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Fentanyl Briefing Guide For First Responders
Fentanyl Briefing Guide For First Responders
n
U.S. Department of Justice
Drug Enforcement Administration
Fentanyl
FURANYL-FENTANYL·ACRYL-FENTANYL·ACETYL-FENTANYL
A Briefing Guide
for First
Responders
CONTENTS
History of Fentanyl 3
Fentanyl Detection 17
Resources 19
Disclaimer
This document contains recommendations on potential best practices for first responders that
may encounter, test and transport exhibits that could contain fentanyl-related substances. It
also contains recommendations for handling and processing of crime scenes and non-drug
evidence, like money, that could be contaminated. This interim guidance is intended for
educational and awareness purposes only, and should not to be treated as technical guidance
related to the handling and processing of fentanyl.
UNCLASSIFIED 1
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
EXECUTIVE SUMMARY
In the last several years, U.S. Law Enforcement has seen a dramatic increase in the availability
of dangerous synthetic opioids. A large majority of these synthetic opioids are structural
derivatives of the synthetic drug “fentanyl.” Fentanyl is a synthetic opioid currently listed as a
Schedule II prescription drug that mimics the effects of morphine in the human body, but has
potency 50–100 times that of morphine. Due to the high potency and availability of fentanyl,
both transnational and domestic criminal organizations are increasingly utilizing these
dangerous synthetic opioids as an adulterant in heroin and other controlled substances. The
presence of these synthetic opioids in the illicit U.S. drug market is extremely concerning as the
potency of these drugs has led to a significant increase in overdose incidents and overdose-
related deaths throughout the nation.
WARNING
There is a significant threat to law enforcement personnel, and other first responders, who
may come in contact with fentanyl and other fentanyl-related substances through routine
law enforcement, emergency or life-saving activities. Since fentanyl can be ingested orally,
inhaled through the nose or mouth, or absorbed through the skin or eyes, any substance
suspected to contain fentanyl should be treated with extreme caution as exposure to a small
amount can lead to significant health-related complications, respiratory depression, or death.
UNCLASSIFIED 2
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
UNCLASSIFIED 3
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
for Disease Control (CDC) reported 33,091 processing and distribution. Seizures
deaths in 2015 which were the result of indicate that China supplies lower volumes
opioid overdoses alone. Of those deaths, of high-purity fentanyl, whereas fentanyl
9,580 were caused by synthetic opioids seizures from Mexico are higher volume but
other than methadone, which includes lower in purity. Fentanyl is also routed and
fentanyl and fentanyl-related substances - smuggled through Canada. China-based
an increase of 72.2 percent over previous trafficking organizations have also been
years. known to use the internet to distribute
fentanyl, fentanyl-related substances, and
synthetic opioids globally.
“… (CDC) reported
Given China’s role as an exporter of illicit
33,091 deaths in 2015
fentanyl products destined for the United
which were the result
States, DEA officials recently met with
of opioid overdoses Chinese officials in Beijing. This meeting
alone. Of those prompted China to regulate four fentanyl-
deaths, 9,580 were related substances under Chinese law,
caused by synthetic effective March 1, 2017, in an effort to help
opioids …” stem the flow of these dangerous synthetic
opioids into the United States.
While pharmaceutical fentanyl in the form In 2014, the DEA established the Heroin-
of transdermal patches or sublingual tablets Fentanyl Task Force (HFTF). The HFTF
is diverted on a small scale, the current consists of several government agencies
increase in opioid-related deaths appears to working together to facilitate a “whole of
be driven by illicitly produced fentanyl government” approach to the fentanyl and
products. synthetic opioid epidemic in the United
States.
Due to the high potency of fentanyl and
other synthetic opioids, transnational The HFTF currently consists of personnel
criminal organizations across the globe are from the DEA, HSI, CBP, FBI, USPIS, and the
competing for the U.S. market. China and IRS. The HFTF is using every available
Mexico appear to be the main source resource to support U.S. law enforcement
countries for illicit fentanyl smuggled into agencies in their respective synthetic opioid
the United States for domestic-based investigations.
UNCLASSIFIED 4
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
Canada
U n ited States
C hina
Mexico
1 Fentanyls in powder form and pill presses are shipped via mail service .s
2. T h e powder fentanyls are processed and m ixed with heroin, or sold
as heroin, or pressed into pills and sold in the C anadian drug market.
2 a Som e fentanyl products are smuggled from C anada into the United
States for sale, on a smaller scale .
3 T h e powder fentanyls are processed and mixed with heroin . or sold
as heroin, or pressed into pills and sold in the United States drug market.
4 Th e powder fentanyls are cut and diluted for further sm ugglin g , or
pressed into counterfeit prescription p ills .
4a Diluted powder fentanyls and counterfeit prescription pilI s containing
fentanyl are sm uggled from Mexico into the United States .
5 Precursors for manufacturing fentanyls are shipped via mail services .
6 Precursors are used to manufacture fentanyls in clandestine laboratories .
P recursors are sm uggled across the Southwest border into Mexico
7
to manufacture fentanyls.
8 Precursors are used to manufacture fentanyls in clandestine laboratories.
SECTION II
Description of Fentanyl-Related
Fentanyl and fentanyl-related substances
Substances
have potency much greater than that of
morphine, but effects can vary greatly
Legal forms of fentanyl are prescribed depending on the identity, potency, and
with, or as a replacement for, morphine and purity level of the substances encountered.
are used in both human and veterinary
medicine as an anesthetic during surgery, to While fentanyl may be 50-100 times more
manage pain after surgery, and to treat potent than morphine, and 30-50 times
chronic pain in patients physically tolerant more potent than heroin, carfentanil, which
to other pain killers. is structurally related to fentanyl, is up to
10,000 times more potent than morphine.
Illicit forms of fentanyl have been, and The toxic dose of carfentanil in humans is
continue to be, identified in conjunction unknown. Regardless, any substance
with heroin, as a replacement for heroin, or suspected to contain fentanyl should be
in the production of counterfeit treated with extreme caution as exposure
pharmaceutical tablets which mimic to a small amount can lead to significant
oxycodone, hydrocodone, and alprazolam health-related complications, or death.
products.
UNCLASSIFIED 5
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
UNCLASSIFIED 6
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
● Powder
● Pill
● Capsule
● Liquid
● (and on) Blotter Paper
UNCLASSIFIED 7
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
During the 1st quarter of 2017, the DEA laboratory system had 230 identifications of fentanyl,
fentanyl-related substances, and other synthetic opioids based on seized drug evidence.
Fentanyl accounted for approximately 58 percent of the identifications. The second most
prominent fentanyl-related substance was furanyl-fentanyl, which accounted for 26 percent of
the identifications. Of all 230 exhibits, heroin was found in combination with fentanyl in 61
percent of the identifications, while U-47700, alprazolam, ketamine and cocaine were found in
other fentanyl-related exhibits in varying degrees.
OPIOIDS/
ANALGESICS
THERE WERE 230 IDENTIFICATIONS OF FENTANYL, FENTANYL-
RELATED SUBSTANCES, AND OTHER SYNTHETIC OPIOIDS. FENTANYL
ACCOUNTED FOR APPROXIMATELY 58% OF THE IDENTIFICATIONS.
THE NEXT MOST PROMINENT FENTANYL-RELATED SUBSTANCE,
FURANYL FENTANYL, ACCOUNTED FOR 26% OF THE
IDENTIFICATIONS. NO NEW OPIOIDS WERE IDENTIFIED THIS QUARTER.
OF THE 134 FENTANYL IDENTIFICATIONS, FENTANYL WAS FOUND AS THE
ONLY CONTROLLED SUBSTANCE IN APPROX 28%
OF THE
IDENTIFICATIONS AND WAS FOUND IN COMBINATION WITH HEROIN
4-ANPP 2
Acetylfentanyl 5
Other controlled substances identified
with fentanyl this quarter include
Carfentanil 6 U-47700, alprazolam , heroin,
ketamine, and cocaine.
Acryl fentanyl 9
U-47700 14
Furanyl fentanyl 60
Fentanyl 134
UNCLASSIFIED 8
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
evidence (e.g., drug proceeds, pill presses, L e v e l A PPE: Level “A ” su it and a self-
scales, or drug paraphernalia) which may be contained breathing
apparatus
contaminated with these substances.
UNCLASSIFIED 9
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
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UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
UNCLASSIFIED 11
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
Incidents of Overdose and Death After assessing the scene, should fentanyl
be suspected, on-site personnel should
First responders should always employ employ the above described safety
universal safety precautions and use, at a protocols referenced under General Safety
minimum, Personal PPE when they arrive at Recommendations as appropriate,
a scene where there has been a suspected depending on the potential level of
overdose incident, or suspected overdose contamination.
death.
First responders should also be mindful of
Assessment the potential “Fentanyl Footprint” in their
respective jurisdictions, which are clusters
Upon arrival, personnel should carefully of overdoses and overdose deaths occurring
examine the environment and situation within a small geographic area, within 48-72
before proceeding in order to detect any hours. Based on incident reporting and
signs of fentanyl contamination. analysis, this could possibly indicate
fentanyl or fentanyl-related substances
Indicators being present.
UNCLASSIFIED 12
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
UNCLASSIFIED 13
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
UNCLASSIFIED 14
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
UNCLASSIFIED 15
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
Fentanyl can be ingested orally, inhaled naloxone by personnel trained in its use.
through the nose or mouth, or absorbed Naloxone is an antidote for opioid
through the skin or eyes. Overdose overdose. Immediately administering
symptoms can include drowsiness, naloxone can reverse an opioid overdose.
disorientation, sedation, pinpoint pupils,
skin rash, clammy skin, and respiratory Depending on the drug’s purity and potency
depression or arrest. The onset of these multiple doses of naloxone may be required
symptoms usually occurs within minutes. to stabilize the victim. Continue to
administer a dose of naloxone every 2-3
minutes until the individual is breathing on
his/her own for at least 15 minutes, or until
“Overdose symptoms EMS arrives.
include drowsiness,
disorientation, sedation, As a best practice, it is recommended that
anyone who has entered a grossly
pinpoint pupils, skin rash,
contaminated environment, or otherwise
clammy skin, and
been exposed to a suspected fentanyl-
respiratory depression or related laboratory or milling operation
arrest.” without wearing proper PPE should undress
and shower, using soap and water, as soon
as possible. It is recommended that grossly
contaminated clothing be bagged and
destroyed as soon as possible.
If an exposure occurs, seek immediate
medical attention as fentanyl and other If a suspected fentanyl-related substance
fentanyl-related substances can be very has been inhaled, move the victim to fresh
fast-acting. In cases of suspected exposure, air.
contact emergency medical services (EMS),
or, if feasible, have EMS on scene prior to If a suspected fentanyl-related substance
conducting enforcement activity. has been ingested through the mouth or
eyes and the victim is conscious, rinse the
If an exposure occurs, remove the exposed victim’s eyes and mouth with cool water.
individual from the contaminated
environment (preferably to a location with Where there has been any skin contact,
fresh air). If they exhibit overdose wash the exposed area immediately with
symptoms, immediately administer soap and water.
UNCLASSIFIED 16
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
https://www.dea.gov/media.shtml
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UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
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UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
RESOURCES
www.dea.gov
www.deadiversion.usdoj.gov
www.cdc.gov
www.cdc.gov/drugoverdose/opioids/fentanyl.html
www.emergency.cdc.gov/han/han00384.asp
www.cdc.gov/niosh/
www.drugabuse.gov
www.drugabuse.gov/publications/drugfacts/fentanyl
www.drugabuse.gov/drugs-abuse/fentanyl
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