Heroin, drugs CDC/ Louis Alexander

Emergency Personnel: Unintentional Occupational Exposure to Opioids

MedicalResearch.com Interview with:
Sophia K. Chiu, MD

Epidemic Intelligence Service, CDC
Division of Surveillance, Hazard Evaluations, and Field Studies
National Institute for Occupational Safety and Health

MedicalResearch.com: What is the background for this study?

Response:  Responders across the United States are reporting work-related health effects during incidents in which suspected opioids (including fentanyl) and other illicit drugs such as cocaine, methamphetamine, cathinones, and synthetic cannabinoids are present, often as a mixture. These health effects have interfered with responders’ ability to perform their job duties.

Since 2018, a number of responder organizations have requested that NIOSH investigate the health effects experienced by emergency responders during these response incidents. These organizations are looking for ways to protect their responders and prevent the symptoms responders have reported experiencing, so that they can in turn better serve the public. NIOSH’s goal is to increase awareness among responders of how they can remain safe while providing the care the public needs.

MedicalResearch.com: What are the main findings?

Response:  The officers developed symptoms during emergency responses where illicit drugs were found at the scene. The causes of their symptoms were hard to characterize with certainty. The symptoms were not consistent with severe, life-threatening opioid toxicity, but these work-related symptoms prevented officers from doing their essential job duties.

The potential exposure routes for fentanyl of greatest concern are inhalation, mucous membrane contact, ingestion, and percutaneous exposure (e.g., needlestick). All of these routes were possible in the two evaluations described. Brief skin contact with fentanyl in powder form is not expected to lead to toxic effects. However, contamination of gloves or bare hands with subsequent hand-to-face contact can lead to mucous membrane exposure. That’s an example of why we think education and training are important for protecting emergency responders. 

MedicalResearch.com: What should readers take away from your report?

  • First responders are on the frontlines of the opioid epidemic.
  • Illicit drugs, including fentanyl, pose a potential hazard to first responders who could unintentionally come into contact with these drugs in different forms during the course of their work and can prevent them from doing their job duties.
  • Despite gaps in knowledge related to the level of risk to first responders, it is imperative that steps be taken to prevent exposure to illicit drugs.
  • Safe work practices plus education and training will protect first responders from illicit drug exposure.
  • NIOSH’s goal is to increase awareness among responders of how they can remain safe while providing the care the public needs.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: NIOSH continues to seek out partnerships with local, state, and federal partners that will lead to reinforcement of current safe work practice recommendations, refinement of those work practices as more information is learned, and addressing  current knowledge gaps.

Currently, gaps in knowledge are related to the degree of risk from unintentional occupational exposure during incidents involving drugs. Improved surveillance of occupational exposures can provide valuable information about the frequency and circumstances of these incidents over time for a larger population of responders. Guidelines for medical evaluation and treatment of potentially exposed responders need to be created and disseminated.


Am J Ind Med. 2019 May;62(5):439-447. doi: 10.1002/ajim.22967. Epub 2019 Apr 23.

Health effects from unintentional occupational exposure to opioids among law enforcement officers: Two case investigations.

Chiu SK1Hornsby-Myers JL2de Perio MA1Snawder JE3Wiegand DM1Trout D1Howard J4.


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Last Updated on May 2, 2019 by Marie Benz MD FAAD