Jeanmarie Perrone MD, an emergency physician and medical toxicologist, answers questions from a reporter about the death of a 10-year- old boy in Miami and the dangers of fentanyl exposure.  Hers is a voice of reason in an understandable climate of hysteria.

Miami Boy’s Death Shows Powerful Opioid’s Chilling Potential

The case is tragic.  A 10-year-old boy walking home from the pool somehow encounters fentanyl and on arrival at home, vomits, collapses and dies, and later tests positive for fentanyl and heroin.

Miami chief: no leads, suspects in young boy’s opioid death

Who knows what the final details of the case will be, but the facts of fentanyl exposure remain the same.  Dermal contact is highly unlikely to cause an overdose.  Injection, inhalation or ingestion are the areas of concern.

CDC: Protecting Workers at Risk

The boy did live in a neighborhood known as “ground zero” of the area’s opioid epidemic.  Could he have found heroin/fentanyl on his way home, and either touched the whitish powder (heroin is often cut with sugar or baby...

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The American College of Medical Toxicology and the American Academy of Clinical Toxicology have issued a joint statement on Preventing Occupational Fentanyl and Fentanyl Analog Exposure to First Responders that states “the risk of clinically significant exposure to emergency responders is extremely low.”

The statement addresses reports of responders suffering overdose from handling or being in proximity to these opioids. Hopefully, this joint statement will help reduce some of the concern and hysteria caused by these stories, and prevent unnecessary delays in treating critical patients without endangering responders.

The statement reads:

“To date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids. Incidental dermal absorption is unlikely to cause opioid toxicity.  Reports of emergency responders developing symptoms after contact with these substances have described nonspecific findings such as “dizziness” or “feeling...

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The woman with the cellphone stands outside the car. She explains that the male in the car has been smoking crack, taking benzos and doing heroin for several days. I ask if he is breathing. She says yes, but he is asleep right now. When she picked him at his friend’s house in their suburban town an hour earlier, he was out cold. His friends were going to give him Narcan, but the girl with them said don’t waste it. The girl then punched him hard twice in the chest and put ice in his pants.  I ask what is her relationship to the person in the car. He is my son, she says.

I approach the car. A heavily tattooed man wearing basketball shorts and an NBA jersey is fully reclined in the passenger seat. His mouth is open and his eyes are shut. I can’t tell if he is breathing. A police officer is standing next to me now. He opens the front door, I open the back door. A sternal rub and the man springs forward. “What? What the fuck!” he says. “What’s going on?” He is in his mid-twenties, a powerfully built thick necked young man with short...

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A story published in Slate magazine yesterday questions the assumptions behind the widely reported episode of the Ohio police officer who required four doses of Naloxone after brushing Fentanyl off his shirt.

The Viral Story About the Cop Who Overdosed by Touching Fentanyl Is Nonsense

Written by Jeremy Samuel Faust, an emergency physician at Boston’s Brigham Young Hospital, the story discusses the case with noted toxicologists, including Dr. Ed Boyer of the Harvard Medical School, who says,  “Fentanyl, applied dry to the skin, will not be absorbed. There is a reason that the fentanyl patches took years [for pharmaceutical companies] to develop.”

The story mentions that the widespread coverage of the Ohio episode and others has caused the American College of Medical Toxicology to speed up the publication of their forthcoming position paper on Fentanyl Exposure.

We should all welcome the toxicologists’ entrance into the debate before the viral stories of “life-threatening” encounters cause any more...

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Carfentanil (which had previously been seen in neighboring states) has now been officially identified in Connecticut.  The discovery of this drug 100 times stronger than Fentanyl poses questions: How much danger does Carfentanil (or Fentanyl for that matter) pose to EMS?  How can we in EMS protect ourselves from exposure to these drugs? What should an EMS responder do if they believe they are exposed or one of their coworkers has been exposed?

Every EMS responder should ask these questions and seek answers from both their medical control and from their services.  Unfortunately, I have had a hard time finding a one-stop source of good information on this question.  What follows is my attempt to share what I believe based on what I have read and people I have talked to.  It should not replace the information you get from your service.

Can Fentanyl or Carfentanil kill you?  Yes, they can.  If you inhale a certain amount of powder, you can go into respiratory arrest.  If no one gives you Naloxone or breathes...

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In troubled times in the metropolis, the unexpected rise up and battle the evils that enslave civilizations.  Today, such a tale is playing out on the streets of Hartford.  Behold…Narcan Man!

Few of us were paying attention when it started to happen.  We get called for a overdose at the bus stop, possibly not breathing.  We arrive in minutes.  There he is!  A man sits on a bench, leaning forward, head down.  We approach.  I can see his chest is moving.  Maybe four, six times a minute.  I give him a shake.  He responds slowly.  His eyes are pinpoint.  I recognize him as a regular on Park Street. His face is very pale.  I see some beads of sweat on his forehead.

Hey are you all right?

“Yeah, yeah, I’m fine,” he says.

I give him another shake.

He is breathing better now.

“How much did you do?” I ask.

“I didn’t do anything.  I’m good.  I’m good.”  He stands and looks around the street.  “I’m just.  I’m just tired, that’s all.”

“You know what day it is?”

“Monday,” he says.

Good guess.

“Who’s...

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I called a meeting of the heroin dealers of Hartford at the pavilion in Pope Park. I had no authority to call the meeting since I am neither a heroin dealer nor affiliated with anyone who is.  I just felt like things had hit a critical point where something had to be said.  I admit I was disappointed when no dealers showed.  True about forty men and a smattering of women did come.  They were of various races and tended to dress similarly, hoodies and flat brimmed baseball hats.  But they all assured me they had nothing to do with dealing drugs.  They were opposed to it.  They just came out because they were interested in why I thought there was so much heroin dealing going on in their city.

What are you serious? I said.  Look around.  Just look at the ground.  See all those ripped bags in the grass.  Pick them up, look at them.  Kong, Amazing, Predator.  Howl.  Those are what the dealers package their heroin in.  (I’ll be talking more about those in a minute.)  And look over there, there’s a syringe not 100 feet from the baseball field....

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EMS responders go through more wallets than pickpockets.  Unresponsive person in an alley.  We need to ID them.  Check for a wallet.  Dead person in a hotel.  Got a wallet.  Unresponsive in car.  Check his pockets.  You are looking for the driver’s license, but you can’t help but notice how much cash they are carrying or not.

I will tell you this.  There are a lot of people out there without any green in their wallets.  Particularly opioid users.  Some may have been rolled before we got there, but it seems the same even when we find them in locked bathrooms or cars.  Not a single bill. 

OD in an apartment stairwell.  2 mgs Narcan IN.  Bag for a few minutes.  Comes around.  Immediately goes for his wallet.  It’s not there.  A firefighter holds it.  He has been writing down the demos.  He hands the wallet back to the man, who looks frantically through it.  “Where’s my money?  There was a twenty in there!”

“You were with people when you used?”

“Yeah, my boy,”

“Your boy, here?”

He looks around.  “Where...

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Stroke Care should follow your local medical direction and treatment guidelines.  Here’s how we do it in North Central Connecticut.

EMS Role

When Emergency Medical Services (EMS) recognizes stroke in the field, and notifies the hospital either by radio patch or transmission, the hospital stroke team can be activated prior to the patient’s arrival. With enough notification, the patient can often go directly to CT Scan on the EMS stretcher. This single intervention has led to a marked decrease in door-to-needle time and improvement in patient outcome. The patient can receive an immediate evaluation by hospital neurologists and the decision can be made whether or not the patient meets the criteria for rTPA. The American Heart Association, recognizing the role EMS can play, has established a new goal of door-to-needle time of 60 minutes.  Even if the patient does not meet the narrow criteria for rTPA, the immediate neurological evaluation will lead to swifter interventions such as blood pressure control that will lead to better outcomes.

Stroke...

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Many years ago, the R.J Reynolds tobacco company got into trouble with its Joe Camel campaign, which featured a cool cartoon camel in human clothing who like to smoke.  The ad campaign was controversial because it seemed to target kids.  The American Medical Association tried to get the company to shut down Joe Camel after a study showed as many six-year-olds knew that Joe Camel was associated with cigarettes as Mickey Mouse was associated with Disney.  Sales statistics backup up a huge increase in underage sales of cigarettes that were also disproportionately camels.  Tobacco company documents were made public that revealed they were indeed targeting kids.  Finally, in 1997, they terminated the campaign and settled to the tune of $10 million dollars to be targeted to teen smoking prevention efforts.

The heroin industry in Hartford seems to be taking a similar tack these days and it is quite disconcerting.  Among the brands to hit the streets in recent weeks are Bugs Bunny, Hello Kitty, Dino babies and Smurfs to go along with the previously...

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