Introduction
Overdose deaths involving opioids in the USA have skyrocketed 41.5% since 2010 [1], with a provisional count of over 47,105 deaths from August 2018 to August 2019 [2]. Synthetic opioids, particularly fentanyl, have driven deaths in recent years due to their high potency and low overdose threshold. Indeed, death statistics in Missouri suggest over 75% of fatal opioid overdoses involved fentanyl in 2018 [3].
In Missouri, emergency medical services (EMS) personnel and law enforcement officers (LEOs) are called to respond to the increasing numbers of opioid overdoses. Emergency responders report frequent occupational safety concerns related to illicit drug use [4]. One common fear is needle stick injury and the subsequent potential risk of contracting infectious diseases [5]. Additionally, emergency responders express concern for their own safety during overdose reversals, including purported instances of aggression and combativeness on the part of the survivor [6, 7].
With the relatively recent surge in fentanyl-related overdoses, a new occupational safety concern has emerged among emergency responders: the fear of overdosing from touching fentanyl [8]. In 2017 alone, over 150 media reports describing first responder exposures to opioids surfaced [9]. Reports of overdose due to fentanyl contact among first responders [10,11,12,13] have been repeatedly refuted by medical experts [14,15,16]. Yet, mixed messages from the US government agencies [17] and their prominence in media outlets have catalyzed the spread of misinformation about the risks of accidental fentanyl contact. The high level of concern about this theoretical threat has been especially stark in the context of the COVID-19 pandemic, particularly in the USA, when police have reportedly expressed comparatively little anxiety about contracting the potentially deadly virus [18].
There has been an increase in products marketed to address the fear of fentanyl, including fentanyl exposure prevention kits [19, 20], gloves marketed to protect against fentanyl [21], other fentanyl-resistant gear and screening devices [22], and fentanyl clean-ups [23]. Additionally, legislators in the USA have proposed the Providing Officers with Electronic Resources (POWER) Act that would fund state and local enforcement agencies to purchase fentanyl screening devices to protect officers from incidental exposure [24]. However, because these screening procedures require the use of class B hazmat suits [25] and other equipment prior to responding to the overdose, these precautions could potentially delay the time-sensitive, lifesaving administration of naloxone and rescue breathing.
Concerns about fentanyl exposure continue to spread despite a clear consensus from medical experts that overdose from incidental skin contact is a medical impossibility [14, 15]. Indeed, this claim has been officially debunked by the American College of Medical Toxicology and the American Academy of Clinical Toxicology [16] and the National Occupational Safety and Health with the CDC [26]. A drug policy advocate has also disproven this myth by holding fentanyl powder in his hand without consequence and widely circulating the internet footage [15]. Researchers who study reported overdoses from fentanyl exposure among emergency responders have explained that cases documented thus far can best be attributed to the “nocebo effect”—a phenomenon in which individuals believe they have encountered a toxic substance and therefore experience the expected symptoms of exposure [27]. This is consistent with our broader understanding of occupational wellness and mental health—or lack thereof—among first responders [28]. When individuals are already operating under acute stress and with few mental health reserves, fear of overdose from touching fentanyl could serve as an additional stressor.
To our knowledge, only one study has examined emergency responders’ perceptions of risk associated with brief exposure to fentanyl. In their study of 247 first responders in New York, Persaud and Jennings found 80% of responders believed “briefly touching fentanyl could be deadly.” Based on these findings, the authors concluded trainings should incorporate accurate information about fentanyl risk and overdose response. To date, no studies have explored the extent to which these beliefs are modifiable through training and education.
As part of a broader effort to improve community access to naloxone, the authors of the current study developed comprehensive training for emergency responders on recognizing and responding to an overdose, basic tenets of addiction, and the roles of treatment and harm reduction strategies. Because unfounded fears about incidental contact with fentanyl could result in delays in responding to overdoses, we incorporated medically accurate information regarding fentanyl exposure into this existing overdose education and response training program. In addition to increasing knowledge and improving attitudes towards overdose recognition and response scenarios [29, 30], we aimed to decrease participants’ endorsement of the pre- and post-training survey statement “I can overdose from touching fentanyl.”
