Since everyone on the Internet has been talking about the cop who claims to have been exposed to Fentanyl, I think it’s appropriate to talk about it. I think it’s a bullshit story. We give Fentanyl in the ED all of the time. We have patients who use it all of the time. I had one patient who was chewing on her Fentanyl patches. She didn’t overdose. Let’s talk about this story:

  1. Fentanyl isn’t readily absorbed through intact skin. Yes, there are Fentanyl patches, but they are specially formulated and take a long time to absorb. Think about it: if it were that easy to overdose on it, the drug dealers would be dropping from it before they could sell it.
  2. From the American College of Medical Toxicology (ACMT) and American Academy of Clinical Toxicology(AACT): “the risk of clinically significant exposure to emergency responders is extremely low. To date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids...Industrial producers of fentanyl use time-weighted average occupational exposure limits (OEL-TWA) for alfentanil (1mcg/m3), fentanyl (0.1 mcg/m3), and sufentanil (0.032 mcg/m3) to limit exposure. 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 vapor pressure of fentanyl is very low (4.6 x 10-6Pa) suggesting that evaporation of standing product into a gaseous phase is not a practical concern
  3. In fact, there has never been a case of LEO opioid overdose that has been confirmed by toxicology.
  4. I watched the video. The symptoms that she is exhibiting are not consistent with opioid overdose. Her respirations are rapid and shallow, and her pupils are far too large for opioids. Nearly every viral story that I have seen is the same. Looks more like anxiety than it does opioids: Dizziness, feels like dying, racing heart, nausea. Look at the pupils.

In opioid overdoses, the pupils look more like this:

Look, I am not hating on the cops here. It’s just that they aren’t trained very well in this. Ever since they began giving Narcan to the cops to carry around, they give it all the time to almost everyone, even people who don’t need it. The cops got a short lecture on naloxone, less than 2 hours of training in some cases, then were turned loose. Now there are tons of companies making money selling “Fentanyl proof” gloves, and the legend grows with every viral, unsupported video.

The odd part is that multiple doctors have stopped in to the local news channel to report that this video looks nothing like an opiate overdose, but the news channel keeps deleting their comments. I wonder why.

Categories: Uncategorized


BobF · December 17, 2022 at 6:26 am

Why? My first guess is that to allow knowledgeable outside comments to stand at the news channels would be akin to admitting that their facts be damned sensationalist scoop storytelling that they hope to pass off as reporting would be wrong. Now, we can’t have “wrong” in news reporting, can we?

But then I figured it was a rhetorical question all along. Heh.

mike · December 17, 2022 at 8:10 am

What do you think it is DM, some other drug or medical condition or a staged incident?

    mike · December 17, 2022 at 8:12 am

    Re-read your post, I see you ascribe it as possibly anxiety.

Grumpy51 · December 17, 2022 at 8:21 am

Anecdotal evidence (aka hearsay) is one of the toughest modes to refute……because most know that Aunt Jenny’s 3rd boyfriend’s cousin had it happen to him/her. Good info, thanks

E M Johnson · December 17, 2022 at 8:43 am

the cops have earned the hate. Bet $$ that cop will file multiple claims including work comp, fmla, and angle for early retirement/disability.

joe · December 17, 2022 at 10:10 am

never had any training on it other then it’s “dangerous”… sounds like it’s more fake news to gin up support for the war on drugs that doesn’t do shit but make certain people rich because it doesn’t do anything to slow the drugs down coming here…

Clown Horns of Jericho · December 17, 2022 at 11:09 am

Brandon’s Yenan way paymasters have to dump it off somewhere.

Aesop · December 17, 2022 at 12:42 pm

1) I can count the actual total of fentanyl overdoses in the U.S. annually on my thumbs, or very nearly.
a) It’s strictly controlled
b) it’s pharmaceutical grade
c) it’s extremely short-acting
2) The pharmaceuticals (and I use that term loosely) encountered by LEOs, if this even was an opioid OD, are mostly all carfentanil, which is
a) garage-brewed and smuggled in, or
b) components smuggled in, and garage-brewed in the US
c) originally designed as rhino tranquilizer (yes, really)
d) the LD50 for which (i.e. the dosage that will kill half the people ingesting that much) is the size of three grains of table salt
e) powderized carfentanil in dusty dope-cutting rooms, plus sweaty skin, gets skin absorption with little additional effort
3) Cut a batch of dope too rich with carfentanil, which has the equivalent lethality of GA/GB/VX nerve gas, and you get people who’re dead before they know it, with the hype needles still stuck in their arms, and whom a gallon of IV Narcan in a drip wouldn’t work fast enough to save.

4) That’s the stuff first responders get dosed with, when they’re actually dosed with anything, and most of what keeps killing junkies with hot batches.
a) This is a feature, not a bug, where junkies are concerned
b) banning Narcan would essentially solve the “opiate epidemic” in about the same way the guillotine solved the French reactionary royalist problem starting around 1789.

5) DM’s analysis looks solid: opiate OD features pupils that look like two pissholes in the snow, not cat eyes. That was vapor lock, not opiate exposure.
So probably BS. Otherwise you probably would have had multiple officers taken out, not just one.

6) That the media knows Jack and Shit about carfentanil versus fentanyl, and even less about the common signs and symptoms of actual opiate overdose, tells you everything you need to know about their credibility on this, or anything else medical, since ever, inclusive. Have we forgotten the lessons of the recent Covidiocy already?

Elrod · December 17, 2022 at 12:55 pm

Psychosomatic, perhaps? She has been told, probably repeatedly, how bad/deadly/incapacitating/etc fentanyl is, so the brain (what there is of it) decided to respond appropriately to stimuli.

OK, she got Narcan, which did “something” to revive here, but what’s the actual chemical analysis on the chemical she handled and at what level of potency?

(Sorry, I realize we’re not supposed to ask about any of that. never mind).

DM, what’s the possibility of overdosing on Narcan? What are the side effects from 3 doses?

    WallPhone · December 18, 2022 at 9:03 am

    I’ve also seen other medical professionals pointing out appearance of panic attack instead of overdose.

    What I don’t yet underhand physiologically–if the panic is literally caused by placebo effect, why do some cases take multiple doses of narcan “placebo antidote” before recovery?

    Perhaps the panic is just extended in a narrow zone, enough oxygen to continue panic breathing, but not enough to percieve aid. Any less oxygen and unconsciousness restores normal brain stem breathing.

    Vlad · December 19, 2022 at 12:40 am

    Even excess doses of narcan don’t do much of anything unless someone is addicted to opiates. 3 doses to a non-opiate addict isn’t shit.
    (Why you would give 3 without obvious signs and symptoms is beyond me)

    Abrupt withdrawal symptoms from the opiates can be BAD but using narcan on someone who ODs on say, Xanax won’t do squat.
    I’ve given only God knows how many doses of Narcan.
    Balancing “you’re not breathing” vs “you *might* go into brief withdrawals” is a no brainer. Its getting pushed.
    In about 20 minutes they’ll be high again/coming out of withdrawal as the naloxone wears off. Opiates last longer than narcan does.

    Aesop · December 19, 2022 at 1:08 pm

    Narcan only blocks reception of opioids.
    You can’t OD on it.
    Three doses with no opiates on board means, effectively, nothing would happen.
    All the side effects are related to actual opiate users.

billo · December 17, 2022 at 1:01 pm

There’s a literature on misingerpreting panic reaction as fentanyl intoxication. For instance:

” Yet these false “overdoses” are more complex. Fentanyl
has well-known sedative effects. Law enforcement officers are generally aware of them. Yet the false belief that one has received a substantial dose, can produce very real, distressing symptoms—panic, hyperventilation, vertigo, a racing heart —that are misrecognized as evidenceof fentanyl’s known effects ( Persaud & Jennings, 2020). Misrecognized symptoms appear to confirm misinformation, and no one’s wellbeing is served.”
(Del Pozo, Brandon, Josiah D. Rich, and Jennifer J. Carroll. “Reports of accidental fentanyl overdose among police in the field: toward correcting a harmful culture-bound syndrome.” Int J Drug Policy 100 (2022): 103520.)

However, it’s also useful to keep one’s mind open to inhalation/insufflation of blown powder, or that it may be a combination of drugs, for instance methamphetamine and fentanyl. Also, some of the fentanyl analogues such as acetylfentanyl and parafluorofentanyl can have an effect at exposures much much lower than native fentanyl.

Nate · December 17, 2022 at 2:53 pm

I agree with you on all, other than I’ve seen a couple of massive overdoses due to chewing patches. I wonder if it’s pure coincidence that I read an article on Smithsonian this morning that a new vaccine is being developed for fentanyl. No, really….

Anonymous · December 17, 2022 at 8:39 pm

This is the most information I have ever read about it.
To include The Generals information.

Interesting indeed.

alan wagner · December 17, 2022 at 8:56 pm

Aesop is spot on with his analysis. Just as an addendum I’d suggest people research what the Russians used to retake the school in Breslan. Possibly atomized carfentanyl or another derivative. Having given a fair amount of fentanyl during my career I’d also mention a seldom seen reaction. Rarely and often associated with high doses chest rigidity occurs.

Jonathan · December 17, 2022 at 10:49 pm

I thought those stories about LE/ EMS seemed awfully overwrought and simplified…
Unfortunately I’m not surprised; I’ve seen cops exaggerate LOTS of things in recent years, they don’t realize how much they are hurting themselves in the process (or they don’t care).

J. Smith · December 18, 2022 at 3:21 pm

Mark this day, I’ll agree with General Asop this one time, on one thing, that is it is carfentanyl that is the street threat, not fentanyl unless its mixed with substances.
I thought her pink badge was a nice touch for a career field struggling with professionalism issues. Well done.
As for fentanyl, keep it. I had my shoulder replaced at walter reed by a phenomenal Army surgeon in 2019, as i came out of surgery, the Navy puke Dr yelled, “oh shit I messed up the nerve block”, as i was just becoming conscious, screaming in pain. They hit me with fentanyl and my heart and breathing stopped, i had to be revived, bagged and then fucked with for the next ten hours, struggling because i just wanted to slip away, its an awesome feeling, a great death experience, good times i highly recommend anyone debating what i just said try it. Fentanyl is cheap garbage and i refuse to allow it to be used on me for all surgeries now and in the future, several medical professionals agree with that opinion. Im sure there will be plenty telling me Im full of crap.

DIck Tickles · December 19, 2022 at 1:10 am

Local news media covering up medical opinions by nurses and doctors? Can only mean corporate media is pushing a narrative and I think it’s wise to assume manufacturers of Fentanyl PPE and NARCAN would like every police department in the country to believe it’s super dangerous and the police unions demand even more taxpayer funds to pay for all this new equipment and emergency medicine.

I say enough is enough. Taxpayers have given police billions to buy weapons, armor, training sessions, lab equipment, etc. to stop school shootings and solve homicides, yet Uvalde, TX stood in the hallway for 80 mins and Moscow, ID can’t solve a quadruple murder? Yet what’s the first thing the cops in Minneapolis did when they got the NG and tanks behind them? Terrorized people sitting on their front porch and Buffalo cops shoved a non-violent 75 year old protestor and fractured his skull.

Real useful, productive members of society…

John · December 23, 2022 at 9:55 am

vasovagal syncope

marc · December 23, 2022 at 4:35 pm

As a medic I’m probably a heretic for not using naloxone. Part of that comes from the older experienced medics who taught me proper use of a BVM and gentle stimulation that keeps them alive to the ER. Too many times I’ve watched these squirrelly overdoses come awake in combat mode from over aggressive administration of narcan.
Next are the untrained, jamming up to 12 mg of narcan up the nose because they dont have the patience to wait a couple of minutes between doses to actually assess their treatment. Then wonder why their patients go into full blown withdrawal, sick, shitting and puking their guts out.
So no, I don’t use it. No one’s died on me either, in over 20 years on the street.

Weekend Knowledge Dump- December 23, 2022 | Active Response Training · January 6, 2023 at 5:41 am

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