San Diego sheriff fentanyl overdose

[Fezman92]

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.

 

[Jim37F]

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

 

[mgr22]

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.

 

[ffemt8978]

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.

 

[mgr22]

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.

 

[CbrMonster]

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

 

[DrParasite]

Stolen from FB.....

 

[CCCSD]

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

 

[DrParasite]

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?

 

[DrParasite]

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.

 

[GMCmedic]

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.

 

[Fezman92]

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

 

[hpclayto]

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

 

[Carlos Danger]

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.

 

[Carlos Danger]

Duplicate post

 

[Tigger]

“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.

 

[DrParasite]

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."

Academics at University of California, San Diego and North Carolina's nonprofit RTI (Research Triangle International) published a paper in June in the peer-reviewed International Journal of Drug Policy that concluded there are no confirmed touch-based cases of first responder fentanyl overdoses, even when naloxone was used to revive them.

Citing similar conclusions on skin contact from the American College of Medical Toxicology and the American Academy of Clinical Toxicology, the International Journal of Drug Policy paper also suggested that panic attacks were at work, and that hyperbolic information about fentanyl didn't help.

The researchers at UC San Diego and RTI blamed social media and the U.S. government for "dubious information about fentanyl risks."

 

[johnrsemt]

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.

 

[Fire 612]

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.

 

[DesertMedic66]

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.

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.