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 the age of 50, has the potential to be transformed into a tool for mass poisoning, health experts warn. This lethal capacity could turn it into a weapon of terror, suggests a group of researchers including experts from Rutgers and other institutions.

In a recently published paper in Frontiers in Public Health, Lewis Nelson, the 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 difficult-to-access agents such as cyanide or nerve agents,” he said. Nelson highlighted the drug’s lethal potential, saying, “Fentanyl can be just as deadly if properly disseminated, and it’s ubiquitous. A motivated person could readily obtain enough to potentially poison hundreds of people – which, uncut, would fit easily onto a teaspoon.”

Different type of threat than biological attack

Fentanyl’s threat is different from that of a biological attack, which could spread globally, potentially claiming millions of lives. In contrast, chemical attacks like fentanyl poisoning harm only those directly exposed. Nevertheless, due to its high toxicity, fentanyl poses a grave threat as an instrument for a destructive, deliberate event aimed at an unsuspecting population.

In terms of the execution of such an attack, an individual with minimum technical skills could potentially introduce lethal doses of the synthetic opioid into building ventilation systems, or local food and water supplies. 

Nelson, however, downplayed the likelihood of a successful large-scale attack, asserting that merely dumping a large quantity of fentanyl into a reservoir would likely not result in significant casualties.

A chilling historical example of its potential usage as an aerosolized 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 apparently used a fentanyl-like drug to end the crisis. They pumped the fentanyl analog into the theater’s ventilation system, incapacitating nearly everyone inside, including the terrorists. 

The authorities then stormed the building and rescued the hostages, but not without a hefty 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

Yet, there is some silver lining in the form of an effective antidote to fentanyl poisoning. Nelson pointed out, “We have no effective antidotes to many poisons, but we do have an antidote to fentanyl poisoning – naloxone, which also goes by the brand name Narcan.” 

Owing to the increasing number of unintentional fentanyl overdoses, naloxone is now widely stocked in healthcare facilities and pharmacies.

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

Nelson underlined the safety of this approach, saying, “Treating based on clinical findings rather than more definitive tests such as blood-test results is generally safe. If you suspect fentanyl poisoning, administer naloxone, and it turns out the poison was another agent, you generally haven’t hurt the patient.”

Outline proposed for a fentanyl attack response plan

The response plan proposed by the panel primarily focuses on preparatory measures, such as training more individuals to recognize the signs of poisoning, setting up efficient reporting channels for unusual fentanyl poisoning cases, and identifying common factors among victims. 

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

The availability of naloxone in both metropolitan and rural areas is encouraging, according to Nelson. “We have a lot of naloxone available in metropolitan and rural areas,” he said. 

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

One of the primary challenges in the event of a mass poisoning incident would be transporting the antidote swiftly to the scene or facilities suddenly overwhelmed with victims. 

“The key in a mass event will be quickly moving naloxone to the scene or to facilities that are suddenly overwhelmed with victims. Fentanyl generally kills more slowly than poisons like cyanide, but it still requires quick action to prevent harm,” explained Nelson.

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

More about fentanyl

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

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

Fentanyl binds to the body’s opioid receptors that control pain and emotions, increasing dopamine levels and creating a state of intense euphoria and relaxation. Its potency comes from its high affinity to these receptors. However, it also affects the 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 U.S., 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 earlier, it’s often used for pain management in cancer patients, especially 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 focus of public health efforts to control the opioid crisis.

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