A pharmaceutical company is apparently targeting police departments to get them to carry OPVEE (nalfemene), a long-acting opioid antagonist that the two top toxicology organizations in the country say has significant risks and has not been studied in actual settings. In an article by New England Public Media, Health experts alarmed at new overdose drug marketed to WMass police departments, a police chief in Dalton Mass stunningly poo-poos the experts’ warnings about the drug, actually saying, “The DPH and these people, they’re not in the field,” she said. “They don’t respond like we do. They have very controlled clinical environments. We don’t have that luxury. So I appreciate their opinion. My job and our job is to save people’s lives and that’s our priority. We don’t have the luxury of a nice, neat office space or a hospital setting.” She also repeats the completely disproven claim that fentanyl exposure is “a really, really dangerous experience.”
The article discusses the pharmaceutical marketing strategy of going after law enforcement with their large budgets and side-stepping the health professionals. The co-director of the national nonprofit Remedy Alliance/For The People, which sells generic naloxone at cost to organizations, Maya Doe-Simkin, uses the term “opioid epidemic opportunists” to describe the pharmaceutical companies efforts to come up with stronger naloxone formulations, and basing the need for them on anecdote or their own industry-written studies.
How about letting the experts make the call.
The dangers of Opvee are described here in the The American College of Medical Toxicology and the American Academy of Clinical Toxicology position statement.
Fact: Newer synthetic fentanyls do not require more doses of naloxone than traditional to reverse an overdose. While the opposite has been widely reported, studies have refuted this. In Connecticut, a review of EMS data over the years 2020-2023 showed there was no year-to-year increase in naloxone dosing. 84% of patients responded to one full dose or less of naloxone with the one full dose being either 2 milligrams or less by the IV or IM route or 4 milligrams or less by the intranasal route. EMS often gives small amounts of naloxone (less than a full dose) titrated to effect to help avoid precipitated withdrawal. Naloxone just needs to regain 50% of the receptors responsible for breathing to reverse an opioid overdose, and to date no opioid has been found not to respond to naloxone.
Naloxone Dosing After Opioid Overdose in the Era of Illicitly Manufactured Fentanyl
Fact: Just Touching Fentanyl Cannot Kill You
Headlines appear about law enforcement officers rushed to the hospital after being exposed to fentanyl. They were on scene when they encountered piles of powder, some powder got on their skin or some was puffed into the air. They felt faint, some even passed out. What happened? Did their exposure to fentanyl cause them to overdose? No. There is no danger of merely being exposed to fentanyl. For fentanyl to harm you, you have to inject it, snort it or ingest it in significant quantities. It is not absorbed through the skin by casual contact. The skin is an effective barrier to powdered heroin. There are fentanyl dermal pads that are specially manufactured with a gel to enable absorption of the drug through the skim. It can take up to 12 hours for enough fentanyl to absorb through the skill to feel its analgesic effects.
What causes the exposed law enforcement officers to pass out? The nocebo effect. The placebo effect is when someone feels better because they believe a pill is going to be good for them. The nocebo effect is where a person feels badly because they believe a pill is going to be bad for them. None of these police officers who are rushed to the hospital for fentanyl exposure ever test positive for fentanyl. The officers’ signs and symptoms are not consistent with opioid overdose. Their typical complaints involve fainting, rapid heartbeats and nausea, all more indicative of an anxiety attack than an opioid overdose. The root cause is the DEA in 2016 told police officers that just touching fentanyl can kill you. So when they touch or are exposed to it, unless that false information has been corrected to them, they think they are going to die. An anxiety reaction, which can include fainting, is not uncommon in such a situation. On July 27, 2017, the American College of Medical Toxicology and the American Academy of Clinical Toxicology had to issue a joint statement, Preventing Occupational Fentanyl and Fentanyl Analog Exposure to First Responders, stating that “the risk of clinically significant exposure to emergency responders is extremely low.” Eventually the DEA corrected the information, instructing those exposed to simply wash their hands with soap, but the rumor persists. The stories serve only to create hysteria and may prevent someone from helping an overdosed person out of fear of being contaminated.
Carpenter J, Murray BP, Atti S, Moran TP, Yancey A, Morgan B. Naloxone Dosing After Opioid Overdose in the Era of Illicitly Manufactured Fentanyl. J Med Toxicol. 2020 Jan;16(1):41-48. doi: 10.1007/s13181-019-00735-w. Epub 2019 Aug 30. PMID: 31471760; PMCID: PMC6942078. https://pubmed.ncbi.nlm.nih.gov/31471760/
Department of Public Health, Office of Emergency Medical Services, “CT EMS SWORD Statewide Opioid Reporting Directive Newsletter,” CT EMS SWORD Statewide Opioid Reporting Directive Newsletter Issue XLVII (April 2023): 2–4, https://portal.ct.gov/-/media/Departments-and-Agencies/DPH/dph/ems/pdf/SWORD/SWORD-newsletters/2023/SWORDApril2023NL_FINALrev.pdf.
J Melichar, David Nutt, and Andrea L. Malizia, “Naloxone Displacement at Opioid Receptor Sites Measured in Vivo in the Human Brain,” European Journal of Pharmacology 459, no. 2–3 (January 1, 2003): 217–19, https://doi.org/10.1016/s0014-2999(02)02872-8.
Del Pozo B, Rich JD, Carroll JJ. Reports of accidental fentanyl overdose among police in the field: Toward correcting a harmful culture-bound syndrome. Int J Drug Policy. 2022 Feb;100:103520. doi: 10.1016/j.drugpo.2021.103520. Epub 2021 Nov 14. PMID: 34785420; PMCID: PMC8810663. https://pmc.ncbi.nlm.nih.gov/articles/PMC8810663/
https://www.mayoclinic.org/drugs-supplements/fentanyl-transdermal-route/proper-use/drg-20068152
“Roll Call Video Warns About Dangers of Fentanyl Exposure,” May 27, 2022, https://www.justice.gov/opa/video/roll-call-video-warns-about-dangers-fentanyl-exposure.
Moss MJ, Warrick BJ, Nelson LS, McKay CA, Dubé PA, Gosselin S, Palmer RB, Stolbach AI. ACMT and AACT Position Statement: Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders. J Med Toxicol. 2017 Dec;13(4):347-351. doi: 10.1007/s13181-017-0628-2. Epub 2017 Aug 25. PMID: 28842825; PMCID: PMC5711758.
“Fentanyl: The Real Deal | Bureau of Justice Assistance,” Bureau of Justice Assistance, https://bja.ojp.gov/fentanyl-real-deal.
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