Remediation Requires Standardized Science to Ensure Efficacy
The Centers for Disease Control and Prevention estimates that in 2023, more than 112,000 Americans died from a drug overdose. Sadly, this is a new annual record. Nearly 70 percent of these deaths were caused by synthetic opioids, and most were due to one that is particularly toxic – fentanyl. That is why understanding the dangers associated with remediation of clandestine production sites and our call for standardized test methods and standards by which decontamination products are measured is so important.
The Rise of Fentanyl In the late 1990s and for about the next 15 years, pain clinics across the country served as distributors for opioids, with Oxycontin being among the most popular. A significant increase in the number of overdose deaths attributed to this drug subsequently followed. This resulted in a crackdown on manufacturers, distributors, and ultimately users. Crack cocaine and heroin quickly filled some of this void, but also left users and the illicit manufacturers looking for a powerful and profitable alternative – enter fentanyl.
Fentanyl is a synthetic opioid, meaning it’s not naturally derived, but created in a lab or in a clandestine site. It targets the opioid receptors in the brain while reducing pain and elevating pleasure and relaxation. There are about 1,400 known fentanyl analogs, 500 or so of interest in today’s market. 30 to 40 of those are the most common that we see within the pharmaceutical industry and on the street. Based on the precursors used to make them, each has a different toxicity, some being much more potent than others.
When pharmaceutically manufactured fentanyl is used as prescribed, it can be a fast-acting opioid that has been described by some as a wonder drug. It can be beneficial for patients in addressing pain or those who are terminally ill, providing quick pain relief. This includes cancer patients, anyone recovering from a surgery, moms recovering from childbirth, athletes with a lingering sports injury. There is a good chance many people have used it after surgery or in recovering from an injury. It is these same populations of non-traditional drug users who become addicted, many times unknowingly. In fact, many first encounters with fentanyl are when it’s prescribed for a medical issue. Between three and 10 percent of people become addicted after only their first use. Everytime they refill a prescription, users are significantly more likely to become addicted, especially for those dealing with significant and chronic pain.
Unfortunately, because of its powerful opioid properties, both pharmaceutically and illicitly manufactured fentanyl can be diverted for abuse.
Benefits for Illicit Manufacturers and Users For illicit manufacturers, fentanyl offers numerous benefits. Foremost, it can be produced much more inexpensively than many illicit drugs, at roughly 1/25th the cost of heroin, but with a similar or greater high for the users. Additionally, because fentanyl is synthetically produced, the production timeline is not as lengthy as a drug like heroin or morphine because it’s not dependent on that cultivation and the processing of poppies.
For users, fentanyl does not have the same stigma associated with it as a drug like heroin either. Because it can be prescribed by a doctor, continued use is often perceived as nothing more than a prescription refill, even if secured illicitly. It also is less expensive than many other drugs while still offering the high sought by users. As a result, when fentanyl first became popular in the early 2010s, it displaced a significant portion of heroin on the market. It also is sometimes used to cut various drugs and increase its potency, reducing its costs or to be disguised as a highly potent version of that drug. Unfortunately, it is also much more toxic. An overdose death can occur when users believe they are purchasing an illicit drug or a counterfeit prescription drug and do not know that it has been cut with fentanyl.
Fentanyl’s Potency and Toxicity Fentanyl is so deadly primarily because of its potency. It simply does not take much to cause an overdose. There are a wide range of doses that can be safely administered to elucidate the desired physiological responses like pain relief. The issue is that while fentanyl has a relatively wide index, that entire range is within a very small amount. This makes it easy for users to overdose on fentanyl.
Ideal therapeutic indexes are roughly in the 10x range or greater. For example, Tylenol, which is roughly 500 milligrams of acetaminophen. It would likely take more than 20 times that to be a toxic dose, which is quite a few pills. For Tylenol, that therapeutic index is about 10x. Fentanyl’s therapeutic index is in the ballpark of 400x, so a lot bigger, but that range ends more than 50,000 times lower for fentanyl versus Tylenol. It’s that two milligrams of fentanyl versus about 10 grams or more of acetaminophen. Humans can very readily distinguish between around 500 milligrams and 10 grams (about the weight of a AAA battery) of a white powder, but not between 1 microgram and 2 milligrams.
Another critical factor is fentanyl’s toxicity. When assessing the toxicity of various drugs, oral morphine has been around a very long time and is typically used as the baseline because it has been studied extensively. Tylenol is 360 times less toxic than morphine. Advil is around 222 times less toxic than morphine. Heroin is about four to five times more toxic than morphine, while fentanyl has been described sometimes 50 to 100 times more toxic than morphine.
The most potent known fentanyl analog is the tranquilizer known as carfentanil, which is used for elephants, horses, and other large animals, particularly in the veterinary fields. It is approximately 10,000 to 100,000 times more toxic than fentanyl, and when people ingest it, it often has deadly results.
Dangers of Clandestine Production Clandestinely produced fentanyl is primarily manufactured in Mexico, India, or China, and then imported into its country of use for further processing. In North America, it is often then cut with baby powder or other inert materials and then it is pressed into pills for further processing or consumption. This processing can result in highly inconsistent product as the amount of fentanyl in each dose can vary widely and pose a significant danger to users. They never know whether the next dose will deliver a high or a death.
Though most fentanyl is manufactured outside the U.S. and then imported, manufacturing sites are still a problem in this country. Since 2020, in the U.S. alone, law enforcement agencies have reportedly found more than 650 locations where chemicals or other items indicating the presence of either clandestine drug laboratories or dump sites for post-production byproducts and precursors, some of which may be even more harmful than the drug itself. Since 2021, more than 61,000 pounds of fentanyl have been seized in nearly 5,000 separate seizure events.
Keep in mind, a potentially lethal dose of fentanyl is approximately two milligrams, which would fit on the lead of a pencil. There are more than 450,000 milligrams in a pound, so 61,000 pounds is more than 13.7 billion lethal doses, which calculates to more than 40 lethal doses per person in the United States.
Remediation of Clandestine Sites The sites where fentanyl is produced or further processed vary. Because they are almost never as simple as a pile of powder or a trace residue on a glass surface that is easy to clean – residue can be found on tile, in carpet, on curtains, in couches – remediation can differ greatly and requires different approaches to cleaning.
The goal for remediation of any site is a rapid return to normalcy. Because many of these sites include places like public ports or private single and multifamily housing, that normalcy should involve the ability to prove that a site is free of any hazards to the next person entering that space. Sometimes the hazard is respiratory or contact, prompting questions like “Did I breathe it in?” and “Did I touch it?”. These exposure situations should be addressed depending on what the hazard is, whether it’s a solid white powder like fentanyl or a volatile liquid precursor or byproduct.
What Does “Clean” Mean? There are many different terms used to describe cleaning something up – removal, disinfection, neutralization, destruction, decontamination, mitigation, remediation, treatment. But when talking about a clandestine drug production or processing site, what does “clean” actually mean? Unfortunately, ambiguity exists when inequitable testing methods and rigor are used to support claims of product efficacy.
When a product is marketed as used against fentanyl, questions about its efficacy and application should be asked:
“Does the product physically remove the threat?”
“If it does remove fentanyl, what do I do with the contaminated wipe or liquid?”
“Does it chemically degrade it? If so, what does it turn it into? Is that more dangerous than what we started with? Does it do some combination of the two?”
“How much of the product was applied?”
“How long should it sit on the surface to decontaminate the surface?”
A spectrum of “clean” exists and it is important to know what products provide what results and what operational scenarios or environments those products should be applied to achieve the desired result.
A Call for Standardized Efficacy Testing Efficacy is a foggy term that is relatively ill-defined when it comes to testing for clandestine chemicals. The industry must establish universal test methods and standards by which decontamination products are measured. By adhering to rigorous and reproducible science, an apples-to-apples comparison between products enables appropriate operational decisions. It is this level of testing that will provide first responders confidence in using products for decontamination and remediation of these sites and the general public confidence that it has been done effectively.
MRIGlobal’s Work to Ensure Safety Each day, the team at MRIGlobal is hard at work solving these issues by:
Working to set the standard for efficacy testing;
Testing and evaluating field portable equipment and users can quickly and accurately identify the hazards in the field;
Working to make sure that PPE protects those working in those hazardous conditions;
Developing the equipment, both hardware and software, that field users rely on for timely answers;
Generating the onboard library entries used to determine the identity of the chemical threat and therefore start the process to render the site safe; and,
Providing training for both commercial and government partners so they have confidence in the results they obtain, are confident in sampling the right spot, and understand how to interpret the results.
Our experience in not only the laboratory but the field operations and real-world use of these methods and equipment gives users confidence the threat was detected and mitigated, ensuring the safety of warfighters and civilians alike.
GETTING STARTED AT MRIGLOBAL Contact MRIGlobal to further understand our work in defense against chemical and biological threats. We work with our clients to test and evaluate current methods to detect, prevent, decontaminate, protect, and destroy these materials.
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