simply clinically managed in emergency departments and not reported or written as case reports.
			Hospitalization or deaths after fentanyl exposure	None
			Naloxone administration after fentanyl exposure	3 persons, none displayed definitive signs of the opioid toxidrome

Comment(s)

In September of 2016, the US drug enforcement administration (DEA) released a warning in response to several media reports of incidental fentanyl overdose due to second hand exposure by first responders. The warning stated “fentanyl can be absorbed through the skin" and advised that first responders should not touch substances thought to be fentanyl. The American College of Medical Toxicology (ACMT) released a position statement that unintentional fentanyl exposure is highly unlikely and that donning full personal protective equipment leads to delays in treatments of critically ill patients. However, misinformation about overdose risk from accidentally touching fentanyl is widespread among police officers. It is important to encourage evidence-based decision-making among first responders. This includes the ability to rapidly recognize the opioid toxidrome, education on personal protective actions, and training in medical management of individuals experiencing an opioid overdose

Clinical Bottom Line

There is insufficient evidence that unintentional dermal fentanyl exposure leads to overdose or adverse effects. Understanding the risk perceptions and knowledge of first responders regarding fentanyl can help identify training gaps.

References

1. Adams A, Maloy C, Warrick BJ. Does occupational exposure to fentanyl cause illness? A systematic review. Clin Toxicol (Phila). 2023 Sep;61(9):631-638.