Fentanyl, first introduced in the 1960s as an intravenous anesthetic, is an opioid often prescribed by doctors to treat the intense pain resulting from advanced-stage cancer or surgery. Today, fentanyl is the most potent narcotic in clinical use and is up to 50 times stronger than heroin and 100 times stronger than morphine. Typically, fentanyl citrate is administered by injection in combination with antianxiety agents or anxiolytics.
Pain Relieving Effects
Fentanyl works by interacting with naturally occurring endorphin-binding opioid receptors within the body. The endorphins, which typically help to reduce pain, are connected to the brain’s “pleasure center.” When opioid drugs, like fentanyl permeate the part of the brain stem called locus ceruleus, their receptors begin slowing respiration, lowering blood pressure and decreasing alertness. The duration of its pain-relieving action is short.
The Danger of Repetitiveness
Taking Fentanyl for an extended time or at a non-prescribed frequency can create a physical dependence. Recent data from SAMHSA (Substance Abuse and Mental Health Services Administration) estimates that nearly 1 million people over the age of 12 abuse fentanyl.
Professionals at Risk
First responders are among those most likely to face unintentional exposure to Fentanyl through daily activities and emergency response measures. Contact through inhalation, ingestion or absorption can be a serious health threat.
NIOSH (National Institute for Occupational Safety and Health) has identified the following professions to be among those with a higher risk of exposure.
EMS (including EMTs, Firefighters, and Paramedics)- Administering care to drug users, performing tasks near overdose scenes.
Law Enforcement- Routine traffic stops, overdose calls, crime scene evaluation, arrests.
Law Enforcement Investigators & Evidence Handlers - Executing search warrants, transporting suspects, collecting and storing evidence, investigating crime scenes.
Remediation Services/HAZMAT Services- Responding to hazardous materials spills, crime scene clean-ups, remediating drug processing and distribution sites.
Safety Recommendations- Protecting Against Fentanyl Exposure
Fentanyl, including fentanyl analogues and novel synthetic opioids, are present in a variety of forms. While inhalation of fentanyl via airborne powder often leads to harmful effects, skin contact is the most common method of exposure for emergency response professionals. Harmful effects related to skin contact are often mitigated with appropriate personal protective equipment (PPE) and thorough handwashing.
The NHTSA (National Highway Traffic Safety Administration) Office of EMS recommends the following PPE safeguards to protect against exposure:
· Wear gloves when the presence of fentanyl is suspected.
· Avoid actions that may cause powder to become airborne.
· Use a properly fitted, NIOSH approved respirator mask, wear eye protection, and minimize skin contact when responding to a situation where small amounts of suspected fentanyl are visible and may become airborne.
It is important to note there is no specific standard or testing method for fentanyl protection. Instead, evaluations are conducted utilizing ASTM 6978, the standard practice for assessment of resistance of medical gloves to permeation by chemotherapy drugs. As such, third-party testing will be in accordance with ASTM D6978-05.
• In a permeation test against Fentanyl Citrate Injection (100mcg/2mL), gloves must hold up against fentanyl and allow no breakthrough for at least 240 minutes. At 240 minutes, the test stops. Recorded testing must state minimum breakthrough detection time as “>240 minutes”.
• VGuard® nitrile gloves are tested in third party labs for protection against fentanyl. Testing reports are available upon request. Please ask your Vanguard Safety representative for a full list of VGuard gloves which have passed all testing requirements against Fentanyl Citrate. 
References and Additional Resources:
https://fof.dea.gov/what-is-fentanyl
https://www.ncdhhs.gov/documents/fentanyl-information-1st-responders-final/download
https://www.cdc.gov/stop-overdose/caring/fentanyl-facts.html
https://www.britannica.com/science/fentanyl
https://www.cdc.gov/stop-overdose/caring/fentanyl-facts.html
https://www.dea.gov/sites/default/files/Publications/Final.pdf
https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
https://www.ems.gov/assets/Fentanyl_Safety_Recommendations_for_First_Responders_August_2021.pdf