SUB-HEADING: "People should not be in jail for imaginary crimes," one expert said."
“Deputy Nearly Dies of Fentanyl Overdose,” read a headline from the Sacramento Bee this summer.
“Officer Exposed to Fentanyl & Transported to Local Hospital,” stated a press release from the Santa Rosa Police Department in 2020. “Police Officer Overdoses After Brushing Fentanyl Powder Off His Uniform,” read the headline on a CNN story from 2017.
But there’s something off about this seeming epidemic of accidental overdoses: It is virtually impossible to overdose simply by touching or getting too close to fentanyl. Doctors and toxicologists warn that the hype around this perceived threat is harming overdose victims, taxpayers, and first responders.
Accidental overdose by skin exposure “is chemically and physically implausible,” said Dr. Ryan Marino, a medical toxicologist and addiction medicine specialist who serves as an assistant professor at Case Western Reserve University School of Medicine.
Dr. Andrew Stolbach, an emergency physician and medical toxicologist at Johns Hopkins Hospital, said, “It's not possible to overdose on fentanyl by touching it. If it was absorbed well through the skin, people wouldn’t inject it and snort it in order to get high.”
Despite this, people who use the drug are facing serious legal repercussions — such as charges of assault or endangerment of officers — for supposedly causing these impossible overdoses.
“People should not be in jail for imaginary crimes,” Marino said.
“Bad timing. Bad luck.”
That’s how Justin Buckel describes what happened the night of May 12, 2017. He had just been released from jail on bond in East Liverpool, Ohio, when he was pulled over. The officer was quickly joined by Chris Green, a local police officer who was off duty but happened to be nearby.
The officers searched Buckel’s car for drugs and found powder that later tested positive for fentanyl. Buckel said at the scene that the powder in the vehicle might include fentanyl. He was arrested. At least an hour later, Green complained to a colleague he didn’t feel well. He had brushed some powder off of his shirt, touching it with his bare skin. The colleague later recounted in police documents that Green “became saturated in sweat and was barely coherent.”
Green told BuzzFeed News he remembers “panicking, trying to talk,” and falling forward, but nothing after that. He was taken to a hospital and treated for an overdose.
Buckel pleaded guilty to charges including trafficking and possession and was sent to prison for six and a half years. In addition, he was charged with assault on a peace officer for “exposing” Green to fentanyl, which made up a year and a half of the jail time.
When he was sentenced, the Ohio attorney general’s office put out a press release that led with the assault charge. Mike DeWine, who was attorney general at the time and is now governor, contributed a quote: "Fentanyl is so dangerous that even the slightest exposure can be deadly, but thankfully in this case naloxone was close at hand.”
(DeWine’s office told BuzzFeed News in a statement that Green’s overdose was a “documented, medical incident” and claimed it is “factually incorrect” that this overdose was medically implausible.) The news media picked the story up accordingly.
Buckel’s arrest was one of many similar stories that got national attention. The prevalence of these tales of accidental overdose has increased along with the amount of fentanyl in the illicit drug supply in the United States.
A study published in the Harm Reduction Journal last year showed that stories of accidental fentanyl exposure made up over 150 media reports in 2017. Stolbach, the Johns Hopkins physician, was one of the authors of a 2020 Journal of Medical Toxicology study that traced the origin of the concern to a small number of reports from 2013, noting that such media reports increased in 2016, the same year the United States Drug Enforcement Agency itself issued a warning that “fentanyl can be absorbed through the skin or through accidental inhalation of airborne powder.”
A DEA spokesperson confirmed the agency later took down an accompanying video warning of this supposed risk that was posted on YouTube and noted that the DEA follows the Centers for Disease Control and Prevention guidelines for preventing occupational exposure to illicit drugs.
More recent first responder guidance from the DEA says, “Incidental skin contact may occur during daily activities but is not expected to lead to harmful effects if the contaminated skin is promptly washed off with water.” Representatives for the agency did not respond to a request for comment on the 2016 warning.
The Journal of Medical Toxicology study noted two distinct spikes in media reports about first responder opioid exposures in 2017. The bigger spike came in the second quarter of the year, the same time period Buckel was arrested.
Green appeared on CBS News five days after Buckel’s arrest, when anchor Norah O’Donnell told viewers, “The opioid crisis is not only dangerous for those addicted to the drugs, but also for first responders.” An on-air graphic declared, “OVERDOSE BY ACCIDENT.”
Representatives for CBS News did not respond to multiple requests for comment on whether medical experts were contacted for the story.
A few months later, CBS’s fictional cop show Blue Bloods featured a harrowing plotline in which an officer was rushed to the hospital after touching a tray containing fentanyl. A suspect and doctor both proclaimed the officer had overdosed.
Representatives for CBS did not respond in time for publication when asked whether toxicologists or other medical professionals were consulted about the episode. Over 8 million people watched it the night it premiered.
Logically, the argument that passive fentanyl exposure poses an overdose risk to first responders falls apart with a little questioning.
If it did, why don’t nurses who work with fentanyl in hospital settings experience similar symptoms? What about dealers, the loved ones of drug users, or volunteers at needle exchange sites?
Experts have long warned that this pervasive concern can create serious consequences for drug users, first responders, and taxpayers.
Marino said he has seen first responders hesitating to resuscitate patients experiencing fentanyl overdoses both in the hospital and in the field.
The 2020 Harm Reduction Journal study pointed out that officers report entering the field with significant fear of fentanyl.
A study published the previous year in Disaster Medicine and Public Health Preparedness surveyed first responders in New York, finding that 80% of them believed “briefly touching fentanyl could be deadly.”
While many first responders clearly experience physical suffering after a believed exposure to fentanyl, experts suggest it’s possible they are experiencing panic attacks or “line-of-sight” afflictions, not overdoses, and are suffering negative consequences to their mental health. Some symptoms of opioid overdoses — such as perspiration and lightheadedness — are also associated with anxiety attacks.
Ryan McNeil, an assistant professor of medicine and public health at Yale University, said first responder descriptions of suspected overdoses sound like panic attacks, not toxicity, and "it's galling that we're treating that as an overdose when it's not even how an overdose presents."
In August, the San Diego County Sheriff’s Department came under fire for releasing a packaged PSA and insisting, even after an outcry from medical experts online, that it showed a deputy overdosing from passive fentanyl exposure.
Recently, a @SDSheriff Deputy was exposed to Fentanyl and nearly died of an overdose. If it wasn't for the quick-thinking of his Field Training Officer in administering Naloxone, that deputy would not be alive today. Watch our public safety video: https://vimeo.com/583169640
The body camera footage is dramatic. Deputy David Faiivae falls to the ground after touching a powder, and one of his colleagues assures him, “I’m not going to let you die!” In the PSA, officers involved that day sit down for confessional-style interviews and Faiivae states, “I almost died.”
What made this instance different from its predecessors was that doctors and experts organized to push back.
Over 400 physicians, nurses, and public health researchers signed a letter demanding retractions from the major outlets that credulously repeated the department’s claim.
They highlighted the 2017 findings of a joint American College of Medical Toxicology and American Academy of Clinical Toxicology task force, which found that “incidental dermal absorption is very unlikely to cause opioid toxicity,” and “toxicity cannot occur from simply being in proximity to the drug.”
Under pressure, the department admitted the deputy never underwent a toxicology screening to determine if fentanyl was in his system, but they refused to disavow the video, even weeks later.
A representative for the department confirmed to BuzzFeed News that Faiivae never underwent a toxicology screening and the organization has “not revisited this topic since that time.”
They had no further comment.
The story of the alleged overdose, dubious as it was, still spread. Green, who also says he is not sure he underwent a toxicology screening after his alleged overdose, posted an article about it to his own Facebook account.
@SDSheriff
We know what factually happened and our deputy almost died from a fentanyl exposure. This is a deadly substance!
Despite the very public myth-busting of fentanyl overdose from accidental contact with the drug, law enforcement officials across the country continue to go to great, very expensive lengths to avoid this “risk,” and people continue to face incarceration for supposedly causing these accidental overdoses.
Officials in Greene County, Tennessee, charged Tommy Starnes with two felony counts of reckless endangerment after a deputy and EMS worker both experienced “symptoms of an overdose” after treating him, according to a release from the Greene County Sheriff’s Department. Greene County Sheriff Wesley Holt would not share additional information with BuzzFeed News on what those symptoms entailed.
Unlike Buckel, who was simultaneously hit with a variety of other trafficking-related charges, Starnes is not suspected of selling drugs. The first responders were called for an overdose. They were there to save Starnes’ life.
Upon arriving at the scene after reports of the first responders’ symptoms, Holt donned a hazmat suit to retrieve evidence.
The Tennessee Highway Patrol even flew in decontamination equipment by helicopter. Holt estimates the total cost of the response was around $3,800.
Holt told BuzzFeed News it’s “a sad situation” that taxpayers foot those bills.
When asked if he was aware of the research showing passive fentanyl exposure poses no significant risk to law enforcement officers (thus rendering the helicopter decontamination unnecessary), he said he was not.
He dismissed the idea that the first responders experienced anxiety or a so-called nocebo effect — the opposite of a placebo effect, wherein a negative outcome arises from negative expectations — and declined to say whether the deputy or EMS worker who came in contact with Starnes were given toxicology screenings.
Reporting by a local journalist later revealed that every officer in Greene County has been given a protective suit in the wake of Starnes’ arrest. Holt estimates that cost the department another $800. The reporting also said the ambulance used to transport Starnes was given “an intense cleaning” with chemicals flown in by the Tennessee Bureau of Investigations.
Representatives for the TBI did not say what that might have cost.
Todd Estep, a public defender who represents Starnes, said he had not been aware of the body of research indicating that the endangerment his client was charged with is medically implausible until he was contacted by BuzzFeed News.
Starnes, who also faces felony charges of possession, remains in jail awaiting an arraignment this month.
Green, like Holt, rejects the idea that any first responder’s reaction to the presence of fentanyl is brought on by anxiety or a nocebo effect. “I’m a pretty hardened guy,” he said. “Nothing really rattles me.” He is no longer with the ELPD.
A review of internal documents showed he was terminated after a number of violations uncovered by an investigation ordered by East Liverpool Mayor Gregory Bricker, including dishonesty and discourteous treatment of the public.
Green told BuzzFeed News he believes he was let go because he raised concerns about corruption in the department and is mounting a legal challenge to ensure “the facts will come out.”
He has since found employment working in drug detection for a private company and told BuzzFeed News it is essentially the same job he had with the ELPD, but he makes “a ton more money.” Green is thrilled with his new gig, saying, “My passion is drugs. Like if I was allowed, I would literally be a cop for free if I could just hunt drugs and drug dealers all day.”
He also dismissed doctors’ insistence that passive exposure cannot cause an overdose, saying, “I don't really care what the naysayers say or feel or whatever. I know what I experienced, and it's godawful.”
It’s impossible to say for sure what is really going on in these instances, though Green and Holt both remain adamant that passive exposure is an overdose threat and the police are not lying or experiencing panic attacks. First responders, Green said, are either “really good actors and we have an elaborate hoax going on or the shit is real.”
Stolbach, who helped author the 2017 position statement from the American College of Medical Toxicology and the American Academy of Clinical Toxicology task force, said that what happened in the San Diego Sheriff’s Department video showed “some sort of medical event, but not opioid-poisoning definitive.”
He doesn’t know why the message that these types of overdoses are impossible isn’t taking hold in police departments, even years after the possibility of passive overdose was debunked.
“Every police officer or police official that I personally come into contact with, they're on board with me and they understand, and yet, somehow, this message isn't penetrating the police,” he said, adding that between the medical and law enforcement communities, “there’s not a lot of interface.”
Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University who is a former senior policy adviser to the White House Office of National Drug Control Policy, believes resistance to accurate information about the possibility of exposure overdoses isn’t just an issue among first responders. His concern lies with prosecutors.
“It may not be an entirely rational process for them,” said Humphreys. “They could just be glad to have another way to charge people. Generally, as prosecutors, the more things you can charge somebody with, the more power you have, so even if they knew that this was mostly hysteria and hokum, they might still welcome the power. I don't know if you can change that.”
Fentanyl can be absorbed through the skin, but only under unique circumstances. Fentanyl patches are used therapeutically by medical professionals all the time, which may have contributed to the belief that instantaneous absorption and subsequent overdose are possible.
Humphreys said he would be willing to stand in front of cops and personally demonstrate the safety of touching fentanyl with his bare hand.
“The fentanyl patch is not just fentanyl, so that is definitely completely different from what's on the streets. The patch is fentanyl combined with an alcohol or glycol product so that it becomes a solution and so those compounds do absorb through the skin,” said Marino, who explained that the 75-microgram patch does not contain “a big dose” and “takes 13 hours to get to just the therapeutic dose.” Overdosing, he said, would require “many, many hours of holding this patch against the skin.”
Green told BuzzFeed News he used hand sanitizer before brushing the powder off of himself that day in 2017 and believes that could have facilitated some kind of absorption. Asked why he had a reaction but Buckel — who handled the powder too, which led to his conviction for tampering with evidence – didn’t, he said it was probably because Buckel used drugs and had a tolerance.
Green also pointed out that another suspect arrested with Buckel was transported to the hospital before he was, though at the time, he questioned whether the suspect was trying to get out of jail.
Green and the police report from the time both noted the suspect said he had asthma. Per the police report, the suspect experienced “shortness of breath and dizziness,” both of which are common symptoms of asthma attacks and do not align with the CDC’s warning signs of overdose.
Both Stolbach and Humphreys expressed concern that fear of fentanyl exposure is increasing anxiety for police officers, whose job involves myriad dangers as it is.
Humphreys said he would be willing to stand in front of cops and personally demonstrate the safety of touching fentanyl with his bare hand. Demonstrations and outreach, he said, could be one way to make the point.
Stolbach said he met with officials from the San Diego Sheriff’s Department in the wake of August’s viral PSA (which has since been removed by Vimeo) and found them “receptive” to his feedback.
Fighting the misconceptions around fentanyl exposure is easier said than done, given the saturation of the narrative within the law enforcement community, as well as in the news and on TV. Buckel’s lawyer, Coleen Dailey, said she tried to fight against Buckel’s assault charge in 2017, “but for every article that said that passive exposure did not cause an overdose, there was one that said it did.”
Buckel, who remains in jail, said all he cares about now is “getting out and getting established,” reconnecting with his kids, and getting back to work. He will remain incarcerated for two more years, but he has advice for Starnes and others charged with endangerment or assault of an officer for fentanyl possession: “Fight the case,” he said.
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