Florida Stands Ready to Protect Its First Responders from Nothing
Florida Stands Ready to Protect Its First Responders from Nothing
The myth of casual-contact fentanyl overdose is wasteful and dangerous, but when has that stopped us?
It’s been a busy year-plus for the criminal justice system in Florida. In 2023, the state legislature resolved to kill more people with less jury support; the judiciary fought transparency in how it kills people; and the executive fired elected prosecutors who enforced their constituents’ priorities instead of his own. In 2024, they’ll take up the fight against the opioid crisis in a bold new way: throwing more people in jail.
HB 231, titled “Exposures of First Responders to Fentanyl and Fentanyl Analogs,“ prescribes criminal penalties for those who “expose” first responders “who are acting in their official capacity to” to fentanyl “when that exposure results in serious injury.” The bill defines “exposure“ as any form of “skin contact, inhalation, ingestion, or contact with the site of a needlestick or a mucus membrane.” Offenders face a minimum of 15 years, with a 30-year minimum for “death or great bodily harm.“
Incidental Contact Overdoses Don’t Happen
Before you ask: yes, I’ve seen that video you’re thinking of, where a cop sees an unidentified powder and immediately going into something resembling either a panic attack or a coma before being “revived“ by naloxone. (I’m aware that there are a lot of them, so let’s go with the most dramatic.) I’ve also seen the follow-up, when actual fentanyl experts note that symptoms like “trying to gasp for breath“ are the exact opposite of opioid overdose and that none of the departments publicizing these “overdoses“ ever seem to get a toxicology report confirming it. The trouble isn’t just that it’s never been confirmed, though; according to a joint 2017 statement from America’s two major toxicology boards, it’s effectively impossible.
Every drug (indeed, every substance in the universe) reacts with the human body according to a principle known as bioavailability. In short, bioavailability is the percentage of a substance that can get through your body’s defenses, into your bloodstream, and down to business. Bioavailability will vary both between substances and, with the same substance, between the routes it takes to get there. Pure fentanyl’s bioavailability through skin is almost nil; it took nearly 30 years for drug companies to overcome this barrier and develop a fentanyl skin patch. In the above-linked statement, the principal American toxicology boards note that even fentanyl patches don’t work fast enough on contact to explain cops’ symptoms; it would take well over 10 minutes for a patch to deliver 100 micrograms, a dose I’ve seen opioid-naive (and even fentanyl-terrified) patients describe as “not touching“ their pain. While the law also addresses more realistic concerns such as mucous membrane absorption (where fentanyl’s bioavailability is high), the boards’ statement does as well: the case study for mucous membrane absorption is a splash of liquid fentanyl to the face, and is “unlikely“ with powdered fentanyl.
On top of all the science, there’s a logical question. IV drug use is heavily stigmatized in society, and users describe the switch from oral to IV drugs as intensely demeaning. If skin contact preserved fentanyl’s bioavailability without the social and psychological consequences of IV, why are no drug users ever found with a skin contact overdose? Is every drug dealer caught with powdered fentanyl that careful? Why is this only happening to a group of people purportedly trying not to get high?
How Fentanyl Exposure Laws Make Us Less Safe
Even without criminal penalties, treating the myth of fentanyl overdose by incidental contact as real is not just a well-intentioned, harmless safety-first overreaction. Estimates of response and cleanup costs for a hazardous materials response run as high as $50,000, and that’s only in monetary terms. Like all opioids, fentanyl kills by depressing respiratory drive; a person who is not breathing begins to lose brain cells in four minutes, far shorter than the time it would take a hazmat team to respond, don PPE, and effect an emergent rescue (before the work of handling a patient’s problem could begin). Even if such a response isn’t called, perceptions of the risks surrounding opioids are already affecting how first responders react to such calls, a risk that patients in respiratory crises can’t afford.
It’s important to note, however, that it’s not totally useless to gin up a felony out of something that doesn’t happen. The Florida legislature, a Republican supermajority since time going on immemorial, essentially acts as a presidential campaign committee for, on a member-to-member basis, either Governor Ron DeSantis or noted resident Donald Trump. As an actual problem whose harms don’t allow any particular demographic to look away, the opioid crisis presents a particularly sticky issue. Actually fighting these harms would require hard work and non-doctrinaire solutions; looking like you’re fighting them only requires treating fentanyl like a B-movie bioweapon and then pivoting to the role of foreign boogeymen in its fulfillment chain. The Florida legislature will soon make it clear which is the priority.