HHE 2018-0083 

Evaluation of Potential Occupational Exposures to Opioid Drugs During a Law Enforcement and 

Emergency Medical Services Response

Interim Report 

April 20, 2018 

Sophia Chiu, MD, MPH 

Jennifer Hornsby-Myers, MS, CIH

Douglas Trout, MD, MHS 

Introduction 

The NIOSH Health Hazard Evaluation program received requests for an evaluation from a 

county’s Fire Chief and Sheriff. The requests concerned possible work-related exposure to 

opioid drugs (including fentanyl or its analogues) among responders during the course of a law 

enforcement and fire and rescue response. On March 1–2, 2018, Deputy Sheriffs and fire fighteremergency medical service (EMS) providers responded to a private residence where a drug 

overdose had taken place. Deputy Sheriffs and fire fighter-EMS providers developed symptoms 

during the response. A total of nine responders were evaluated at a local hospital. We visited the 

Fire and Rescue Department, Sheriff’s Office, and hospital on March 13–14, 2018. On March 

16, 2018, we sent an interim letter to the requestors and employee representatives briefly 

summarizing our activities and preliminary findings. This interim report summarizes current 

findings and recommendations for this evaluation. 

At the time of the evaluation, the Fire and Rescue Department had 131 full-time career fire 

fighter-EMS providers operating from 13 stations. The department also included approximately 

200 active volunteer fire fighter-EMS providers operating via 14 volunteer fire/rescue or EMS 

squads. Daily staffing for the department included six paramedic transport units (ambulances) 

and four fire suppression units (engines), along with various other support equipment. Fire 

fighter-EMS providers worked in 24-hour shifts on days 1, 3, and 5 of a 9 day-day cycle and 

were off on days 2, 4, and 6–9 of the cycle. The Sheriff’s Office included a Field Operations 

Division with 114 assigned deputies. Deputies were assigned to one of three overlapping 11.5-

hour shifts (day, evening, or midnight). 

In the recent past, both the Fire and Rescue Department and Sheriff’s Office had received an 

increased volume of calls related to drug overdoses. This trend is consistent with the increased 

number of overdose fatalities related to fentanyl, fentanyl analogues, and other illicit drugs 

nationally [CDC 2018]. The Fire and Rescue Department responded to over 170 calls related to 

opioid use in 2017. Among those responses, over 120 different victims received naloxone as part 

of the response. 
Page 2 – HHE 2018-0083 Interim Report

Methods

The objectives of our evaluation were to: 

1. Review activities of the responders (fire fighter-EMS providers and Deputy Sheriffs) 

during the March 1–2, 2018 response to characterize potential exposure to opioid drugs. 

2. Review information concerning any health effects experienced by the responders who 

underwent medical evaluation, including information from available medical records. 

3. Make recommendations on how to prevent exposures to opioid drugs among responders. 

We conducted voluntary, confidential interviews with six fire fighter-EMS providers and three 

Deputy Sheriffs who underwent medical evaluation immediately after the March 1–2, 2018 

response. During the interviews, we discussed the response, work history and practices, training, 

personal protective equipment (PPE) use, and any health effects experienced around the time of 

the response. 

We spoke with emergency department staff who coordinated decontamination procedures at the 

hospital and attended to the overdose victims and responders. Specifically, we spoke with one of 

two treating physicians and nursing staff. We also reviewed the medical records related to the 

response for all nine responders who were evaluated at the hospital. 

In addition, we discussed the response, departmental policies and procedures, and call volume 

with three members of the Fire and Rescue Department command staff. We reviewed the 

narratives from the Sheriff’s Office and the Fire and Rescue Department for the response. We 

discussed emergency dispatcher procedures for potential overdoses with a member of the county 

emergency communications center. 

Results

Summary of Events of the March 2018 Response 

The following summary of the response is based on the interviews we conducted and review of 

records. On the evening of March 1, 2018, Deputy Sheriffs and fire fighter-EMS providers were 

dispatched for a reported drug overdose at a private residence. The initial responder on the scene 

was a Deputy Sheriff (Deputy Sheriff 1), who was directed to a bathroom where a male (Victim 

1) was unresponsive in the shower area. Victim 1 was wet as the result of attempted revival by 

other civilian bystanders on the scene. With the assistance of a civilian, Deputy Sheriff 1 moved 

Victim 1 to the floor of a nearby bedroom. Victim 1 was described as having a pulse with 

“inconsistent” breathing (respirations reportedly only occurred every 15–20 seconds). Victim 1 

was also described as cyanotic. Deputy Sheriff 1 administered intranasal naloxone and 

performed sternal rubs on Victim 1 with no response. 

Fire fighter-EMS providers arrived soon after and took charge of resuscitation efforts. Life 

support measures performed for Victim 1 included ventilation via a nasal airway and bag-valve 

mask and obtaining intravenous access. In total, Victim 1 received 10 milligrams of intranasal 
Page 3 – HHE 2018-0083 Interim Report

and intravenous naloxone. Victim 1 was transported using a portable flexible stretcher to the 

ambulance and then to the emergency department. Victim 1 became responsive and began 

breathing on his own during transport to the emergency department. A fire engine at the scene of 

the response and a Deputy Sheriff also proceeded to the emergency department. As the 

ambulance was on its way to the emergency department, a report was provided to the emergency 

department that a fire fighter-EMS provider (FF-EMS 1) was symptomatic; the health effects are 

described below. 

Two Deputy Sheriffs developed symptoms at the scene of the response (described below) and 

were transported to the emergency department. Nine responders who went to the hospital were 

met outside the emergency department in the hospital’s decontamination area. All nine 

responders who went to the hospital underwent the decontamination procedures set up by the 

hospital, which included removal of clothes, showering, and re-clothing with a disposable 

hospital gown. The responders were then observed within the emergency department.

The scene of the response was described as a private residence. No powders suspected to be 

opioid drugs were observed on Victim 1 during the resuscitation efforts. An unspecified amount 

of a “white powdery substance” and a “plunger to a needle” were found in a nightstand drawer in 

the bedroom where Victim 1 was resuscitated. There were no reports that this substance was 

disturbed during the response. Several responders and hospital staff reported civilians present on 

the scene provided various information about possible substances being used at the residence.1

Some responders reported a slight haze in the residence; some responders thought it was related 

to tobacco or marijuana smoke. Information from the interviews and records reviewed were not 

clear on whether any materials from the scene were sent for forensic analysis in a laboratory. 

There were approximately six or seven other civilians at the scene. All were thought by 

responders to have been under the influence of unknown substances, in part due to their semiresponsive states. Two other civilians (Victims 2 and 3), who at various times during the incident 

may have been indoors or outdoors, were subsequently transported to the emergency department 

for care. Law enforcement personnel administered naloxone to one of these civilians on the 

scene due to signs of opioid toxicity; it was reported that the civilian’s status was improved after 

naloxone administration. 

Summary of Responders’ Job Tasks and Symptoms during the Response 

 

1 Information reported concerning possible substances being used at the residence included: (a) the activity was a 

“pill party;” (b) participants were “doing roxy;” and (c) participants were “snorting oxycontin.” There was no 

confirmation of any information concerning forms or formulations of any of the substances potentially used at the 

scene.
Page 4 – HHE 2018-0083 Interim Report

Of the nine responders who were evaluated at the emergency department, six were the first fire 

fighter-EMS providers on the scene, and three were the initial Deputy Sheriffs on the scene. 

There were other fire fighter-EMS and law enforcement personnel on the scene at the residence 

during the response, but they were not evaluated at the emergency department and were not part 

of this evaluation. All nine responders reported that their routine duties included periodic 

responses to overdose scenes in the community. Although responses to overdose incidents were 

reported to sometimes occur in clusters, they reported responding to approximately two to three 

overdose incidents per month. 

FF-EMS 1, 2, and 3 were three of the four responders who provided the most direct care to 

Victim 1 (e.g., managing the airway, establishing intravenous access). Several responders helped 

lift Victim 1 from the floor using a flexible stretcher and moved Victim 1 into the ambulance. 

Deputy Sheriff 1 had assisted in moving Victim 1 out of the shower with ungloved hands. After 

donning gloves, Deputy Sheriff 1 administered the first dose of naloxone to Victim 1. All other 

interviewed responders reported wearing gloves throughout the response. Deputy Sheriff 1 

subsequently performed other routine duties as part of the response. The other Deputy Sheriffs 

had no direct contact with Victim 1; their activities on the scene included other duties for this 

type of response. 

During the response, all interviewed responders reported wearing their usual uniform, which 

consisted of a long-sleeve garment. The responders reported changing gloves at varying intervals 

during the response. All nine responders who underwent medical evaluation reported being at 

their baseline level of health prior to the response. In our interviews, two responders staffing the 

ambulance (FF-EMS 1 and 2) and one from the fire engine (FF-EMS 3) reported symptoms 

during the response. Of the three other fire fighter-EMS providers from the engine (FF-EMS 4, 

5, and 6), two reported mild symptoms during the evaluation at the emergency department, and 

one reported no symptoms. Table 1 summarizes the response activities and reported symptoms. 

Approximate duration of the symptoms is reported in Table 1; in general, most of the symptoms 

resolved after several hours, with one responder’s symptoms lasting less than an hour. 
Page 5 – HHE 2018-0083 Interim Report

Table 1. Activities and symptoms reported by responders during interviews and medical records (n = 9)

Responder Activities Symptoms reported 

during interview or 

in medical records

Symptom onset 

location

Time to 

onset*

(minutes)

Approximate 

duration of 

symptoms (hours)

FF-EMS 1 Provided patient care 

to Victim 1

Palpitations, numb 

feeling in lips and 

fingertips, mental 

confusion, weakness, 

headache, nausea

Outside the 

residence, as 

Victim 1 was being 

loaded on 

ambulance

10–15 2–3

FF-EMS 2 Provided patient care 

to Victim 1

Lightheadedness, 

mental confusion

Hospital, upon 

arrival

20 Several

FF-EMS 3 Provided patient care 

to Victim 1

Palpitations, 

weakness, nausea,

stomach discomfort

Hospital, 

decontamination 

area

20 3

FF-EMS 4 No direct contact 

with Victim 1; various 

response activities 

inside and outside

Mild weakness Uncertain; 

symptoms 

resolved prior to

arrival at hospital

10–15 10–15 minutes

FF-EMS 5 Brief direct contact 

with Victim 1 – 

helped initiate care; 

various response 

activities inside and 

outside

No symptoms N/A N/A N/A

FF-EMS 6 Assisted with care of 

Victim 1 in residence 

and ambulance

Lightheadedness, 

“just feel off”

Prior to arrival at 

hospital

20–30 1.5

Deputy Sheriff 1 Moved Victim 1 to 

bedroom without 

gloves, administered 

naloxone and sternal 

rubs to Victim 1

Lightheadedness, 

nausea, weakness

Inside the 

residence

5 1.5

Deputy Sheriff 2 Law enforcement 

activities inside and 

outside; no direct 

contact with Victim 1

Headache, double 

vision, “altered 

feeling,” palpitations

En route to 

hospital

20–30 4–5

Deputy Sheriff 3 Law enforcement 

activities inside and 

outside; no direct 

contact with Victim 1; 

direct contact with 

other civilians on

scene

Lightheadedness, 

palpitations, mild 

chest discomfort, 

lower leg numbness, 

headache

Outside the 

residence

10–15 Several

N/A = not applicable

* Approximate time from arrival on scene to symptom onset (minutes)
Page 6 – HHE 2018-0083 Interim Report

Figure 1 summarizes the symptoms experienced by the nine responders as documented in the 

medical records and from our interviews. The symptoms in the medical records were generally 

consistent with what hospital staff and responders reported to us during interviews. Several 

responders were noted by emergency department staff to be objectively flushed and 

uncomfortable upon presentation. Eight of the nine responders evaluated in the emergency 

department had one or more symptoms documented in the emergency department medical 

records. 

Figure 1. Symptoms reported by responders in the emergency room medical records and interviews (n = 

9). Mental confusion includes symptoms of ‘feeling off’ and ‘altered feeling.’ 

Alt text: Bar graph showing the number of responders reporting a symptom. Weakness and mental 

confusion were the most commonly reported symptom. One responder reported no symptoms. 

The primary healthcare performed in the emergency department for the responders included 

monitoring of vital signs and observation. Responders had normal temperature and heart rate, 

normal to elevated blood pressure, and normal to elevated respiratory rate during the course of 

1

1

1

1

1

2

3

3

3

4

4

No symptoms

Stomach discomfort

Chest discomfort

Headache

Double vision

Numbness

Lightheadedness

Nausea

Palpitations

Mental confusion

Weakness

Number of responders reporting symptom
Page 7 – HHE 2018-0083 Interim Report

observation in the emergency department. Pupils were noted to be dilated in one responder, and 

the eye examination was documented as “normal [to] inspection” in two responders. However,

actual pupil size was not documented for any of the responders. Hospital staff indicated that the 

responders were all ‘clinically stable’ during the observation periods and the mild elevations in 

blood pressure and respiratory rate mentioned above were not thought to be unusual. One 

responder had a urine drug screen performed; the screen was negative for seven drugs. All 

responders’ symptoms improved over the time of evaluation in the emergency department. One 

responder received acetaminophen and an anti-nausea medication; the other responders were 

observed. The clinical impressions of the emergency department physicians for the responders 

included two with “chemical exposure” and seven with “accidental overdose (opiate, possible 

occupational exposure)” or impressions with very similar wording. 

Emergency department staff coordinated the decontamination process for all responders and the 

three victims who presented to the hospital. No drugs or visible contaminants were noted by 

hospital staff on the responders or the three victims presenting to the emergency department. 

Decontamination was performed in the hospital’s decontamination rooms, which were readily 

accessible from the ambulance entry area and adjacent to the emergency department. 

Summary of Other Interviews

We also had brief discussions concerning emergency dispatch procedures with a member of the 

county emergency communications center and a member of the Fire and Rescue Department 

command staff. During these discussions, we learned some details concerning the standard 

information that emergency dispatchers would collect from callers and convey to responders 

during an incident. For example, emergency dispatchers use various cue cards to prompt callers 

for more information. The cue card for overdose/poisoning includes prompts to ask whether the 

overdose victim is alert, breathing normally, changing color, and violent. The cue card also 

prompts dispatchers to ask callers what the overdose victim might have taken. In addition to 

giving a verbal account of the call to responders, dispatchers enter information from the call into 

an electronic record that fire fighter-EMS providers can access from their vehicles.

Discussion 

From 2015 to 2016, there was a 100% increase in the rate of overdose deaths involving synthetic 

opioids (which includes fentanyl and its analogues) in the United States [CDC 2018]. This has 

raised concerns about the potential for exposure to opioid drugs among emergency responders, 

who might come into contact with those substances in the course of their work. In this 

evaluation, which began 12 days after the response, we collected information from interviews 

with the affected first responders, interviews with the involved healthcare personnel, and review 

of available records. 
Page 8 – HHE 2018-0083 Interim Report

Issues Related to Potential Exposures to Responders 

In general, inhalation, mucous membrane contact, ingestion, and percutaneous exposure (e.g., 

needlestick) are potential work-related routes of exposure to opioid drugs among responders. 

Brief skin contact by itself with small amounts of fentanyl or its analogues is not expected to 

cause symptoms [Lynch 2018; Moss et al. 2017; NIOSH 2017], but possible subsequent hand-toface contact could be a possible route of exposure. 

The information reviewed suggested Victim 1 experienced life-threatening opioid toxicity 

(overdose) in the residence. Responders reported that they determined that the clinical condition 

of Victim 1 was consistent with opioid overdose, and Victim 1 had an apparent positive clinical 

response to naloxone administration. Naloxone was reportedly administered to one other civilian 

during the incident, also with a positive clinical response. The emergency responders and 

hospital staff we interviewed reported no powder suspected to be opioids on the victims. The 

Sheriff’s Office narrative noted the presence of a white powdery substance in the bedroom where 

Victim 1 was resuscitated. 

We cannot rule out several possible exposure scenarios or the possibility that more than one 

work-related factor may be associated with the observed symptoms among the symptomatic 

responders. For example, a small amount of opioids might have been present at the residence and 

been transferred to the responders’ mucosal membranes (nose or mouth) or eyes through 

inadvertent hand or glove contact. A slight haze in the residence was noted by several 

responders; we have no information on the source of the reported haze. 

Issues Related to Health Effects

Eight responders reported a range of symptoms during various time points during the emergency 

response and evaluation at the hospital. None of the symptomatic responders had the classic 

signs of life-threatening opioid toxicity. These classic signs include lethargy or other indications 

of central nervous system depression; shallow, slow, or absent breathing; and miosis (small or 

“pinpoint” pupils) [Boyer 2012; Ropper et al. 2014]. Additionally, there were no findings in the 

clinical evaluations that were consistent with severe opioid toxicity. Symptoms of mild opioid 

toxicity (compared to severe toxicity that includes respiratory depression) might include 

symptoms such as nausea and lightheadedness [Lynch et al. 2018]. A number of non-specific 

symptoms which could be consistent with mild opioid toxicity were reported by the responders. 

The clinical impressions from the emergency department physicians included “chemical 

exposure” and “accidental overdose (opiate, possible occupational exposure).” 
Page 9 – HHE 2018-0083 Interim Report

Conclusions

During a response in March 2018, Deputy Sheriffs and fire fighter-EMS providers developed 

health effects shortly after treating or transporting a victim with suspected opioid overdose. The 

etiology of symptoms and potential source(s) of exposure for the workers could not be 

definitively identified. None of the responders’ health effects involved classic, life-threatening

opioid toxicity. A mild degree of opioid toxicity can cause symptoms similar to some of the nonspecific symptoms reported by responders in this response. 

Recommendations are provided below. Training and education to improve understanding of the 

routes of exposure to opioid and other drugs likely to cause symptoms and measures to protect 

against work-related exposure to opioids and other drugs can help prevent exposures and prevent 

health effects among Sheriff’s Office and Fire and Rescue Department employees. 

Further evaluations and research are needed to improve understanding of the routes of exposure 

and potential health effects among first responders potentially exposed to opioid drugs (including 

fentanyl and fentanyl analogues) in the course of their work. 

Recommendations

NIOSH has issued interim guidance on how to protect emergency responders from exposures to 

fentanyl and its analogues [NIOSH 2017]. We believe that the current NIOSH guidance is 

applicable to this evaluation, even though whether fentanyl or fentanyl analogues were involved 

in this response cannot be confirmed with the available evidence. On the basis of our findings, 

we recommend the actions listed below. 

We encourage the Sheriff’s Office and the Fire and Rescue Department to use labor-management 

health and safety committees or working groups to discuss our recommendations and develop an 

action plan. Those involved in the work can best set priorities and assess the feasibility of our 

recommendations for the specific situation at the Sheriff’s Office and the Fire and Rescue 

Department. 

1. Provide training to all Deputy Sheriffs and firefighter-EMS providers on how to prevent 

occupational exposure to fentanyl and its analogues, including standard safe operating 

procedures, training, PPE, and decontamination. These topics are addressed in the 

NIOSH webpage Topic Page "Fentanyl: Preventing Occupational Exposure to 

Emergency Responders" (https://www.cdc.gov/niosh/topics/fentanyl/risk.html). In 

addition to established work practices, responders should follow the following 

recommendations when fentanyl or its analogues are known or suspected to be present: 

a. Do not eat, drink, smoke, or use the bathroom while working in an area with 

known or suspected fentanyl.

b. Do not touch the eyes, mouth, and nose after touching any surface potentially 

contaminated with fentanyl.
Page 10 – HHE 2018-0083 Interim Report

c. Avoid performing tasks or operations that may aerosolize fentanyl due to 

increased exposure risks. 

d. Change gloves when they become contaminated as soon as practical during 

response activities; gloves should also be changed periodically during response 

activities even without evident contamination.

e. Wash hands with soap and water immediately after a potential exposure and after 

leaving a scene where fentanyl is known or suspected to be present to avoid 

potential exposure and to avoid cross contamination. Do not use hand sanitizers or 

bleach solutions to clean contaminated skin. 

2. Continue to work with the county emergency communications center to identify any 

possible improvements in a) gathering information about potential overdoses and whether 

powders suspected to be opioids are on-scene, and b) relaying this information to first 

responders during dispatch communications. Having this information before arriving at 

the scene can help first responders anticipate the potential level of exposure and prepare 

accordingly before conducting their own on-scene risk assessment. 

3. Continue to work with local hospitals that receive victims from EMS responses to 

identify any possible improvements in EMS providers’ conveying of information about 

the emergency response to emergency department staff. Such information should include 

details related to potential contamination of the victims and providers. Having this 

information before arrival at the hospital can help healthcare personnel better assess 

whether decontamination is necessary and coordinate medical evaluation and treatment of 

potentially multiple victims and responders. 

4. Continue to follow NIOSH recommendations for procedures and work practices in work 

situations where the exposure level to fentanyl or its analogues is anticipated to be 

“minimal,” which is defined is as defined a situation where no fentanyl products are 

visible in the NIOSH webpage noted above. 

5. Develop new or modify existing policies or procedures for work situations in which the 

anticipated exposure level to fentanyl or its analogues is determined to be “moderate” or 

greater.

a. A “moderate” exposure level is defined as a situation where small amounts of 

fentanyl products are visible. 

b. Conduct a risk assessment to identify potential hazards related to fentanyl and 

fentanyl analogues during law enforcement and fire and rescue activities and 

determine what is appropriate PPE for moderate or high exposures. NIOSH 

recommendations for these exposure levels are detailed on the NIOSH webpage 

noted above. 

6. Coordinate with local hospitals to ensure that soap and water are available after EMS 

responses where fentanyl products are known or are suspected to be present for washing 

skin and decontaminating surfaces and equipment before disinfectants are used. 
Page 11 – HHE 2018-0083 Interim Report

7. Develop standard procedures for coordination between the Sheriff’s Office, Fire and 

Rescue Department, and other partners such as the regional HAZMAT team, to follow up 

on forensic testing results of evidence collected during future response activities. If 

substances are identified as being present at the scene of response activities, that 

documentation should be placed in the occupational health or personnel records of 

applicable law enforcement staff and fire fighter-EMS providers. 

8. Encourage employees to report possible exposures to and health effects resulting from 

exposure to opioids to their supervisors. This information, along with information on the 

identity of the substances from forensic testing, can be periodically reviewed to identify 

any trends affecting the risk of work-related exposure to opioids and any associated 

health effects. Use this information to help determine whether changes in current 

procedures may be needed. 
Page 12 – HHE 2018-0083 Interim Report

References

Adams AJ, Banister SD, Irizarry L, Trecki J, Schwartz M, Gerona R [2017]. “Zombie” outbreak 

caused by the synthetic cannabinoid AMB-FUBINACA in New York. N Engl J Med 

376(3):235–242, 

https://www.sciencedirect.com/science/article/pii/S037907381630055X?via%3Dihub

Behrman AD [2008]. Luck of the draw: common adulterants found in illicit drugs. J Emerg Nurs 

34(1):80–82, http://dx.doi.org/10.1016/j.jen.2007.10.001. 

Broséus J, Gentile N, Esseiva P [2016]. The cutting of cocaine and heroin: A critical review. 

Forensic Sci Int 262:73–83, http://www.nejm.org/doi/10.1056/NEJMoa1610300. 

Boyer EW [2012]. Management of opioid analgesic overdose. N Engl J Med 367(2):146–155, 

http://dx.doi.org/10.1056/NEJMra1202561. 

Centers for Disease Control and Prevention (CDC) [2018]. Overdose deaths involving opioids, 

cocaine, and psychostimulants – United States, 2015–2016. MMWR 67:349–358, 

http://dx.doi.org/10.15585/mmwr.mm6712a1. 

CFR. Code of Federal Regulations. Washington, DC: U.S. Government Printing Office, Office 

of the Federal Register.

Cole C, Jones L, McVeigh J, Kicman A, Syed Q, Bellis M [2011]. Adulterants in illicit drugs: a 

review of empirical evidence. Drug Testing and Analysis 3(2):89–96, 

http://dx.doi.org/10.1002/dta.220. 

Lynch MJ, Suyama J, Guyette FX [2018]. Scene safety and force protection in the era of ultrapotent opioids. Prehospital Emergency Care 22(2):157–162; 

https://doi.org/10.1080/10903127.2017.1367446. 

Moss MJ, Warrick BJ, Nelson LS, McKay CA, Dubé P-A, Gosselin S, Palmer RB, Stolbach AI 

[2017]. ACMT and AACT position statement: preventing occupational fentanyl and fentanyl 

analog exposure to emergency responders. Clin Toxicol 56(4): 391–400, 

http://dx.doi.org/10.1080/15563650.2017.1373782. 

NIOSH [2017]. Fentanyl: preventing occupational exposure to emergency responders. 

Cincinnati, OH: U.S. Department of Health and Human Services, Centers for Disease Control 

and Prevention, National Institute for Occupational Safety and Health, 

https://www.cdc.gov/niosh/topics/fentanyl/risk.html. 

Ropper AH, Samuels MA, Klein JP, eds. [2014]. Adams and Victor's principles of neurology. 

10th ed. New York: The McGraw-Hill Companies.

_________________________
Page 13 – HHE 2018-0083 Interim Report

The Health Hazard Evaluation Program investigates possible health hazards in the workplace 

under the authority of the Occupational Safety and Health Act of 1970 (29 U.S.C. § 669(a)(6)). 

The Health Hazard Evaluation Program also provides, upon request, technical assistance to 

federal, state, and local agencies to investigate occupational health hazards and to prevent 

occupational disease or injury. Regulations guiding the Program can be found in Title 42, Code 

of Federal Regulations, Part 85; Requests for Health Hazard Evaluations (42 CFR Part 85). 

Disclaimer 

The recommendations in this report are made on the basis of the findings at the workplace 

evaluated and may not be applicable to other workplaces.

Mention of any company or product in this report does not constitute endorsement by NIOSH. 

Citations to Web sites external to NIOSH do not constitute NIOSH endorsement of the 

sponsoring organizations or their programs or products. NIOSH is not responsible for the content 

of these Web sites. All Web addresses referenced in this document were accessible as of the 

publication date. 

______________________________________