# San Diego sheriff fentanyl overdose



## CbrMonster (Aug 7, 2021)

Sheriff's deputy overdoses after exposure to fentanyl during arrest
					

The video was released by the San Diego County Sheriff's Department to promote public safety.




					www.google.com
				










So after watching this, seems like the weirdest overdose I’ve seen, just looking at physical presentation of the patient.

I’ve never seen anyone eyes open, and holding their arms up after overdosing, usually get the wet noodle limp, pale cool cyanotic ect

i did some research, is this one of those “rare” wooden chest syndrome (chest wall rigidity) reactions and would that also explain the arms?

What’s your thoughts?


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## mgr22 (Aug 7, 2021)

I can't access the video, but I can tell you that standing close to Fentanyl in its natural state would, by itself, almost never lead to an OD.


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## CbrMonster (Aug 7, 2021)

mgr22 said:


> I can't access the video, but I can tell you that standing close to Fentanyl in its natural state would, by itself, almost never lead to an OD.


Attached a YouTube link, looks to have been touching it without gloves hands, just seems weird


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## E tank (Aug 7, 2021)

hmmmmm......odd story all around...but too much fentanyl doesn't mean immediate, flaccid, unconscious apnea...a witnessed event like this with immediate treatment certainly could happen before the former events. Probably aerosolized in the vehicle.


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## CbrMonster (Aug 7, 2021)

E tank said:


> hmmmmm......odd story all around...but too much fentanyl doesn't mean immediate, flaccid, unconscious apnea...a witnessed event like this with immediate treatment certainly could happen before the former events.


Also true, working prehospital generally don’t see moments leading up to the event, only the aftermath


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## E tank (Aug 7, 2021)

CbrMonster said:


> i did some research, is this one of those “rare” wooden chest syndrome (chest wall rigidity) reactions and would that also explain the arms?
> 
> What’s your thoughts?


Wooden chest, IMO, is probably an iteration of a drug induced myoclonus. Not uncommon with a lot of drugs that affect the central nervous system including hypnotics like propofol and etomidate. So, yeah, there could be an element of that in this case.


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## CbrMonster (Aug 7, 2021)

E tank said:


> Wooden chest, IMO, is probably an iteration of a drug induced myoclonus. Not uncommon with a lot of drugs that affect the central nervous system including hypnotics like propofol and etomidate. So, yeah, there could be an element of that in this case.


Interesting, we give fent pretty often, I’ve never seen the chest wall rigidity reaction, but I’m also very conservative with how much I push at any given time same with the myoclonus, admittedly I had to look that one up. learn something new everyday.

I assume with versed it’s possible to have myoclonus, or would the versed typically prevent that as well as it’s own MOA?


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## E tank (Aug 7, 2021)

CbrMonster said:


> Interesting, we give fent pretty often, I’ve never seen the chest wall rigidity reaction, but I’m also very conservative with how much I push at any given time same with the myoclonus, admittedly I had to look that one up. learn something new everyday.
> 
> I assume with versed it’s possible to have myoclonus, or would the versed typically prevent that as well as it’s own MOA?


You need to approach around 10 - 15 mcg/kg  delivered fentanyl before you'd start to suspect this type of phenomenon. You don't see myoclonus with big doses of versed, at least I never have.

The mechanisms are not well/not understood, but we don't see this 'wooden chest' very often in the hospital when we do use these big doses of fentanyl (or analogues) because the patient has also usually received some versed which, again, IMO, mitigates that type of side effect. 

Similarly, with induction doses of 'naked' propofol (that is, without any pre-induction sedation) you see more myoclonus than you might with sedation.


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## CbrMonster (Aug 7, 2021)

E tank said:


> You need to approach around 10 - 15 mcg/kg  delivered fentanyl before you'd start to suspect this type of phenomenon. You don't see myoclonus with big doses of versed, at least I never have.
> 
> The mechanisms are not well/not understood, but we don't see this 'wooden chest' very often in the hospital when we do use these big doses of fentanyl (or analogues) because the patient has also usually received some versed which, again, IMO, mitigates that type of side effect.
> 
> Similarly, with induction doses of 'naked' propofol (that is, without any pre-induction sedation) you see more myoclonus than you might with sedation.


ah ok, I usually do 50mcg increments, most refuse or say they’re ok at 1 of 50mcg, sometimes they want more but it’s rare.

but we have the standing order to push x1 100mcg with 2x50mcg after that totaling 200mcg.

this leads me into another question, 

say you get this chest wall rigidity response, how does one correct this without paralytics we do not have rsi in my county. From what I’ve read narcan will not reverse the rigidity and can potentially last 10-15+ minutes. We can request for flight medics but that is also  30 minute response times.


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## mgr22 (Aug 7, 2021)

Have a look at this article:









						Opinion | Opioid Hysteria Comes to Massachusetts Courts (Published 2018)
					

A new policy based on a delusion will worsen what is already a dire public health crisis.




					www.nytimes.com
				




It may explain what happened at the scene you mentioned.


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## CbrMonster (Aug 7, 2021)

Have a look at this article:


mgr22 said:


> Opinion | Opioid Hysteria Comes to Massachusetts Courts (Published 2018)
> 
> 
> A new policy based on a delusion will worsen what is already a dire public health crisis.
> ...


Unable to read it, I don’t have a subscription

Also have been indulging in this article 









						Noradrenergic Mechanisms in Fentanyl-Mediated Rapid Death Explain Failure of Naloxone in the Opioid Crisis
					

In December 2018, the Centers for Disease Control declared fentanyl the deadliest drug in America. Opioid overdose is the single greatest cause of death in the United States adult population (ages 18–50), and fentanyl and its analogs [fentanyl/fentanyl ...




					www.ncbi.nlm.nih.gov


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## E tank (Aug 7, 2021)

mgr22 said:


> It may explain what happened at the scene you mentioned.


Pay wall...summary? If you're suggesting that the deputy succumbed to some kind of psychogenic hysteria at the suggestion by the other deputy that he was in danger, that question could have been easily answered by the urine tox screen that the treating physician at the receiving hospital undoubtedly ordered. 



CbrMonster said:


> ah ok, I usually do 50mcg increments, most refuse or say they’re ok at 1 of 50mcg, sometimes they want more but it’s rare.
> 
> but we have the standing order to push x1 100mcg with 2x50mcg after that totaling 200mcg.
> 
> ...


You're not going to see this with those doses.

Were you to see that phenomenon in the very early stages of an overdose with this type of drug it would be Narcan and OPA with aggressive jaw thrust while someone else gave continuous positive pressure with the bag. It would break...but you'd better make sure there wasn't a foreign body occluding the airway...that could be embarrassing...


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## mgr22 (Aug 7, 2021)

I'll PM both of you copies.


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## CCCSD (Aug 7, 2021)

Ah. More decisions about things no one was there to see. Accusations that cops are hysterical. Good thing narcan isn’t regulated to ALS, otherwise there’d be some dead bodies across the land.


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## EpiEMS (Aug 7, 2021)

CbrMonster said:


> So after watching this, seems like the weirdest overdose I’ve seen, just looking at physical presentation of the patient.



Some sort of neurally mediated vasovagal syncope caused by (undue) anxiety.


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## CbrMonster (Aug 7, 2021)

CCCSD said:


> Ah. More decisions about things no one was there to see. Accusations that cops are hysterical. Good thing narcan isn’t regulated to ALS, otherwise there’d be some dead bodies across the land.


I’m just trying to learn because it seemed off and we frequently run on fentanyl overdoses at the numerous casinos including dealers with also large quantities of drugs


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## CbrMonster (Aug 7, 2021)

EpiEMS said:


> Some sort of neurally mediated vasovagal syncope caused by (undue) anxiety.


I’m not gonna lie I was considering this at first with presentation and then found out about muscle rigidity. Obviously wasn’t there so everything is with a grain of salt.


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## Akulahawk (Aug 7, 2021)

EpiEMS said:


> Some sort of neurally mediated vasovagal syncope caused by (undue) anxiety.


Pretty much this.


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## EpiEMS (Aug 7, 2021)

For reference 
	

		
			
		

		
	






In short, don’t worry too much about it.


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## E tank (Aug 7, 2021)

So ultimately the question is "Did the San Diego County Sheriff compel the deputy to lie on video for public distribution about his inadvertent opioid overdose (thus implicating himself of mishandling evidence against protocol), lie about his treatment and, as a result,  be publicly humiliated as a result of his lack of proper handling of an illegal controlled substance. 

 If that is so, that deputy should call his union, 'cause he'll never have to work a day in his life again, courtesy San Diego county...

Or, all of the deputies and the sheriff are complicit in a public disinformation conspiracy....

Like I said above...the treating hospital should be able to provide the urine tox screen that shows that the deputy had actually overdosed and clear this up once and for all.... If the hospital doesn't come forward, they're complicit too....


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## Fezman92 (Aug 8, 2021)

As a BLS provider, what should I take away from this? Also the deputy had such a reaction because of the drug or some kind of severe anxiety attack? I’m still a bit confused.


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## Jim37F (Aug 8, 2021)

Could be the Fent, could be a poly pharm overdose if the drug bust they were inventorying had that (which is not exactly unlikely). So the hospital tests come back and show some Fent and so the cops are all like "Yup that's it" even if there was more than that present. Drug dealers aren't exactly known for ensuring they only have non toxic safe materials to cut with their drugs... So yeah, could very easily have gotten a mix of stuff in doses not meant for a single person in that one sitting if he was handling a large (well more than just a single person's personal use stash) bust and had a hole in his gloves..

Personally I highly doubt anxiety would produce this sort of reaction in and of itself


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## mgr22 (Aug 8, 2021)

Consider this quote from the victim: "I was trying to gasp for breath, but I couldn't breathe at all." To me, that sounds like something other than an opiate OD. However, if the video helps discourage the public from abusing narcotics, I suppose it's worth publicizing.


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## ffemt8978 (Aug 8, 2021)

mgr22 said:


> Consider this quote from the victim: "I was trying to gasp for breath, but I couldn't breathe at all." To me, that sounds like something other than an opiate OD. However, if the video helps discourage the public from abusing narcotics, I suppose it's worth publicizing.


Discouraging narcotics abuse with possibly false information will do more harm in the long run, and we should not be condoning such actions.


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## mgr22 (Aug 8, 2021)

ffemt8978 said:


> Discouraging narcotics abuse with possibly false information will do more harm in the long run, and we should not be condoning such actions.


Publicizing the video isn't condoning the video or the possibly false information in it; it's highlighting the video and encouraging discussion of what it contains, which is what the OP did yesterday and at least one major newspaper has done this morning.


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## CbrMonster (Aug 8, 2021)

mgr22 said:


> encouraging discussion of what it contains, which is what the OP did yesterday


This was my intent, just purely seeking deeper thought, as I’ve quite literally have never seen a reaction like what this cop had from opiates/synth opiates. I can see a rookie and large amounts of very powerful drugs causing heightened anxiety, that’s seems to be a totally reasonable reaction, maybe not for someone seasoned.

I would like to not think that cops in this day and age would fake or intentionally distribute things not factual.

i truly would be interested too see his tox screen and to see what levels of what were in his system. Maybe that could explain his signs and symptoms presentation ect.

Nbc news calls bs per experts at this being an overdose and calling it psych 









						Viral video of San Diego deputy's fentanyl exposure raises questions
					

Some experts expressed doubts about the scenario. "You can't just touch fentanyl and overdose," physician Ryan Marino said.




					www.nbcnews.com


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## DrParasite (Aug 9, 2021)

Stolen from FB.....


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## CCCSD (Aug 9, 2021)

And this crap is WHY I teach cops not to ever allow “EMS” to second guess their decisions.


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## DrParasite (Aug 9, 2021)

CCCSD said:


> And this crap is WHY I teach cops not to ever allow “EMS” to second guess their decisions.


because... EMS doesn't treat panic attacks with 16mg of narcan?


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## DrParasite (Aug 9, 2021)

Let's look at this objectively:
1) EMS doesn't administer Narcan to wake up overdoses.  we do it to restore respirations.  did the cop stop breathing?  not sure, but it doesn't look like he was turning cyanotic.
2) this was done following a traffic stop.  how did the vehicle occupants not overdose while they were driving in the car (I believe the deputies said there was white powder everywhere), yet after a few minutes of exposure, this deputy is ODing multiple times, including in the ambulance?
3) Assuming it was a fentanyl OD, was it preventable?  Should the PO have been wearing an N95 to prevent inhaling it, and latex gloves to prevent absorption?  In the covid times, every public safety professional should have at least these on their person.
4) they administered 16mg of narcan to this conscious cop, and when EMS arrived, he started ODing again in the ambulance?  that's impressively potent stuff.  But realistically, even if it wasn't a Fent OD, it's highly unlikely that it had any negative effect on the patient.  So.... yay on the cops?  but maybe they could use some education on what a Fentanyl OD looks like?  By an actual toxicologist or medical professional, not someone who just repeats the crap they read about on social media or internal communications.

the DEA put out some bad information about fentanyl a while ago, and it's causing cops to have episodes that are blamed on instant overdoses.  there have been numerous documented cases of this, with most of the time, the toxicology report doesn't back it up. I don't expect the hospital to release the tox report (HIPAA requirements and such), especially if it paints the officer in a not so great light.  but the SO was able to make a PR video about it, it made one cop look like a hero (he'll probably get a medal for it), and to the uneducated public, it shows how dangerous fentanyl can be when used as a street drug.


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## GMCmedic (Aug 9, 2021)

CCCSD said:


> And this crap is WHY I teach cops not to ever allow “EMS” to second guess their decisions.


Not sure where you're going with this, but police decisions do not effect my treatment decisions. They certainly don't "allow" me to do anything.


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## Fezman92 (Aug 9, 2021)

I'm still confused as to what caused the reaction that the cop had.


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## hpclayto (Aug 9, 2021)

It's a shame we'll never be able to see the tox screen on this.


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## Carlos Danger (Aug 9, 2021)

There may have been fentanyl involved here, but I'd say there is definitely more going on in the video than just a fentanyl OD. Fentanyl in large doses _reliably_ causes prompt CNS depression and usually muscle relaxation and loss of reflexes, especially in a person who is not opioid-tolerant, and those doses don't actually even have to be huge. That's why you can do the smoothest of inductions with 3mcg/kg of remi and a few mg of versed or a little propofol and no relaxant at all (just watch out for the BP). So I don't see how you could have brain concentrations of fentanyl sufficient to cause any type of profound reaction while still maintaining consciousness and respiratory drive.

Keep in mind though that there are many opioid receptors and receptor subtypes and many more opioid agonists out there than just fentanyl. Some of these chemicals in high doses would cause presentations very different from what we normally think of with opioids. Delta receptor agonists, for instance, can cause seizures. Kappa receptor agonists can cause dissociative effects. There are probably some agonists or combination of agonists that can cause severe myoclonus without a large degree of CNS depression. Confusion and anxiety are probably very easy to induce with these drugs. Given the lack of quality control and purity involved in the manufacture of these drugs, it doesn't seem unlikely that there was more in the "fentanyl" than just fentanyl, including things that may not have been detected by the tox panel.

It's quite possible that this guy was exposed to some fentanyl, but I'd wager that isn't what caused the presentation in the video.


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## Carlos Danger (Aug 9, 2021)

Duplicate post


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## Tigger (Aug 9, 2021)

“And this crap is WHY I teach cops not to ever allow “EMS” to second guess their decisions.”
I don’t tell cops how to do their jobs, I expect the same courtesy. This wasn’t an overdose. The end.


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## DrParasite (Aug 10, 2021)

A comment stolen from social media, posted by someone smarter than me:


> The drug dealer that sells that must be easy to spot. He would need to wear a Level A hazmat suit. It’s interesting that the symptoms started after he heard that it might be fentanyl.



and some factual information from the article @CbrMonster linked to above, that should be mandatory reading for @CCCSD , the DEA, and all LEOs who might come in contact with drugs:


> "We have a lot of scientific evidence and a good knowledge of chemical laws and the way that these drugs work that says this is impossible," said Ryan Marino, medical director for toxicology and addiction at University Hospitals in Cleveland.
> 
> "You can't just touch fentanyl and overdose," he said. "It doesn't just get into the air and make people overdose."
> 
> ...


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## johnrsemt (Aug 10, 2021)

I have wondered that for years:

An officer drives a drug dealers car to impound and OD's because he touched the steering wheel:  the same steering wheel that didn't kill the dealer for the last few months.
OR
officers on a raid knock over a table and Fentanyl spills and 5 officers drop unconscious,  but the dealers that were cutting drugs  in the room for that last 2 weeks weren't bothered.
Etc., etc., etc.,.

The only ones that are believable are the dog's that OD because of their noses.


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## Fire 612 (Sep 6, 2021)

E tank said:


> You need to approach around 10 - 15 mcg/kg  delivered fentanyl before you'd start to suspect this type of phenomenon. You don't see myoclonus with big doses of versed, at least I never have.
> 
> The mechanisms are not well/not understood, but we don't see this 'wooden chest' very often in the hospital when we do use these big doses of fentanyl (or analogues) because the patient has also usually received some versed which, again, IMO, mitigates that type of side effect.
> 
> Similarly, with induction doses of 'naked' propofol (that is, without any pre-induction sedation) you see more myoclonus than you might with sedation.


In this case, I believe the assumption is the Fentanyl is in powder form and in a much higher concentration the what we use in liquid form. This statement is made from the justice.gov opioid awareness site.

Fentanyl powder has the power to kill with the ingestion, inhalation, or skin absorption of just two milligrams. By comparison, a sweetener packet found on a restaurant tabletop generally contains 1,000 milligrams per packet.









						Opioid Facts
					






					www.justice.gov
				




This is such a small amount of powder that it is not hard to paint a scenario where an officer or one of us comes in contact with it unknowingly. think of how many overdose calls you have run and you get into the house and move some furniture out of the way to work. If this powder is present you could get all of the providers on scene. I know it is a long shot but I think this video just highlights the need to be extra careful.


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## DesertMedic66 (Sep 6, 2021)

Fire 612 said:


> In this case, I believe the assumption is the Fentanyl is in powder form and in a much higher concentration the what we use in liquid form. This statement is made from the justice.gov opioid awareness site.
> 
> Fentanyl powder has the power to kill with the ingestion, inhalation, or skin absorption of just two milligrams. By comparison, a sweetener packet found on a restaurant tabletop generally contains 1,000 milligrams per packet.
> 
> ...


Except none of his symptoms line up with a fentanyl overdose. None of the “overdoses” that have been in the media line up symptom wise. Nor have their been any blood work released from any of the “overdoses” that confirm drugs in their system. All while many toxicologists and doctors have agreed that it’s really not possible unless you are actively snorting the drug. Having some fentanyl on your skin will not be absorbed into your system.

At this point I think I would be more fearful of a dirty needle stick than overdosing on a call.


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## mrhunt (Sep 22, 2021)

CCCSD said:


> And this crap is WHY I teach cops not to ever allow “EMS” to second guess their decisions.


Because you should be a cop, And let Medical be medical and we can all play nice.  Im not stopping by questioning how you write your tickets or do your traffic stops.  So dont question my training of years in the medical field. 

The cops in my area think they know more than us too, and Put TQ's on papercuts, and call us because someone **** themselves at 2am. I guess i shouldnt second guess that though, After all, the cops know more than me medically!

Im just dumb old "EMS".  The quotation marks alone come off as incredibly rude towards the profession especially when your posting on a EMS board.


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## johnrsemt (Oct 3, 2021)

Fire 612:  rub your arm with talcum powder, and watch and see how long it takes for it to be absorbed:  then do the same thing with powdered fentanyl.  Powder doesn't absorb through the skin:  otherwise people at the beach and kids playing in the dirt would all die.

Again:  read the article:  the car had a white powder on the inside:  the 3 or 4 people in the car breathing the white powder were fine, but the officer who walked up to the car and got a little sniff through the open window overdosed, but not until someone suggested it might be Fentanyl?

I think the officer OD'd on the power of suggestion


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