Opioids Crisis Affects Workplaces Nationwide, Panelists Say

The AIHce EXP 2018 opening session on May 22 offered a stark look at the crisis. There were more than 65,000 overdose deaths, most involving opioids, in the United States during 2016.

PHILADELPHIA -- The U.S. opioids epidemic was the focus of a panel discussion on mitigating exposure risks to first responders that was the opening session May 22 at AIHce EXP 2018 here in downtown Philadelphia. It was a high-powered panel moderated by AIHA Immediate Past President Steven Lacey and featuring NIOSH Director Dr. John Howard; Kemp Chester, associate director of the federal Office of National Drug Control Policy; Donna Heidel, CIH, FAIHA, an AIHA board member; and Adam K. Thiel, Philadelphia’s fire commissioner. Together, they offered a stark look at the crisis and how it affects communities and workplaces nationwide.

Lacey began by asking those in the audience to raise their hands if they or their communities had been affected in some way by the opioids crisis, and dozens of hands went up. “This is a public health crisis,” he said to the audience. “I want you to think of how far we can go in terms of primary prevention.” He noted that not only are first responders at risk, but any “workers who come in contact with opioid materials, including crime lab analysts, customs and border control agents, and even coroners and funeral directors.”

There were more than 65,000 overdose deaths, most involving opioids, in the United States during 2016, he said.

Chester attributed the development of the opioids crisis to a number of factors, including a revolution in pain management leading to an increase in prescribed opioids and an increase in heroin production in Mexico, leading to higher availability of illicit opioids. More recently, there has been an increase in synthetic opioids such as fentanyl and its analogs, some of which are deadly in even very small amounts. According to Chester, one of the most fundamental things that can be done to combat the opioids crisis generally is to reduce the availability of drugs. He explained that the drug trafficking environment is ever-evolving and stakeholders must evolve with it in order to reduce the availability of these drugs in the United States.

He also stressed the importance of early prevention and closing the treatment gap to make support more readily available to those who need it, saying the country does not want to be in a position where it’s easier to get heroin or fentanyl in communities than to get treatment.

Thiel, whose personnel are on the front lines of the epidemic, said Philadelphia’s first responders will administer about 5,000 doses of Naloxone this year to reverse overdoses, and the city recorded 1,217 opioid-related deaths in 2017 alone. “Certainly, here, we’re seeing a lot of fentanyl,” he said. “The prevalence of fentanyl now, synthetic opiates, this is a real problem for us now.” He said a handful of law enforcement officers in the city have sustained opioid exposures on the job, but none of them suffered lasting harm.

Heidel reinforced that industrial hygienists must realize that first responders work in non-routine operations, where hazards and exposure risks are often unknown. Because opioids are fine, highly soluble powders, disturbing clothing or other materials could result in airborne concentrations that exceed occupational exposure limits and cause adverse effects, she said.

Howard discussed seven Health Hazard Evaluations done by NIOSH to evaluate first responders’ exposures to opioids. None of the exposed responders experienced overdose symptoms such as respiratory distress, he said. However, the HHEs did find that responders have been exposed accidentally from actions such as donning gloves in the presence of powder at a scene and then typing on their dashboard computers.

Even surface contamination to vulnerable areas such as the skin, eyes, and mucus membranes of the mouth can result in adverse effects, Heidel said, adding that industrial hygienists need to provide effective control methods and detailed procedures for donning and doffing PPE.

She said AIHA has developed an opioids working group that will focus on protecting first responders and also is developing an opioids resource guide. NIOSH worked with a variety of other federal agencies to create a one-page document of safety recommendations for responders dealing with fentanyl and related substances.

Heidel called on industrial hygienists to recognize that the crisis is affecting all workplaces, and workers who are using opioids as prescribed or illicitly are at increased risk for occupational injury to themselves and others. She said that those who administer first aid must understand not only the signs and symptoms of an opioid overdose and how to administer treatment, but also how to protect themselves.

The panelists agreed there is no end in sight to the crisis, for now, and Chester called it “a generational struggle” but also said it is not an insurmountable challenge.

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