By Nicholas Greco IV, M.S., BCETS, CATSM, IPSA Mental Health Committee Chair

As a first responder, many of you are aware of the dangers of heroin laced with fentanyl, carfentanil and U-47700. In addition, there are a number of other synthetic opioids that seem to evade detection due to the constant tweaking of their molecular structure by street chemists.

Fentanyl-related substances can be absorbed through the body through injection, orally, contact with one’s mucous membranes, inhalation and through the skin. Not only does exposure pose a clear and present danger to humans, our K-9 officers are also at risk. At minimum, officers should always have their own Personal Protective Equipment consisting of nitrile gloves, N-95 dust masks, sturdy eye protection, paper coveralls/shoe covers and naloxone injectors.

While the widespread use and increased acceptance of naloxone has helped to reverse overdoses in both users and first responders, we are seeing an upward trend of increased naloxone doses to reverse the effects of opioid exposure. Unfortunately, with the proliferation of heroin and continued diversion of prescription painkillers, this epidemic shows no signs of letting up.

Handling prescription meds (or so you think)

Never open a prescription bottle or package and empty the contents into your hands. Once again, even in a prescription bottle, there is no guarantee of the contents. What is labelled on the bottle may not be innocuous, and may be laced with fentanyl or any number of substances. Many persons with mental illness have more than one psychiatric condition and often their mental illness may also be accompanied with alcohol and substance abuse as a means to self-medicate.

While people may be taking anxiolytics such as the following commonly prescribed benzodiazepines: Ativan (lorazepam), Klonopin (clonazepam), Librium (chlordiazepoxide), Valium (diazepam), and Xanax, Xanax XR (alprazolam) to relieve anxiety and produce feelings of relaxation, these may be counterfeit. Xanax (alprazolam) along with oxycodone, and hydrocodone are replaced with fentanyl to mimic the effects of these real products.

Thus, fentanyl and other synthetic opioids, in pill or capsule form, have been represented as Xanax (alprazolam), OxyContin (oxycodone), and other pharmaceutical drugs. In the case of fentanyl and carfentanil, an amount as small as a grain of sand could kill you. Additionally, there are a number of prescription medications in patch form which are easily absorbed through the skin, while others can be absorbed in the mouth through saliva and orally disintegrate.

You can now see why even opening a closed pill bottle can expose you to minute amounts of the substance.

Safety tips

When dealing with unknown substances and to minimize exposure, it may be best practice to not open any containers, bottles, or bags, nor field test any substances. The best advice is to safely handle the substances using PPE, maintain chain of custody, and directly send to the lab for testing and confirmation. 

More first responders are getting crisis intervention team training, commonly referred to as CIT. And this training is helping to increase awareness of psychological issues in the communities they serve. 

Lastly, the DEA has released a number of rollcall videos warning of the dangers of handling and field testing suspected illicit substances. The latest DEA rollcall video is a must watch for all first responders. Remember, stay safe by minimizing your risk.

About the Author

Nicholas Greco IV, M.S., B.C.E.T.S., C.A.T.S.M. is President and Founder of C3 Education and Research, Inc., a training and consulting firm. Nick has held multiple positions over a 20-year career in clinical operations, project management, multidisciplinary training for civilians and law enforcement, as well as diagnostics and assessment. He has directed, managed and presented training programs globally across various topics including depression, bipolar disorder, schizophrenia, verbal de-escalation techniques, post-traumatic stress disorder, burnout, and vicarious traumatization. Nick is a member of the International Law Enforcement Educators and Trainers Association and Committee Chair of the IPSA's Mental Health Committee.

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