Purpose
- Identify the risks illicit fentanyl and its analogues pose to healthcare personnel who could come into contact with these drugs.
- Identify the healthcare occupations at risk.
- Identify the potential exposure routes of greatest concern to healthcare personnel.
Risks
Illicit fentanyl and its analogues (for the purpose of this document, referred to as illicit fentanyl) pose a potential hazard to healthcare personnel who could come into contact with these drugs in the course of their work in hospital and clinic settings. This potential risk, which is related to external sources of fentanyl (i.e., originating in the community), is distinct from the hazards posed by diversion of pharmaceutical fentanyl (which is used in many healthcare settings as part of routine patient care; see for information related to drug diversion).
Occupations at risk
Healthcare personnel who could potentially be exposed to illicit fentanyl include nurses, nursing assistants, physicians, technicians, therapists, phlebotomists, pharmacists, students, and trainees. Healthcare personnel not directly involved in patient care, but who could potentially be exposed to illicit fentanyl in the healthcare setting, include clerical, dietary, environmental services, laundry, security, engineering and facilities management, administrative, billing, and volunteer personnel. Possible exposure routes to illicit fentanyl vary based on the source and form of the drug. Healthcare personnel might be exposed when the patient or their personal items are contaminated with illicit fentanyl, which may be present in powder, tablet, or liquid forms. While the clinical findings for a person presenting with fentanyl (or other opioid overdose) may be wide-ranging, respiratory depression or arrest, disorientation or stupor, and pinpoint pupils (miosis) generally suggest severe opioid toxicity.
Exposure routes
Potential exposure routes of greatest concern include inhalation of powders or aerosols, mucous membrane contact, ingestion, or exposure secondary to a break in the skin (for example a needlestick). Any of these exposure routes can potentially result in a variety of symptoms that can include the rapid onset of life-threatening respiratory depression. Skin contact is also a potential exposure route but is not likely to lead to overdose unless exposures are to liquid or to a powder over an extended period of time. Brief skin contact with illicit fentanyl is not expected to lead to toxic effects if any visible contamination is promptly removed.