The severity of the opioid epidemic is well-documented. In 2017, the Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths in the United States more than tripled from 1999 to 2015.[1] From 2015 to 2016, opioid overdose deaths increased by more than 20 percent—rising from 52,898 in 2016 to 64,070 deaths in 2017.[2] Additionally, in 2016, U.S. life expectancy declined for the second year in a row caused in part by an increase in unintentional injuries, chiefly drug overdoses.[3],[4] The unintentional use of illicitly manufactured fentanyls (synthetic opioids) alone, or added to heroin, cocaine, or to counterfeit prescription tablets resembling oxycodone or hydrocodone, has been cited as an important driver of the recent increases in opioid overdose deaths.[5],[6] In March, the President announced a new opioid initiative to combat what he termed “worst drug crisis in American history,” declaring it to be a public health emergency,[7],[8] and proposing $10 billion in funding to combat the epidemic.[9]
First responders and other workers are potentially exposed to opioids as a result of their employment and may be at risk of acute opioid intoxication themselves. There have been many reports detailing symptoms first responders have developed when responding to drug overdose incidents in environments where multiple types of illicit drugs may be present.[10],[11],[12],[13] These reports have involved public sector police officers and fire-fighter emergency medical service providers as well as emergency medical service providers that are part of the public safety model but separate from police and fire departments. The National Institute for Occupational Safety and Health has been at the forefront of efforts to protect workers from opioid exposure. A new article published in the American Journal of Industrial Medicine, “Fentanyls and the Safety of First Responders: Science and Recommendations”, provides an in-depth review of opioid pharmacology, probable routes of exposure related to specific job tasks, signs and symptoms of acute opioid intoxication, management of intoxication, and recommended exposure prevention measures. We hope that this commentary assists first responders, police and fire department management, clinicians, and other interested parties in gaining a better understanding of the current scientific basis for existing exposure prevention recommendations as well as emphasizing that any set of recommendations to protect first responders must be based on sound scientific findings.