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Summary of U.S. Department of Justice, Drug Enforcement Administration publication, “Fentanyl, A Briefing Guide for First Responders.”

In response to the threat of fentanyl to law enforcement and other first responders, the Drug Enforcement Administration (DEA) published a briefing guide for first responders in 2017.

The DEA’s briefing guide contains information on the following topics:

  1. Personnel Protective Equipment

  2. General Safety

  3. Incident Response

  4. Routine Activity

  5. Drug Related Evidence Collection

  6. Non-Drug Related Evidence Collection

  7. Packaging of Drug Evidence

  8. Exposure Risks and Treatment

  9. Fentanyl Detection

  10. Remediation and Decontamination 

General information on fentanyl and several safety points covered in the briefing guide are summarized below.

Fentanyl

Fentanyl is a synthetic opioid which mimics the effects of morphine. Fentanyl as used in this communication includes related substances such as carfentanil, furanyl, and other synthetic opioids.

Illicit forms are both imported and clandestinely manufactured. 

  1. Used as an adulterant in other controlled substances such as heroin, cocaine and methamphetamine.

  2. Used in counterfeit pharmaceutical pills or capsules such as oxycodone, hydrocodone and alprazolam.

Forms include/identified in or on:

  1. Powder 

  2. Pill

  3. Capsule

  4. Liquid

  5. Blotter Paper

Fentanyl could also be mixed with other drugs or concealed in nasal spray or eye dropper bottles. Fentanyl can be ingested, inhaled through the nose or mouth, or absorbed through the skin or eyes. Even a small amount of fentanyl exposure (2-3 milligrams) can lead to significant health-related complications, respiratory depression, or death.

Personnel Protective Equipment (PPE)

Individual PPE Kits

If the presence of fentanyl is suspected, personnel should follow their hazardous materials protocol. Law enforcement personnel and other first responders should NOT take samples or otherwise disturb any powdered substances. An Individual PPE Kit consists of: Nitrile Gloves Safety goggles/glasses N-95 dust mask Paper coveralls-shoe covers Naloxone (Narcan)

More detailed PPE recommendations for protection against fentanyl can be found at: CDC/NIOSH

Respirator Notes: 

  1. NIOSH recommends a more protective respirator, a P100 respirator, whereas DEA lists a N-95.

  2. Facial hair that interferes with the respirator sealing surface or valves is prohibited.

  3. A respiratory protection program which includes medical clearance and fit-testing is required in order to wear any of the respirators listed.

  4. Assistance in establishing a respiratory protection program can be obtained from DSPSSBSafetyAndHealthTech@Wisconsin.gov.

Glove Notes:

  1. Nitrile gloves should have a minimum thickness of 5 mil (0.127 nm).

  2. Gloves should be replaced after 30-50 minutes of use or when exiting the processing location.

  3. Double gloving is recommended. 

    1. If sleeve cuffs are worn, they should be placed under the inner glove, while the outer gloves should be worn over the sleeve cuff.

    2. Consider using two different color gloves.

  4. Powder may show up better on a darker color glove.

  5. Two colors can help visualize outer glove holes or tears.

  6. Immediately wash hands with soap and water after properly disposing of gloves o Do NOT use hand sanitizer as a substitute for washing with soap and water.

  7. Hand sanitizers may contain alcohol, which may increase the absorption of fentanyl through the skin.

General Safety

At this time, the DEA is advising against first responders’ field testing suspected fentanyl substances. The briefing guide indicates that agencies can contact their nearest DEA field office or HAZMAT incident response team for assistance if fentanyl is suspected of being present.

  1.  At a minimum, Individual PPE Kits as referenced above should be utilized if any fentanyl indicators such as powders, pills or capsules are observed during motor vehicle stops or responding to service calls.

  2. As previously noted, hand sanitizers should not be used as a substitute for hand washing. Hand sanitizers may contain alcohol, which may increase the absorption of fentanyl through the skin.

  3. Personnel should refrain from eating, drinking, or smoking while in the presence of any suspected fentanyl-related substance.

  4. Hazmat protocols should be implemented in situations involving unknown powdered substances and/or pill milling or encapsulating operations.

Incidents of Overdose and Death

  1. At a minimum, Individual PPE Kits should be utilized at a scene where there has been a suspected overdose incident or death. 

  2. Personnel should look for any loose powders, nasal spray bottles or opened mail/shipping materials located at the scene. China-based organizations have utilized conventional and commercial means to ship fentanyl.

  3. Be mindful of clusters of overdoses or overdose deaths occurring within a small geographical area within a 48-72 hour period.

This summary only highlights some of the safety related information contained in the DEA’s briefing guide. Drug related evidence collection and packaging information can be found on pages 12-15 of the guide. Non-drug related evidence collection is covered on pages 13 and 14 of the guide. Law enforcement and other first responders are encouraged to consult the briefing guide for additional information.

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