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The widely available drug fentanyl, already the number one killer of Americans under 50, could be weaponized and used for terrorist mass poisoning, according to health experts at Rutgers and other institutions.
“Before fentanyl, the only viable mass poisons were rare and hard-to-access agents such as cyanide or nerve agents,” said Lewis Nelson, chairman of the department of emergency medicine at Rutgers New Jersey Medical School and senior author of the new study. Frontiers in public health paper. “Fentanyl can be just as deadly when distributed properly, and it’s ubiquitous. A motivated person could easily get enough to potentially poison hundreds of people — which, uncut, would easily fit on a teaspoon.”
Unlike biological attacks, where a weaponized disease can spread worldwide and kill millions, chemical attacks can generally only harm the victim through direct exposure. Still, fentanyl’s high toxicity makes it a viable tool for unleashing a harmful, deliberate event on an unsuspecting populace.
Attackers with little technical knowledge could introduce the synthetic opioid in lethal doses into building ventilation systems or local food or water supplies. Nelson said it is unlikely to be successful in a large-scale attack, so simply dumping a truckload into a reservoir is unlikely to cause significant casualties.
History vividly demonstrates its potential as an aerosol, inhaled poison. Russian authorities appear to have used a fentanyl-like drug as a weapon in 2002 after Chechen terrorists seized a crowded theater and threatened to execute hundreds of hostages unless Russia pulled out of Chechnya.
Conventional rescue operations against 40 well-armed and well-fortified kidnappers seemed impossible, so security forces pumped a fentanyl analogue into the theater’s ventilation system, incapacitating nearly everyone inside. They then stormed the building, shot the unconscious terrorists and took the hostages for medical care.
The operation killed 130 hostages and demonstrated the extent of damage possible when fentanyl is used for non-peaceful purposes.
“We don’t have an effective antidote for many poisons, but we do have an antidote for fentanyl poisoning – naloxone, also known by the brand name Narcan – and the extreme frequency of accidental fentanyl overdoses means we now stock this antidote in large quantities. healthcare facilities and pharmacies,” Nelson said.
The frequency of accidental overdose also means that many healthcare providers and non-medical personnel have learned to recognize the signs of fentanyl poisoning while there is still time to reverse it. The paper’s plan to minimize vulnerability to fentanyl attacks calls for training more healthcare providers to recognize victims quickly and administer naloxone early.
“Treating based on clinical findings rather than more definitive tests such as blood test results is generally safe,” Nelson said. “If you suspect fentanyl poisoning, administer naloxone and it turns out the poison was another agent. You generally did not hurt the patient.”
The panel’s response plan is largely based on such preliminary steps: educating more people to recognize poisoning, creating channels to report unusual victims of fentanyl poisoning, finding commonalities between these victims, and eliminating the sources for obtaining fentanyl. It also includes figuring out ways to quickly transfer many doses of naloxone to where they are needed most.
“We have a lot of naloxone available in metropolitan and rural areas,” Nelson said. He noted that it is safe to help poison victims because fentanyl powder must be inhaled or ingested to hurt rescuers, and this is extremely unlikely. There is essentially no risk of rapid absorption through the skin. “The key in a mass event will be getting naloxone quickly to the scene or to facilities that are suddenly overrun with victims. Fentanyl generally kills more slowly than poisons like cyanide, but it still requires quick action to prevent damage. ”
More information:
Susan M. Cibulsky et al, Public health and medical preparedness for mass casualties from the deliberate introduction of synthetic opioids, Frontiers in public health (2023). DOI: 10.3389/fpubh.2023.1158479
Quote: Fentanyl can be used as a weapon, but preparation could minimize damage (2023, May 31) Retrieved May 31, 2023 from https://medicalxpress.com/news/2023-05-fentanyl-weaponized-minimize.html
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