Fentanyl can be weaponized, but preparation could minimize the damage

The widely-available drug fentanyl, already the primary killer of Individuals beneath 50, may very well be weaponized and used for terroristic mass poisoning, in accordance with well being consultants at Rutgers and different establishments.

“Earlier than fentanyl, the one viable mass poisons have been uncommon and difficult-to-access brokers resembling cyanide or nerve brokers,” stated Lewis Nelson, chair of the Division of Emergency Drugs at Rutgers New Jersey Medical College and senior creator of the brand new Frontiers in Public Well being paper. “Fentanyl could be simply as lethal if correctly disseminated, and it is ubiquitous. A motivated individual might readily acquire sufficient to doubtlessly poison lots of of individuals—which, uncut, would match simply onto a teaspoon.”

Not like organic assaults, during which a weaponized illness might unfold globally and kill thousands and thousands, chemical assaults usually solely hurt the sufferer via direct publicity. Nonetheless, fentanyl’s excessive toxicity makes it a viable software for unleashing a harmful, intentional occasion on an unsuspecting inhabitants.

Attackers with little technical information might introduce the artificial opioid in deadly doses into constructing air flow programs or native meals or water provides. Nelson stated it is unlikely to achieve success in a large-scale assault, so merely dumping a truckload in a reservoir can be unlikely to provide important casualties.

Historical past vividly demonstrates its potential as an aerosolized, inhaled poison. Russian authorities appear to have weaponized a fentanyl-like drug in 2002, after Chechen terrorists seized a crowded theater and threatened to execute lots of of hostages except Russia withdrew from Chechnya.

Standard rescue operations towards 40 well-armed and well-fortified captors appeared unattainable, so safety forces pumped a fentanyl analog into the theater’s air flow system, incapacitating almost everybody inside. They then stormed the constructing, shot the unconscious terrorists, and introduced the hostages for medical care.

The operation left 130 hostages useless and demonstrated the size of hurt that’s potential when fentanyl is used for non-peaceful functions.

“We have now no efficient antidotes to many poisons, however we do have an antidote to fentanyl poisoning—naloxone, which additionally goes by the model identify Narcan—and the intense frequency of unintentional fentanyl overdoses means we now inventory this antidote in giant portions at well being care amenities and pharmacies,” Nelson stated.

The frequency of unintended overdose additionally signifies that many healthcare suppliers and non-medical personnel have realized to acknowledge the indicators of fentanyl poisoning whereas there’s nonetheless time to reverse it. The paper’s plan for minimizing vulnerability to fentanyl assaults requires coaching extra caregivers to identify victims shortly and administer naloxone early.

“Treating based mostly on medical findings relatively than extra definitive checks resembling blood-test outcomes is usually protected,” Nelson stated. “Should you suspect fentanyl poisoning, administer naloxone, and it seems the poison was one other agent, you usually have not harm the affected person.”

The panel’s response plan depends largely on such preparatory steps: coaching extra folks to acknowledge poisoning, creating channels to report uncommon victims of fentanyl poisoning, discovering commonalities amongst these victims, and eliminating the sources for acquiring fentanyl. It additionally includes devising methods to shortly switch many doses of naloxone to the place they’re wanted most.

“We have now a whole lot of naloxone obtainable in metropolitan and rural areas,” stated Nelson. He famous that it is protected to assist poisoning victims as a result of fentanyl powder have to be inhaled or ingested to harm rescuers, and that is exceedingly unlikely to happen. There may be primarily no threat of fast absorption throughout the pores and skin. “The important thing in a mass occasion might be shortly shifting naloxone to the scene or to amenities which can be all of the sudden overwhelmed with victims. Fentanyl usually kills extra slowly than poisons like cyanide, nevertheless it nonetheless requires fast motion to stop hurt.”