Fentanyl can be used as a weapon, but preparation might minimize the damage

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The widely available drug fentanyl, already the number one killer of Americans under 50, could be weaponized and used in terrorist mass poisoning, according to health experts at Rutgers and other institutions.

\”Before fentanyl, the only viable mass poisons were rare and hard-to-access agents like cyanide or nerve agents,\” said Lewis Nelson, chair of the Department of Emergency Medicine at Rutgers New Jersey Medical School and senior author. of the new Frontiers of public health paper. \”Fentanyl can be just as deadly when distributed correctly, and it\’s ubiquitous. A motivated person could easily get enough of it to potentially poison hundreds of people who, uncut, would easily fit in a teaspoon.\”

Unlike biological attacks, in which a weaponized disease could spread globally and kill millions, chemical attacks generally only harm the victim through direct exposure. However, fentanyl\’s high toxicity makes it a viable tool for unleashing a malicious, intentional event on an unsuspecting population.

Attackers with little technical knowledge could introduce the synthetic opioid in fatal doses into building ventilation systems or local food or water supplies. Nelson said it was unlikely to be successful in a large-scale attack, so simply dumping a loaded truck into a reservoir was unlikely to produce significant casualties.

History vividly demonstrates its potential as an aerosolized and inhaled poison. Russian authorities reportedly weaponized a fentanyl-like drug in 2002 after Chechen terrorists seized a crowded theater and threatened to execute hundreds of hostages unless Russia withdrew from Chechnya.

Conventional rescue operations against 40 well-armed and well-fortified captors seemed impossible, so security forces pumped a fentanyl analogue into the theater\’s ventilation system, incapacitating nearly everyone inside. They then stormed the building, shot the terrorists unconscious, and took the hostages for medical treatment.

The operation claimed the lives of 130 hostages and demonstrated the extent of the damage that is possible when fentanyl is used for non-peaceful purposes.

\”We don\’t have effective antidotes against many poisons, but we do have an antidote against fentanyl naloxone poisoning, which also has the brand name Narcan, and the extreme frequency of unintentional fentanyl overdoses means that we now stock this antidote in large quantities in healthcare settings and in pharmacies.” said Nelson.

The frequency of accidental overdose also means that many healthcare professionals and non-medical personnel have learned to recognize the signs of fentanyl poisoning while there is still time to reverse it. The document\’s plan to minimize vulnerability to fentanyl attacks calls for training more healthcare professionals to quickly locate victims and administer naloxone early.

\”Treatment based on clinical findings rather than more definitive tests such as blood test results is generally safe,\” Nelson said. \”If you suspect fentanyl poisoning, give naloxone, and it turns out the poison was another agent, you generally haven\’t injured the patient.\”

The panel\’s response plan relies heavily on such preparatory steps: train more people to recognize poisoning, create channels to report unusual fentanyl poisoning victims, find commonalities among these victims, and eliminate sources to obtain the fentanyl. It also involves devising ways to quickly get many doses of naloxone to where they\’re needed most.

\”We have plenty of naloxone available in metropolitan and rural areas,\” Nelson said. He noted that it is safe to help poisoning victims because fentanyl powder must be inhaled or ingested to injure rescuers, and that is extremely unlikely to happen. There is essentially no risk of rapid absorption through the skin. \”The key in a mass event will be to move naloxone quickly to the scene or into structures that are suddenly overwhelmed with victims. Fentanyl generally kills more slowly than poisons such as cyanide, but still requires rapid action to prevent damage.\”

More information:
Susan M. Cibulsky et al, Public health and medical preparedness for mass casualties due to deliberate release of synthetic opioids, Frontiers of public health (2023). DOI: 10.3389/fpubh.2023.1158479

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