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Fentanyl, the number one killer of Americans under 50, could be weaponized and used to poison terrorists, health experts at Rutgers and other institutions say.

“Prior to fentanyl, the only viable mass poisons were rare and hard-to-reach drugs like cyanide or nerve agents,” said Lewis Nelson, chairman of the Department of Emergency Medicine at Rutgers New Jersey School of Medicine and the new senior author. Frontiers in public health Paper. “Fentanyl can be deadly if it’s properly distributed, and it’s ubiquitous. A motivated person can easily find hundreds of people to poison — uncut, easily fit on a teaspoon.”

Unlike biological attacks, where a weaponized disease can spread globally and kill millions, chemical attacks generally only harm the victim through direct exposure. Still, fentanyl’s high toxicity makes it a viable tool for unleashing a harmful and deliberate event on the unsuspecting population.

Attackers with little technical knowledge can introduce lethal doses of synthetic opioids by building ventilation systems or local food or water supplies. A large-scale attack is less likely to succeed, Nelson said, so simply dumping a truck in a reservoir is less likely to cause significant damage.

History clearly demonstrates its potential as an aerosolized, inhaled poison. In 2002, after Chechen terrorists seized a crowded theater and threatened to execute hundreds of hostages unless Russia withdrew from Chechnya, Russian authorities apparently seized the drug, fentanyl.

A routine rescue of 40 well-armed and heavily fortified captives appeared impossible, so security forces pumped a fentanyl analog into the theater’s ventilation system, incapacitating nearly everyone inside. They then raided the building, shot the unconscious terrorists and brought the hostages in for treatment.

The operation killed 130 hostages and showed the extent of damage that can be caused when fentanyl is used for non-peaceful purposes.

“We don’t have an effective antidote for most poisons, but we do have naloxone for fentanyl poisoning, which is under the brand name Narcan — and inadvertent fentanyl overdoses mean we now stockpile this drug in health care facilities and pharmacies,” Nelson said.

Due to the frequency of accidental overdoses, many health care providers and non-medical people have learned that there is still time to recognize the symptoms of fentanyl poisoning. The paper’s plan calls for training more caregivers to quickly identify victims and administer naloxone early to reduce exposure to fentanyl attacks.

“Treatment based on clinical findings is generally safer than more accurate tests such as blood-test results,” Nelson said. “If you suspect fentanyl poisoning, administer naloxone, and when the poison turns out to be another agent, it generally does not harm the patient.”

The panel’s response plan depends largely on such preparedness measures: training more people to recognize poisonings, creating channels to report rare fentanyl poisoning victims, finding commonalities among these victims, and eliminating sources of fentanyl poisoning. It also involves devising ways to quickly transfer large doses of naloxone to where they are needed most.

“We have a lot of naloxone in metropolitan and rural areas,” Nelson said. Aiding poisoning victims is safe because fentanyl powder must be inhaled or ingested to harm lifesavers and this is unlikely to happen. Basically, there is no risk of rapid absorption on the skin. “In a mass incident, the key is to move naloxone quickly to the scene or to facilities that are crowded with victims. Fentanyl generally kills more slowly than poisons like cyanide, but still requires quick action to prevent injury.”

Additional information:
Susan M. Cibulski et al. Public Health and Medical Preparedness for Mass Victims of Intentional Release of Synthetic Opioids; Frontiers in public health (2023) DOI: 10.3389/fpubh.2023.1158479

Magazine Information:
Frontiers in public health

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