How dangerous is fentanyl exposure to first responders, if at all?

BILLERICA — Doubt has been cast on the Billerica Police Department’s recent report to the community that an officer lost consciousness and was hospitalized due to her exposure to fentanyl during an arrest.

Police Chief Roy Frost claims the officer may have unintentionally inhaled the potent opioid when a bag containing the drug was torn open inside a suspect’s vehicle, causing the substance to become airborne within the tight space.

“We are grateful that our officer is expected to make a full recovery, but alarmed that such a small amount of fentanyl caused an officer to lose consciousness,” Frost stated in a press release issued by the department on Thursday.

Though there’s little doubt that illicit fentanyl sold on the street is dangerous when consumed, medical research has shown that experiencing an adverse medical reaction to fentanyl due to a brief exposure to the drug is highly unlikely.

The facts of fentanyl

The National Institutes of Health states fentanyl, a synthetic opioid used in medicine to treat severe pain, is similar to morphine, but 50 to 100 times more potent.

Dr. Nathan MacDonald, an emergency physician and president of medical staff at Lowell General Hospital, said morphine is given to patients in milligram doses, while fentanyl is administered in microgram doses.

“A milligram is like the lead point on a pencil, so as you can imagine, a microgram is 1,000 times less than that,” MacDonald said. “That’s what makes it so dangerous. A small amount can pose a risk.”

According to MacDonald, 2 milligrams of pure fentanyl would be considered a lethal amount.

The Drug Enforcement Administration states fentanyl, which is cheap for illicit drug markets to manufacture and transport, is often mixed with substances like heroin or cocaine as a means to enhance the desired effects of those drugs.

According to the DEA, fentanyl causes relaxation, euphoria, sedation, drowsiness, dizziness, vomiting, unresponsiveness, and pupillary constriction. It also can cause respiratory depression, which can lead to respiratory and cardiac arrest.

NIH stats show synthetic opioids are the No. 1 cause of overdose deaths in the U.S.

“The difference between an amount you would use to get high and an amount to kill you is miniscule,” MacDonald said.

But the harm from ingesting, smoking, snorting or injecting fentanyl does not transfer to emergency responders who might have incidental contact with the drug.

Dr. Balram Sharma, who is the director of acute pain service and regional anesthesia at Lahey Hospital & Medical Center, part of Beth Israel Health, referenced a 2017 joint statement from the American College of Medical Toxicology and American Academy of Clinical Toxicology that states, though fentanyl is potent, “the risk of clinically significant exposure to emergency responders is extremely low.”

The information provided states “inhalation is an exposure route of concern if drug particles are suspended in the air.” However, Sharma pointed out the joint statement references a study that found, “the industrial aerosolized exposure at the highest possible concentration during the manufacture of fentanyl presents very low risk.”

The study says at the highest airborne concentration, an unprotected individual would need to breathe fentanyl for nearly three and a half hours to reach just a therapeutic dose.

According to Sharma, for opioid toxicity to occur, the drug must enter a person’s blood and their brain, and that toxicity will not occur from being in proximity to fentanyl.

If the fentanyl was on an individual’s skin, Sharma said fentanyl can enter the body through a cut or an abrasion, but even then, it presents an extremely low risk of harm.

Sharma added that it’s when the fentanyl comes in contact with a mucous membrane — located in the nose, mouth and eyes — that the risk of harm increases.

Allegations in Billerica

The Billerica Police report states at 3:35 p.m. Wednesday, the officer had conducted a traffic stop of a vehicle with a canceled registration on Webb Brook Road.

During the stop, the report alleges that the vehicle’s operator was seen by the officer “ripping and dumping a bag of heroin, while seated in the driver seat of the vehicle.”

Police said the officer opened the driver’s side door and attempted to get the suspect out of the vehicle to prevent him from destroying the evidence. During the course of the struggle between the pair, police said the bag ripped and the powdered substance became airborne, spreading across the suspect’s hands and throughout the rear quarter panel of the vehicle.

Frost claims this is when the officer inhaled the substance as it clouded within the vehicle.

Police reports state the suspect, 65-year-old Charles Lang, told officers the substance in the bag was “H,” which police said in the report is a slang term for heroin. Frost said the substance tested positive for fentanyl during a field test. He added, however, that the contents of the bag would not be identified with certainty until it’s analyzed at the State Police Crime Lab.

When Lang was in police custody, Frost said the officer returned to the police station, at which point “she immediately reported not feeling well.” According to Frost, the officer in charge “noticed that her eyes began to roll,” and she collapsed.

Frost said he witnessed the officer “unresponsive and vomiting,” before she was taken to a local hospital for evaluation. Police have said Narcan, used to treat opioid overdoses, was not used on the officer.

According to Frost, the officer “spent many hours being tested” at the hospital, but said he would not share the outcome of those tests. When asked if medical professionals at the hospital confirmed his belief that fentanyl exposure caused the officer’s medical reaction, Frost said he was unable to comment.

“I haven’t read the medical reports,” Frost said. “I’m reporting in this press release that my officer was exposed to a substance that is believed to be fentanyl. The officer aspirated this airborne dust and that is what we believe caused the issue.”

Frost conceded that it’s “possible but not probable” that the medical event experienced by the officer was not directly related to her exposure to fentanyl.

“I gave a course of events that a reasonable person could infer that it was the result of her aspirating this substance,” Frost said. “This person was healthy, and then they weren’t.

The Journal of Medical Toxicology released information about a study in 2020 that showed many of the reported fentanyl exposure incidents among police share the symptoms of a panic attack. However, Frost said what his officer experienced was not anxiety-related.

“I made these observations myself,” the chief said. “This wasn’t an anxiety attack, this was a person who was healthy, who inhaled a substance and had a medical reaction. Whether or not it’s possible that her medical reaction was related to something coincidentally that happened contemporaneously with her exposure, that’s always possible, but this person was healthy, very motivated and excited about making an arrest, and then all the sudden was unconscious and unable to respond.

“I’m comfortable about what we said,” he added about the information released to the public. “I’m not looking to create a controversy here. I put it out there because it’s a dangerous job that these people are being exposed to these drugs, and this isn’t an allegation that somebody touched fentanyl and overdosed. That’s not what we’re alleging. And I’m not even alleging that she overdosed.”

Is it possible?

When discussing scenarios related to the information released by police, MacDonald said it’s possible the officer could have experienced a medical event from fentanyl exposure, but not from inhalation of the substance.

“I can’t say with any certainty, because I wasn’t there and I’m not privy to all the details,” he said. “It’s an unlikely scenario that it gets inhaled in from the air, because that powder would settle very quickly on surfaces. I think the likeliest route would be that it could have gotten on the officer and then made its way from her hands, her skin or her clothing into a mucosal surface, like the mouth, the nose or the eyes.”