March 7, 2018 by Mike Wiebe, Partner & General Manager, Trauma Scene Bio Services
What is fentanyl?
Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more toxic. When used legitimately, it is a Schedule II prescription drug and it is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.
In its prescription form, fentanyl is known by such names as Actiq, Duragesic, and Sublimaze. Street names for fentanyl or for fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango & Cash.
The illustration above shows how some nerves make opioids (endorphins) send a signal to other nerves. Narcotics (exogenous opiates) mimic this signal, turning down the activity of a nerve involved in sensing pain. Naloxone (Narcan) is a short-acting drug, which will bring a patient out of an opiate overdose by stripping the opiate from the opiate receptor. It is a life-saving drug. Naltrexone, a short acting opiate/alcohol blocking agent has been used for the last 30 years.
All narcotics work basically the same way fentanyl works, by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions. When opioid drugs bind to these receptors, they can drive up dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation.
So what’s the difference between morphine and fentanyl? The major differences relate to how the drug is handled by the body. Fentanyl attaches much more tightly to the opiate receptors than morphine, so you need much less drug to ease the same amount of pain (in fact, fentanyl is about 100 times more potent than morphine). But fentanyl doesn’t last as long in the body. A dose of morphine can kill pain for four to six hours, compared to only an hour or so for a single dose of intravenous fentanyl.
Origin and Production
Fentanyl is mainly produced by chemists in China. It is shipped in bricks, or kilos. One kilo of fentanyl, when cut at a ratio of one part fentanyl to 100 parts filler (such as caffeine), will produce approximately a million pills. There are estimated to be 1,400 analogs of fentanyl with only 200-plus that have been synthesized and studied.
It is odourless and tasteless and therefore hard to detect. In one study, the “NIK” (Narcotic Identification Kits) correctly identified fentanyl in only two out of 10 cases. An ion scanner, when correctly set up, will identify fentanyl and various analogs of fentanyl 99.97 percent of the time.
One of the most dangerous things about fentanyl (or any drug or bio hazard) is cross-contamination. In a fentanyl remediation we conducted earlier this year, the drug producer living in the two-bedroom apartment had been walking in and out of the unit, contaminating the hallways, the elevators and other common areas of the building.
In this particular case, fentanyl (and carfentanyl) had been cut with caffeine and was being placed in capsules instead of pressing it into pills. Fentanyl powder and residue was extensive throughout the kitchen and living room as well as the bedroom, where the producer had been using and ultimately overdosed and died.
After the apartment was secured and locks changed, we received the call to assess the situation. We were immediately concerned about the traffic area between his fourth floor apartment and the foyer and entrance on the main floor. This had all been contaminated by footwear used in the apartment.
We had to decontaminate the entire hallway, the elevator, both stairwells leading to the main foyer, as well as the hallways from the elevator and stairwells to the foyer. This was completed in a three-step process with a commercial extractor using our bio-wash solution as the encapsulating agent. The contaminated solution is contained and later discarded at the biohazard waste area designated at the municipal waste management station.
Now we could set up our zones in the hallway and apartment: red for the contaminated area, yellow for the transitional area and green for the decontaminated area. The PPE (personal protective equipment) required for such a decontamination process must be very thorough—from booties, Tyvek suits, double nitrile gloves, full-face respirators, and wrists and ankles duct-taped to prevent outside contaminants from entering. The hazard assessment completed, now the remediation of the contaminated apartment began.
The encapsulating solution we use was tested on actual fentanyl, wet and dry, using an ion scanner that had been programmed for five to seven different analogs of fentanyl. After spraying the fentanyl with our encapsulating solution and wiping only once with our biohazard wipes, the ion scanner reported a 99.997 percent loss of detection. The ion scanner will measure down to the nanogram. The fact that we bio-wash all contaminated hard surfaces with solution twice and once with a clean rinse wipe, clearly indicates the elimination of any fentanyl presence after our remediation process is complete.
Fentanyl remediation is a process foreign to restoration companies. Trauma Scene Bio Services specializes in only trauma and crime scene biohazards, which includes drug labs, and fentanyl. Based on this two-bedroom decontamination, our fentanyl remediation process has been examined and approved by Alberta Health Services. Their results stated that our process went above and beyond their expectations. As a result, they will be using our remediation process as a guideline and precedent going forward.
Education and awareness
The key to ensuring safety in our communities is awareness education. Fentanyl drug labs are increasing in Canada, and they have been found just about anywhere—in rented homes and apartments, motel rooms, rental vehicles, abandoned buildings, barns and garden sheds.
Everyone should be alert for signs of a potential fentanyl drug lab operation, including: an unusual amount of white or coloured powder on walls or floors; unusual thumping sounds that could indicate a pill press machine; chemical odours—often a strong vinegar smell; tenants reluctant to allow landlords to inspect the property; payment of rent in cash; surveillance cameras; curtains always drawn and exhaust fans running at odd times. Residents may wear filtration masks, safety glasses or other protective equipment, commenting that they are “painting”.
If you suspect a clandestine fentanyl lab operation, leave the area immediately. Do not investigate. Do not enter the premises. Contact your local police.
Mike Wiebe is Partner & General Manager of Trauma Scene Bio Services