HHE 2018-0015 

Evaluation of Potential Occupational Exposures to Opioids in a City Fire and Police Department 

Interim Report 

May 31, 2018 

Sophia Chiu, MD, MPH 

Kendra Broadwater, MPH, CIH

Jessica F. Li, MSPH

Introduction 

The National Institute for Occupational Safety and Health (NIOSH) Health Hazard Evaluation 

(HHE) Program received a request for an evaluation from a city in Ohio. The request concerned 

possible unintentional exposure to opioids among police officers and fire fighters during first 

responder activities. In January 2018, the city provided us with reports from the city’s risk 

management database for eight possible opioid exposure incidents in 2017 involving eight police 

officers. As of April 25, 2018, there had been no reports of potential opioid exposures among fire 

fighters. This interim report summarizes our evaluation of these eight reported incidents. 

Ohio was one of three states with more than 20 law enforcement encounters involving fentanyl 

per 100,000 residents in 2015 [Centers for Disease Control and Prevention (CDC) 2016]. At the 

time of this evaluation, the police department had approximately 1,000 sworn officers and 125 

civilian employees. 

Methods

During January and February 2018, we interviewed all eight police officers involved in the 

incidents noted above: one by telephone and seven in person. We discussed incident details, 

work practices and processes, personal protective equipment (PPE) use, and health information. 

For two incidents, we also spoke with a co-worker who had been present while the police officer 

involved was experiencing symptoms. 

We reviewed medical records related to the incidents for the seven officers who consented to 

medical record review. We also reviewed crime laboratory reports for substances submitted for

forensic testing from incidents during which drug evidence had been collected. Crime laboratory 

reports list the substances of abuse detected in the sample or indicates that the sample is

“negative for any commonly abused substances.” The crime laboratory does not determine the 

concentrations of detected drugs in the sample. Additionally, the crime laboratory does not have 
Page 2 – HHE 2018-0015 Interim Report

information about the lowest concentration at which a substance could be detected. Body camera 

footage for these incidents was not available. 

We abstracted information gathered from the incident reports, interviews, medical records, and 

crime laboratory reports. We summarized this information using descriptive statistics. 

We defined a case of possible work-related opioid toxicity as health effects experienced by a 

police officer during law enforcement activities where opioids were suspected or known to be 

present during 2017. A health effect was considered present if a health symptom or sign was 

mentioned in the incident report, interview, or medical records.

The eight incident reports and interviews provided us with information about activities during

which opioids were suspected or known to be present. We assessed the likelihood of exposure to 

a suspected opioid (including fentanyl and its analogues) by identifying whether there was (1) 

handling of and/or contact with eyes and mouth with suspected opioid powder and/or (2) close 

proximity to potentially aerosolized powder suspected to contain opioids.

Results 

Of the eight officers, seven met our case definition for possible work-related opioid toxicity. One 

police officer reported no symptoms but filed an incident report out of concern about a possible

inhalational exposure. For that incident, the crime laboratory identified the material to which the 

officer was exposed as “negative for any commonly abused substances.” This incident was not 

included in further analyses. 

Characteristics of incidents involving possible work-related opioid toxicity 

Of the seven police officers meeting our case definition, six were male. The median age was 33 

years (range: 27–49). The median years of service was 9 (range: 2–19). Selected characteristics 

of the seven incidents where the officer met the case definition are summarized in Tables 1 and 

2. Five incidents occurred in the field; two incidents occurred at district headquarters. Four 

officers were assigned to uniform patrol at the time of the incident.

Six of seven officers described seeing or working with a powder or residue that they suspected to 

be drugs. Samples were submitted to the crime laboratory for analysis in these six incidents. 

Heroin, fentanyl, or a fentanyl analogue was identified in samples from four of six incidents; 

samples containing heroin, fentanyl, or an analogue weighed less than 1 gram in three of the 

incidents. Cocaine was identified in three incidents, and marijuana was found in two. The 

seventh officer did not see suspected drugs or residue, but found drug paraphernalia during a 

vehicle search. 
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Table 1. Characteristics of incidents in which officers met the case definition 

for possible work-related opioid toxicity, 2017 (n = 7) 

Characteristic Number

Location 

Field 5

Headquarters 2

Month

May 2

August 4

October 1

Time of day 

12:01 am to 6:00 am 0

6:01 am to 12:00 pm 1

12:01 pm to 6:00 pm 5

6:00 pm to 12:00 am 1

Crime lab results (n = 6)*

Heroin 4

Fentanyl 4

Cyclopropyl fentanyl 2

Butyryl fentanyl 1

Carfentanil 1

U-47700 1

No opioid† 2

Cocaine 3

Marijuana 2

* No samples were submitted to the crime laboratory for one incident. Some 

incidents included multiple substances identified.

† Sample submitted to the crime laboratory may be only subset of 

substances at scene per officers’ descriptions. 

For Incidents 2 and 3, the officer’s account suggested that samples submitted for forensic testing 

were not necessarily representative of all substances at the scene (Table 2). In Incident 2, the 

officer scraped powder from the carpet of a vehicle floorboard that tested “negative for any 

commonly abused substances.” However, the officer also performed other activities during the 

traffic stop that may have resulted in exposure to substances that were not collected (e.g., 

manually searching obscured locations in the vehicle). In Incident 3, the suspect disposed of a 

small amount of a powder on a windy day that blew into the officer’s face; the powder was not 

able to be collected for testing. Powder from a wallet or coin purse collected during this incident 

tested “negative for any commonly abused substances.” A hand-rolled cigarette also collected 

during this incident tested positive for marijuana. 
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Five of seven officers reported wearing gloves during the incident; one officer reported putting 

on gloves after searching the suspect and conducting a preliminary search of a vehicle for 

weapons. Two officers reported keeping their gloves on after completing tasks such as handling 

evidence or searching a suspect or vehicle while they performed administrative tasks such as 

making a phone call or working at a computer station. None of the officers reported wearing a 

respirator, safety glasses or goggles, or long-sleeved clothing during the incidents.
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Table 2. Summary of potential work-related opioid toxicity cases, 2017 (n = 7)

Case Task Activities

Visible 

suspected 

opioid 

powder 

Glove 

use Reported health effects*

Pertinent 

physical 

examination 

findings in ED

Substances 

identified by crime 

laboratory

1 Evidence 

processing

Handled and looked in plastic 

bag containing drug 

paraphernalia with residue

Yes Yes Palpitations, difficulty breathing, 

chest tightness, pinpoint pupils

Pupil size not 

documented, 

alert and 

oriented

Heroin, fentanyl, 

cyclopropyl fentanyl, 

carfentanil, cocaine, 

marijuana

2 Traffic stop Searched vehicle and suspect, 

collected evidence sample via 

scraping vehicle floorboard 

carpet

Yes Yes† Lightheadedness, difficulty 

breathing, pinpoint 

pupils

Normal pupil 

size, alert and 

oriented

Negative for any 

commonly abused 

substances‡

3 Interacting 

with 

suspect

Searched suspect and 

suspect’s wallet, wind blew 

suspected drugs onto officer’s 

face 

Yes Yes Lightheadedness, palpitations, 

nausea, tingling 

around the mouth, pinpoint 

pupils

Pupil size not 

documented, 

alert and 

oriented

Marijuana‡

4 Search Handled open box containing 

drugs in baggies collected 

during a search

Yes Yes Lightheadedness, palpitations, 

flushing, pinpoint pupils

NA Heroin, fentanyl, 

butyryl fentanyl, U47700, cocaine

5 Interacting 

with 

suspect

Searched suspect and opened 

two small folded paper 

packages (bindles) containing 

drugs

Yes Yes Lightheadedness, palpitations, 

nausea, diaphoresis, tingling 

around the mouth, mental 

confusion

Pupil size not 

documented, 

alert and 

oriented

Heroin, fentanyl, 

cyclopropyl fentanyl, 

cocaine

6 Traffic stop Searched vehicle and handled 

drug paraphernalia after K9 

indicated presence of drugs 

No No Lightheaded, palpitations, 

diaphoresis, nausea, 

mental confusion

Pupil size 

normal, alert 

and oriented

—

7 Evidence 

processing

Handled folder paper (bindle) 

containing drugs during 

evidence processing

Yes No Lightheadedness, palpitations, 

chest tightness, diaphoresis, 

clammy skin, lower extremity 

weakness and tingling

Pupil size not 

documented, 

alert and 

oriented

Heroin, fentanyl

ED = emergency department; NA = not available

* A health effect was considered present if its presence was mentioned in the incident report, interview, or medical records.

† Gloves were used during part of a vehicle search 

‡ Sample submitted to the crime laboratory were not necessarily representative of all substances at the scene of the incident on the basis of the officer’s 

description of the incident. 
Page 6 – HHE 2018-0015 Interim Report

Health effects 

Six of the seven police officers who met the case definition were evaluated at the same

emergency department immediately after the incident and subsequently at the city’s employee 

health services clinic. The other police officer underwent evaluation only at the employee health 

services clinic. 

Table 2 shows the health effects mentioned in the incident report, interview, or medical records

and findings from the medical evaluation. Four police officers reported either having been told 

they had miosis (small or pinpoint pupils) or observing miosis in a mirror. Miosis is a sign 

associated with opioid toxicity. Lightheadedness and palpitations (sensation of rapid or irregular 

heartbeat) were the most frequently reported health effects, reported by six officers each (Figure 

1). 

Figure 1. Health effects reported among police officers meeting case definition for possible work-related 

opioid toxicity (n = 7). A health effect was considered present if its presence was mentioned in the 

incident report, interview, or medical records.

Alt text: Bar graph showing the number of police officers reporting a health effect among the seven 

meeting the case definition for possible work-related opioid toxicity. Palpitations and lightheadedness 

were the most commonly reported 

1

1

1

2

2

2

2

3

3

4

6

6

Lower extremity weakness/tingling

Flushing

Clammy skin

Difficulty breathing

Chest tightness

Tingling around the mouth

Mental confusion

Diaphoresis (sweating)

Nausea

Miosis (small or pinpoint pupils)

Lightheadedness

Palpitations

Number of responders with reported health effect

Reported health effect
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Medical record review

Medical records were available for six officers. On the basis of the incident report and medical 

records, the six officers arrived in the emergency department approximately 25 to 90 minutes 

after potential exposure. Officers’ symptoms had mostly or completely resolved by arrival in the 

emergency department; one officer had an elevated heart rate upon arrival. All six police officers

had normal temperature and respiratory rate and all had elevated blood pressure. Two officers

(Officers 2 and 6) were documented to have normal pupil size at the time of physical 

examination in the emergency department. Pupil size was not documented for the remaining four 

officers. None had signs of respiratory distress or depression.

Blood samples were obtained in two officers; tests for electrolytes, complete blood count, and 

troponin (to assess for damage to heart muscle) were normal. Electrocardiograms performed for

three officers did not reveal any electrocardiographic abnormalities.

Urine collected from one officer (Officer 5) approximately 3 hours after the start of symptoms 

tested negative in a screen for 11 types of drugs: amphetamine, barbiturates, buprenorphine, 

benzodiazepines, cocaine, methadone, opiates, oxycodone, tricyclic antidepressants, 

tetrahydrocannabinol, and fentanyl. Forensic samples collected during this incident tested

positive for heroin, fentanyl, cyclopropyl fentanyl, and cocaine in the crime laboratory. 

The six police officers underwent observation in the emergency department for approximately 40 

minutes to 2 hours and 15 minutes. None of the officers received naloxone at any point. One 

police officer received an anti-nausea medication from emergency medical services providers en 

route to the emergency department. One police officer received intravenous fluids in the 

emergency department. The most common clinical impression of the emergency department 

physician was “chemical exposure,” provided for three officers. For another officer, the clinical 

impression was “accidental poisoning by heroin.” Upon subsequent evaluation, the six police 

officers were returned to full duty by a clinician at the city’s employee health services clinic. 

Five officers were cleared to return to full duty by the next weekday and one officer was cleared 

to return to duty within 1 week. 

Detailed description of Incident 1

At police district headquarters, Officer 1 was assisting with the processing of evidence obtained 

during the execution of a search warrant. Officer 1 did not participate in the execution of the 

search warrant. Officer 1 moved a plastic bag containing seized money into a safe with gloved 

hands. Next, Officer 1 looked inside another plastic bag containing a measuring cup and spatula,

and moved this bag from the floor onto a table to place it near other evidence collected during 

the search warrant execution. Officer 1 reported seeing a residue on the measuring cup in the 

plastic bag. Shortly after moving the bags, Officer 1 began to experience palpitations, difficulty 

breathing, and chest tightness while logging in evidence at a computer terminal in the same 

room. A colleague pointed out that Officer 1’s pupils were pinpoint. Officer 1 was taken to the 

emergency department by another police officer. 
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Subsequently, another police officer put on a disposable coverall, a fullface respirator (unknown 

type), and two pairs of gloves to complete evidence processing. This officer noted that the drug 

evidence was not contained and the exterior of the plastic bags had powder on them. According 

to the crime laboratory reports, the evidence collected during this search warrant execution tested 

positive for heroin, fentanyl, cyclopropyl fentanyl, carfentanil, cocaine, and marijuana. The 

samples containing heroin, fentanyl, and fentanyl analogues had a combined weight of over 8 

grams, and were distinct from other samples from this incident that tested positive for cocaine 

and marijuana. Among all the incidents with samples collected and tested, this was the highest 

combined weight of opioid-containing samples.

According to the emergency department physician’s notes, Officer 1’s symptoms began 

approximately 30 minutes before arriving in the emergency department. The physician noted that

Officer 1’s respiratory symptoms lasted approximately 5 minutes before resolving spontaneously

and Officer 1 was no longer symptomatic by the time of the medical evaluation. Other than an 

elevated blood pressure, Officer 1’s vital signs were within normal limits. Pupil size and

respiratory distress were not documented in the emergency department medical records; Officer 

1 appeared alert and oriented on physical examination. An electrocardiogram was normal. 

Officer 1 did not receive naloxone. Officer 1 was discharged after approximately 80 minutes of 

monitoring in the emergency department. The clinical impression was “chemical exposure.” 

Discussion

Background

From 2015 to 2016, there has been 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 opioids among emergency 

responders (e.g., law enforcement officers, fire fighter-emergency medical service workers), who 

might come into contact with opioids in the course of their work. Inhalation, mucous membrane 

contact, ingestion, and percutaneous exposure (e.g., needlestick) are important potential routes of 

exposure. Brief skin contact with fentanyl or its analogues is not expected to lead to toxic effects 

if visible contamination is promptly removed [Interagency Board 2017; Moss et al. 2017; 

NIOSH 2017]. 

Issues related to health effects

Classic signs and symptoms of severe opioid toxicity include lethargy or other indications of 

central nervous system depression, shallow or slow breathing, miosis, slow heart rate, and low 

body temperature [Boyer 2012; Ropper et al. 2014]. However, not all patients experiencing 

opioid intoxication consistently experience all of these components [Boyer 2012]. Symptoms of 

mild opioid toxicity (compared to severe toxicity that includes respiratory depression) may 

include nausea and lightheadedness [Lynch et al. 2018; Suzuki and El-Haddad 2017]. 
Page 9 – HHE 2018-0015 Interim Report

We described seven cases of possible work-related opioid toxicity. The health effects 

experienced by the police officers were not consistent with severe opioid toxicity described 

above. None had respiratory depression that required treatment with naloxone. Four police 

officers reported either being told they had miosis or observing miosis in a mirror, including 

Officer 1, who also briefly experienced non-specific respiratory symptoms. Nonspecific 

symptoms, which could be consistent with mild opioid toxicity, were reported by officers who 

met the case definition. Two police officers reported mental confusion following exposure, 

which might be consistent with central nervous system depression. Most officers’ symptoms had 

resolved by the time they arrived in the emergency department. Most officers did not receive any 

treatment in the emergency department beyond evaluation and monitoring. All of the police 

officers for whom medical records were available were discharged from the emergency 

department within several hours and subsequently cleared for full duty. Taken together, the 

officers who met the case definition for possible work-related opioid toxicity appeared to have 

experienced health effects that were not life-threatening and resolved quickly. 

Issues related to potential exposures among officers

Evidence collected and tested for four of seven incidents contained heroin and fentanyl. In three 

of these four incidents, the evidence tested also contained fentanyl analogues. Samples collected 

during two incidents did not contain opioids, but the samples tested represented only a subset of 

material present at the scene according to interviews with the officers involved. Cocaine was 

identified in forensic samples from three incidents where opioids were also identified. Cocaine 

intoxication can result in symptoms such as nausea and vomiting, dizziness, palpitations, 

sweating, and chest pain, and signs such as elevated heart rate, elevated blood pressure, and 

dilated pupils. Cocaine also has local anesthetic effects such as numbness and tingling [Aronson 

2016]. Because these nonspecific health effects associated with cocaine toxicity overlap with 

health effects associated with mild opioid toxicity, it might not be possible to distinguish whether 

health effects resulted from a specific drug or a combination of drugs when multiple exposures 

are involved.

In some incidents, inhalation and mucous membrane contact were likely, for example, when a 

powder blew into an officer’s face. In other incidents, possible contamination of hands or gloves 

with subsequent hand-to-face contact could have led to inhalation, mucous membrane contact, or

ingestion.

The forensic testing of evidence samples in Incident 5 revealed heroin, fentanyl, cyclopropyl 

fentanyl, and cocaine. Urine collected from Officer 5 tested negative for opiates, cocaine, and 

fentanyl. The ability to detect synthetic opioids in blood (or serum) and urine is an area of active 

investigation, with known limitations [Armenian et al. 2017, Suzuki and El-Haddad 2017]. For 

example, current opiate screens will not detect any of the synthetic opioids such as fentanyl

[Suzuki and El-Haddad 2017]. Other uncertainties include the timing of testing relative to 

potential exposure and the sensitivity of any tests performed. 

We described Incident 1 in greater detail to illustrate how we considered the various sources of 

information and to highlight an important work activity that could be associated with work-
Page 10 – HHE 2018-0015 Interim Report

related exposure to opioids. Officer 1 developed symptoms after handling items that later tested 

positive for heroin, fentanyl, and fentanyl analogues, including carfentanil, a synthetic opioid 

that is 10,000 times more potent than morphine [George et al. 2010]. Health effects occurred 

during evidence processing and involved the largest amount of confirmed opioids among all 

seven incidents. Prior NIOSH HHEs have examined workplace exposures among criminalists 

[NIOSH 2009] and forensic laboratory workers [NIOSH 2016], but not police officers, who 

handle evidence earlier in the chain of custody in non-dedicated work areas. This incident 

highlights that handling evidence is a work activity that increases the potential for work-related 

exposure to opioids. 

This is an interim report for this HHE. The case definition we used to define possible workrelated opioid toxicity was broad, in order to help gather information that will be used to inform 

our remaining activities in this HHE. For example, the information from these incidents will help 

us identify if some tasks or scenarios present a greater risk of exposure to suspected opioids than 

other tasks. As next steps, we plan to use a survey to evaluate work practices, use of PPE, and 

prevalence of exposures among police officers to suspected opioids and associated health effects. 

We also plan to assess surface contamination in evidence handling areas and common areas in a 

subset of district offices. 

Preliminary conclusions 

Seven of eight incidents involving police officers met our case definition for possible workrelated opioid toxicity. The incidents occurred during law enforcement duties in the field and 

evidence processing at police headquarters. Most cases involved samples of illicit drugs that 

tested positive for opioids. Officers reported a range of health effects, including miosis, a sign 

suggestive of opioid toxicity, along with non-specific symptoms. Most health effects were brief

and had resolved by the time officers were evaluated at the emergency department. None were 

consistent with severe opioid toxicity and none required naloxone for respiratory depression. The 

exact route(s) of exposure could not be determined for each incident. Evidence handling, 

especially processing high volumes or highly concentrated drug evidence, might be associated 

with a higher potential for unintentional exposure resulting in symptoms. 

Preliminary recommendations

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

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

applicable to these incidents, even though fentanyl or its analogues were not necessarily involved 

in all the incidents. 

On the basis of our findings to date, we recommend the actions listed below. We encourage the 

City and Police Department to use an employee-employer health and safety committee or 

working group 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 police department. 
Page 11 – HHE 2018-0015 Interim Report

1. Provide training to officers on how to prevent occupational exposure to fentanyl and its 

analogues, including standard safe operating procedures specific to police work, training, 

PPE, and decontamination. These topics are addressed in the NIOSH 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.

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

increased exposure risks.

d. 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. Collect samples of substances to which symptomatic officers may have been exposed for 

forensic testing. If possible, retain any body camera video of potential opioid exposure 

incidents going forward. Both types of information 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. 

3. Encourage officers to report possible work-related drug exposures through inhalation, 

mucous membrane contact, ingestion, and percutaneous routes and any resulting health 

effects to their supervisors and healthcare providers. 

4. Encourage officers to wear nitrile gloves during tasks when fentanyl or its analogues are 

suspected to be present. When fentanyl is not visible, but suspected to be present, 

exposure level can be considered “minimal” according to NIOSH guidance for first 

responders. Train officers (1) on how to remove gloves safely and (2) to remove gloves 

after completing their work task and before working in an area where fentanyl is not 

suspected to be present. 

a. For example, when processing evidence, an officer should remove gloves after 

handling suspected opioids or unknown drugs before using a computer in a 

common space for record keeping. 
Page 12 – HHE 2018-0015 Interim Report

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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.