Fentanyl can easily be weaponized, nation needs emergency response plan

Fentanyl, a common drug that has already become the leading cause of death for Americans under 50, has the potential to be turned into a tool for mass poisoning, health experts warn. This lethal capability could turn it into a terror weapon, suggests a group of researchers including experts from Rutgers and other institutions.

In an article recently published in Frontiers of public healthLewis Nelson, chair of the Department of Emergency Medicine at Rutgers New Jersey Medical School, spoke about this looming threat. Nelson, who is also the senior author of the research paper, expressed concern about the ready availability of this deadly substance.

“Before fentanyl, the only viable mass poisons were rare and hard-to-access agents such as cyanide or nerve agents, he said. Nelson emphasized the lethal potential of the drug, saying that fentanyl can be just as deadly if properly disseminated and is ubiquitous. A motivated person could easily get enough to potentially poison hundreds of people, which, uncut, would easily fit in a teaspoon.

Different type of threat than biological attack

The threat from fentanyl is different from that of a biological attack, which could spread globally, potentially claiming millions of lives. In contrast, chemical attacks such as fentanyl poisoning only harm directly exposed people. However, due to its high toxicity, fentanyl poses a serious threat as a tool for a deliberate and destructive event aimed at an unsuspecting population.

In terms of carrying out such an attack, an individual with minimal technical skills could potentially introduce lethal doses of synthetic opioids into building ventilation systems or local food and water supplies.

Nelson, however, downplayed the likelihood of a successful large-scale attack, saying that simply dumping a large amount of fentanyl into a tank would likely not result in significant losses.

A chilling historical example of its potential use as an aerosol poison comes from Russia in 2002. Chechen terrorists had seized a crowded theater, threatening to execute hundreds of hostages unless Russia withdrew from Chechnya.

In response, Russian authorities reportedly used a drug similar to fentanyl to end the crisis. They pumped the fentanyl analogue into the cinema’s ventilation system, incapacitating nearly everyone inside, including the terrorists.

The authorities then stormed the building and rescued the hostages, but not without a heavy price: the operation resulted in the death of 130 hostages, a grim demonstration of the destructive power of fentanyl when used maliciously.

Effective antidotes currently available

However, there is some silver lining in the form of an effective antidote to fentanyl poisoning. Nelson pointed out, “We don’t have effective antidotes for many poisons, but we do have one antidote for fentanyl poisoning: naloxone, which is also called Narcan.”

Due to the growing number of inadvertent fentanyl overdoses, naloxone is now widely stocked in healthcare settings and pharmacies.

This unfortunate increase in accidental overdoses has led to an increased awareness among healthcare professionals and non-medical personnel about recognizing the signs of fentanyl poisoning. The research paper calls for more training for healthcare professionals to quickly identify victims and administer naloxone as soon as possible.

Nelson emphasized the safety of this approach, stating, “Treatment based on clinical findings rather than more definitive tests such as blood test results is generally safe.” If you suspect fentanyl poisoning, give naloxone, and it turns out the poison was another agent, you generally have not injured the patient.

Proposed outline for a fentanyl attack response plan

The response plan proposed by the panel focuses mainly on preparatory measures, such as training more people to recognize the signs of poisoning, establishing efficient reporting channels for unusual cases of fentanyl poisoning, and identifying common factors between victims.

Additionally, the plan also calls for more efforts to eliminate access to fentanyl sources. A crucial part of the strategy includes devising ways to quickly transport substantial quantities of naloxone to the places where they are needed most during an emergency.

The availability of naloxone in metropolitan and rural areas is encouraging, according to Nelson. “We have plenty of naloxone available in metropolitan and rural areas, she said.

The drug can be safely administered to victims, as fentanyl powder poses little threat to emergency responders unless inhaled or ingested. There’s essentially no risk of rapid absorption through the skin, he reassured.

One of the major challenges in the event of a mass poisoning would be quickly transporting the antivenom to the scene or facilities suddenly overwhelmed with victims.

“The key in a mass event will be to move naloxone quickly to the scene or to facilities that are suddenly overwhelmed with casualties. Fentanyl generally kills more slowly than poisons such as cyanide, but still requires rapid action to prevent damage,” explained Nelson.

While the prospect of fentanyl being weaponized is ominous, health care experts are working diligently to prepare for and protect themselves from such a potential event. As the medical community continues to learn from accidental overdose cases, their knowledge and alertness could prove invaluable in responding to an intentional mass poisoning event.

Read more about fentanyl

Fentanyl is a synthetic opioid pain reliever that is 50 to 100 times more potent than morphine. It is approved for the treatment of severe pain, typically advanced cancer pain. It is often prescribed in the form of transdermal patches or lozenges and is used under the supervision of a doctor.

However, because of its potency, fentanyl has also been produced illicitly and misused, often with deadly consequences. Illegally produced fentanyl is sold through illegal drug markets due to its heroin-like effect. It is often mixed with heroin and/or cocaine to increase its potency, but users are often unaware of its presence, resulting in a high risk of overdose.

Fentanyl binds to the body’s opioid receptors that control pain and emotion, increasing dopamine levels and creating a state of intense euphoria and relaxation. Its potency comes from its high affinity for these receptors. However, it also affects areas of the brain that control breathing rate, and a high dose of opioids, especially potent ones like fentanyl, can cause breathing to stop completely, leading to death.

Fentanyl overdoses have been a significant contributor to the opioid epidemic in the United States. By 2021, fentanyl was the leading cause of drug overdose deaths in the United States, and its potential misuse continues to pose significant public health risks.

In terms of medical use, fentanyl can be a very effective drug for managing severe pain. As mentioned above, it is often used for pain management in cancer patients, particularly those who have built up a tolerance to other opioids.

Overall, while fentanyl has legitimate medical uses, its potency and potential for misuse make it a significant target of public health efforts to control the opioid crisis.

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