I was having a discussion with one of my clients the other day about Fentanyl, and she was telling me that they hear warnings to the effect of: be sure to wipe down the handle on the shopping cart at the grocery store, or you could be exposed to Fentanyl, and possibly overdose.
There are also numerous stories in the news, usually local TV or newspaper, where a police officer or other first responder touches Fentanyl and finds themselves ill. There has even been a news story about an EMT whose patient overdosed, and in transit to the hospital had coughed on the medic’s skin, after which he began to feel ill.
Scary stuff, right?
Those of you who participated in our Fentanyl webinar from last September may remember my description of the potency of Fentanyl (50-100 times more potent than Morphine), as well as other analogues (such as Carfentanil – nearly 5,000 times more potent than Morphine). So, without question, Fentanyl is an extremely powerful drug that can represent grave danger when someone comes into contact with it.
But what constitutes dangerous contact?
As it turns out, Fentanyl has notoriously poor transdermal properties: in other words, Fentanyl does not “soak through the skin” as much of the media would have you believe.
“But Eric,” you say, “one of the most popular Fentanyl delivery systems is a transdermal patch. How can you say it doesn’t soak through the skin?” Well, as it turns out, the companies that manufacture these Fentanyl patches use some pretty high-tech formulas that facilitate the transfer of the medication through the skin.
Want to hear it from people much smarter than I? Here is the Position Statement from the American College of Medical Toxicology and the American Academy of Clinical Toxicology.
Interestingly enough, even a transdermal preparation of Fentanyl takes too long to absorb to be any serious threat. From the above linked policy position: However, incidental dermal absorption is unlikely to cause opioid toxicity. If bilateral palmar surfaces were covered with fentanyl patches, it would take 14 min to receive 100 mcg of fentanyl (using a body surface area of 17,000 cm2, palm surface area of 0.5% , and fentanyl absorption of 2.5 mcg/cm2 /h ). This extreme example illustrates that even a high dose of fentanyl prepared for transdermal administration cannot rapidly deliver a high dose.
Please do not mistake this to mean that it is completely harmless to come into contact with Fentanyl; if there are Fentanyl particles in the air, inhaling them would certainly have a dangerous effect. EDIT: Also, as Allyson was kind enough to point out in the comments below, any open wound (cut on the hand/finger) or contact with mucus membrane (mouth, nose, etc.) would not fall into the “transdermal” category and would be cause for concern. But as for shopping carts? Wipe them down because they can be gross, but not over concerns of Fentanyl exposure!
So you are saying that touching Fentanyl is not dangerous. What about wiping your eyes, nose, or mouth after touching it? What about cuts on your hand? After receiving training in this area, it is my understanding that even partials of this drug can potentially fatal.
You make an excellent point, and my apologies for not being clear on this part of it. I was addressing only the transdermal nature of Fentanyl; mucus membrane and open wounds are a completely different matter and would certainly allow Fentanyl to enter the bloodstream. And yes, even a small amount of Fentanyl can be hazardous. I have made a change the to the text of the blog post to reflect this, but felt it was appropriate to leave your comment and my response because I do appreciate questions (or even disagreements), especially if it will help the next person who reads the post. Thank you for pointing out this important detail that was missing.
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