Evaluation of Occupational 

Exposure to Opioids in a City 

Police Department

HHE Report No. 2018-0015-3383

August 2021 
Authors: Sophia Chiu, MD, MPH

Kendra Broadwater, MPH, CIH

Jessica F. Li, MSPH

Desktop Publisher: Shawna Watts

Editor: Cheryl Hamilton

Keywords: North American Industry Classification System (NAICS) 922190 (Police Protection), 

Ohio, Police, Law Enforcement, Illicit Drug, Opioid, Fentanyl

Disclaimer 

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 USC 669a(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]. 

Availability of Report

Copies of this report have been sent to the city, police department, and union. The state and local 

health departments and the Public Employment Risk Reduction Program have also received a copy. 

This report is not copyrighted and may be freely reproduced.

Recommended Citation

NIOSH [2021]. Evaluation of occupational exposure to opioids in a city police department. By Chiu 

S, Broadwater K, Li JF. Cincinnati, OH: U.S. Department of Health and Human Services, Centers 

for Disease Control and Prevention, National Institute for Occupational Safety and Health, Health 

Hazard Evaluation Report 2018-0015-3383, https://www.cdc.gov/niosh/hhe/reports/pdfs/2018-

0015-3383.pdf. 
Table of Contents

Main Report

Introduction....................................................................................................................................................... 1

Our Approach ................................................................................................................................................... 1

Our Key Findings.............................................................................................................................................. 1

Our Recommendations .................................................................................................................................... 3

Supporting Technical Information 

Section A: Workplace Information............................................................................................................ A-1

History of Issue at Workplace................................................................................................................ A-1

Workplace and Process Description...................................................................................................... A-1

Section B: Methods, Results, and Discussion .......................................................................................... B-1

Methods: Incident Characterization ...................................................................................................... B-1

Results: Incident Characterization ......................................................................................................... B-2

Methods: Review of Staff Notes, Training Bulletins, and Sections of the Police Handbook and 

Standard Operating Procedures............................................................................................................. B-9

Results: Review of Staff Notes, Training Bulletins, and Sections of the Police Handbook and 

Standard Operating Procedures........................................................................................................... B-10

Discussion ............................................................................................................................................... B-11

Limitations............................................................................................................................................... B-15

Conclusions............................................................................................................................................. B-16

Section C: Tables.......................................................................................................................................... C-1

Section D: References.................................................................................................................................. D-1
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1

Introduction

Request

A city in Ohio requested a health hazard evaluation (HHE) concerning possible unintentional exposure 

to opioids among police officers and firefighters during first responder activities. As one part of the 

HHE request, city and police department officials were concerned about incidents where police officers 

developed health symptoms after potential exposure to substances suspected to be opioids during the 

course of their work. 

To learn more about the workplace, go to Section A in the Supporting Technical Information

Our Approach

For each of the 16 incidents of potential unintentional exposure to opioids reported during 2017–2019, 

we completed the following activities during our evaluation:

• Conducted confidential interviews with the affected police officers about the incidents, work 

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

• Reviewed incident reports, medical records, and forensic laboratory reports when available. 

• Reviewed body camera footage recorded during incidents, when available. 

Using this information, we categorized the incidents and looked for patterns across incidents. We 

focused on incidents where a police officer experienced health effects during or after law enforcement 

activities where (1) opioids were suspected or known to be present and (2) there was no other plausible 

alternative diagnoses. 

We also reviewed police department weekly staff notes, training bulletins, and the department 

procedure manual for information related to preventing unintentional exposure to opioids at work.

We evaluated the information in the context of scientific publications and guidance about preventing 

occupational exposure to illicit drugs, including exposure to suspected illicit opioids. 

To learn more about our methods, go to Section B in the Supporting Technical Information

Our Key Findings

Most incidents involved multiple substances and happened during law enforcement 

duties away from police headquarters

• During 2017–2019, 16 officers had unintentional exposure to suspected opioids documented in 

an incident report. Of these 16 officers, 12 officers had health effects associated with law 
2

enforcement activities where opioids were suspected or known to be present and there were no 

other plausible explanations for the health effects. We based our evaluation on the 12 incidents 

involving these officers.

• Of 12 incidents, 11 had samples of the suspected illicit drug submitted for forensic laboratory 

testing. The most common substance identified was opioids, followed by cocaine and marijuana 

or its active component tetrahydrocannabinol.

• Multiple substances were identified in 8 of 10 incidents where any substance was identified. 

Fentanyl was identified in 8 incidents, always along with at least one other substance. Substances 

co-identified with fentanyl included heroin (75% of the time), cocaine (75% of the time), and 

fentanyl analogues (50% of the time).

• Of 12 incidents, 9 occurred while officers were performing law enforcement duties away from 

police headquarters such as searching a person or a location, interacting with suspects, making 

traffic stops, or processing an admission to the county jail. Two incidents occurred when 

officers were processing evidence at police headquarters. One incident occurred during other 

activities at a police location that was not district headquarters. 

Officers reported having work-related health effects after they might have been 

exposed to opioids 

• The 12 officers reported a range of symptoms. The most common were lightheadedness, 

palpitations, and nausea. Four officers reportedly had miosis (small or pinpoint pupils), a sign 

associated with opioid toxicity. 

• Most health effects were brief. Among 11 officers who went to the emergency department, 

7 reported that their symptoms had mostly or completely resolved by the time they 

arrived there. 

• None of the officers had objective signs of serious (life-threatening) opioid toxicity. None had 

signs of respiratory distress or depression. None received naloxone.

• The cause of health effects could not be definitively identified. Nonetheless, the officers’ health 

effects interfered with their ability to carry out important job duties. 

• Drugs could have been inhaled in 7 of the 12 incidents; come into contact with eyes, nose, or

mouth in 9 of the 12 incidents; and come into contact with skin in 5 of the 12 incidents. Skin

contact alone was unlikely to lead to health effects. 

Officers did not have or use PPE appropriate for handling unknown powders in an 

uncontrolled setting and were insufficiently trained on using PPE

• Half of the officers who had suspected exposure incidents wore nitrile gloves, which are 

recommended, during part of or the entire incident. One of those officers put gloves on midway 

through the incident. 
3

• A quarter of the officers who had suspected exposure incidents wore long-sleeved clothing that

provided wrist and arm protection during the incident. 

• None of the officers reported wearing respiratory protection, such as an N95 filtering facepiece 

respirator. According to the staff notes and training bulletins, respiratory protection was 

voluntary. Respirators were not standard issue safety equipment for officers at the time of 

the incidents. 

• Only the criminalistics squad in the Criminal Investigation Section was included in the written 

respiratory protection program. 

• Officers received training on handling unknown powders and preventing exposures to suspected 

fentanyl via attachments to staff notes. 

• Officers had to report to their supervisors that they had reviewed training bulletins, but 

education objectives were not established for this training. It was not clear if training 

effectiveness was evaluated (e.g., via knowledge checks or post-tests). 

To learn more about our results, go to Section B in the Supporting Technical Information

Our Recommendations

Benefits of Improving Workplace Health and Safety:

 Improved worker health and well-being  Enhanced image and reputation 

 Better workplace morale  Superior products, processes, and services

 Easier employee recruiting and retention  May generate overall cost savings

The recommendations below are based on the findings of our evaluation. For each recommendation, 

we list a series of actions you can take to address the issue at your workplace. The actions at the 

beginning of each list are preferable to the ones listed later. The list order is based on a well-accepted 

approach called the “hierarchy of controls.” The hierarchy of controls groups actions by their likely 

effectiveness in reducing or removing hazards. In most cases, the preferred approach is to eliminate 

hazardous materials or processes and install engineering controls to reduce exposure or shield 

employees. Until such controls are in place, or if they are not effective or practical, administrative 

measures and PPE might be needed. Read more about the hierarchy of controls at

https://www.cdc.gov/niosh/topics/hierarchy/. 

We encourage the police department to use a health and safety committee to discuss our 

recommendations and develop an action plan. Both union representatives and management 

representatives should be included on the committee. Helpful guidance can be found in 

“Recommended Practices for Safety and Health Programs” at

https://www.osha.gov/shpguidelines/index.html. 
4

Recommendation 1: Reduce the potential for unintentional occupational exposures 

to illicit drugs 

Why? Fentanyl and other drugs pose a potential health hazard to emergency responders (such as 

police officers, firefighters, and emergency medical services personnel) who come into contact with 

these drugs in the course of their work. Possible exposure routes to illicit drugs can vary based on the 

source and form of the drug. Responders are most likely to encounter fentanyl and its analogues in 

powder (including compressed powder), tablet, or liquid form. Potential exposure routes of greatest 

concern include inhalation, mucous membrane contact, ingestion, and percutaneous exposure (e.g., 

needlestick). Any of these exposure routes can potentially result in toxic effects. Brief skin contact 

with powdered fentanyl or its analogues is not expected to lead to toxic effects if any visible 

contamination is promptly removed. 

Police officers experienced health effects that required medical attention, preventing them from 

continuing to perform essential job duties after exposures to illicit drugs.

How? At your workplace, we recommend these specific actions: 

Perform job hazard analyses for the routine and emergency tasks or work 

responsibilities performed by officers and develop controls according to 

the risks identified. 

Consider working with occupational safety and health experts or persons with expertise on 

both PPE and police work on these job hazard analyses. Specific topics to address include 

the following:

• How to provide PPE and other equipment that are easily and safely cleaned or disposed 

of after responding to illicit drug incidents. 

• How to maintain clear and effective communication while wearing PPE, particularly 

over radios or similar devices. 

• Including officers in a written respiratory protection program if department procedures 

require or encourage respiratory protection for officers. The written program should 

include medical evaluations, annual fit testing, and respiratory protection training.

• How to coordinate proper respirator use, including topics such as

o Using respirators properly, along with the other equipment carried by police 

officers, such as duty belts, body cameras, and radios

o Timing for putting on PPE in unsecured or unsafe conditions when illicit drugs 

might be present

• Procedures for when to change gloves and how to dispose of used gloves after tasks 

with a potential for illicit drug contamination. These tasks include handling illicit drugs, 

performing searches, and handcuffing subjects who might have recently handled them.
5

For additional information on job hazard analyses, refer to the Occupational Safety and 

Health Administration’s document at

https://www.osha.gov/sites/default/files/publications/osha3071.pdf.

Develop new or modify existing policies and procedures for emergency 

response work involving illicit drugs for situations where the anticipated 

level of exposure is “moderate” or greater. 

• “Moderate” refers to situations where small amounts of illicit drugs in powder or liquid 

form are visible. 

• Follow guidance in the NIOSH Topic Page entitled “Preventing Emergency 

Responders’ Exposures to Illicit Drugs” at

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

Review and update safety policies and procedures regularly. 

• Include city and police department management in the review process, in discussion 

with employees and their representatives.

• Review policies and procedures to determine if safety protocols should be expanded 

from “fentanyl” to “unknown illicit drugs” or “unknown suspected opioid” given the 

evolving nature of the drug supply. 

• Update the department’s safety data sheet management process. The department can 

refer to or rely on the city’s hazard communication program if it includes police 

department employees.

Provide training to officers to prevent potential exposure to unknown 

powders. 

• Resources related to training are available in the Illicit Drug Tool-Kit for First Responders at 

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

• Ensure training has clear objectives, uses a variety of methods, and is evaluated for 

effectiveness using methods such as pre- and post-tests or safety audits in the field and 

in evidence storage and processing areas. 

• Provide officers with training on these topics: 

o How to conduct an on-site risk assessment

o How to use PPE that is recommended based on the risk assessment

o How to appropriately don (put on) and doff (take off) gloves. Make sure officers

know to remove gloves after handling suspected drugs and to wash their hands 

immediately after removal. 
6

• Train officers annually on respirator use, donning and doffing, maintenance, storage 

before use, and disposal after use. 

o How to handle and collect evidence safely (e.g., avoiding scraping samples that 

may contain hazardous drugs from furniture or vehicle floors; instead, rely on 

another method such as tape sampling)

o When to use the ventilated cabinet (“fume hood”)

o When and how to decontaminate work surfaces, hands, or other areas of the body 

that have been in contact with unknown drugs 

• Be clear and specific about what actions are expected from officers through policies and 

procedures and during training. For example, the procedures for using the ventilated 

cabinet suggest that the officer should handle unknown powders in the centrally located 

ventilated cabinet. Give officers more information about the amount of drugs that is 

too small to be handled in the cabinet and the amount that is too large to be handled by 

one officer alone. 

• Ensure previous training bulletins are available to and reviewed by new officers. 

Ensure officers can access recommended PPE and are trained to use it. 

• All recommended PPE should be made available to officers, and they should be trained 

on its use. For example, staff notes and training bulletins specifically mention eye 

protection and N95 filtering facepiece respirators; therefore, this PPE should be readily 

available and officers must know how and when to use it.

• Officers who might handle unknown powders should be medically cleared and fit tested 

to wear an N95 filtering facepiece respirator appropriately and safely to protect 

themselves during those job tasks. 

Recommendation 2: Continue to evaluate new exposure incidents involving 

unintentional workplace exposures to suspected illicit drugs

Why? Continuing to evaluate exposure incidents can help identify any gaps in policies and procedures

or training meant to protect police officers from exposure to illicit drugs. It can also ensure that 

policies and procedures remain effective for preventing exposure to new illicit drugs that emerge over 

time.
7

How? At your workplace, we recommend these specific actions:

Encourage officers to report when they might have had illicit drug 

exposure, or a near miss, to their supervisors. Remind them to also report 

any possible health effects that result from those potential exposures.

Collect and analyze any suspected drugs that officers may have been

exposed to, when safe and feasible. 

• Train officers on procedures for sample collection by a nonaffected officer according to 

written exposure incident response procedures. Include sample collection in training 

bulletins on preventing exposures to illicit drugs. 

• Ensure sample and evidence collection procedures include exposure controls such as 

minimal handling, avoiding actions that may aerosolize loose powders (e.g., pressing 

evidence bags to remove air, collecting powder from porous surfaces), and wearing 

appropriate PPE. 

Review reported exposure incident summaries and follow up with 

affected officers. 

• Consider conducting interviews with officers who have been exposed to help inform if 

policies and procedures or training can be modified to prevent future exposure 

incidents. 

• Retain and review body camera video footage of the incidents, when available, as part of 

the incident review. 
Supporting Technical Information

Evaluation of Occupational Exposure to Opioids in a 

City Police Department 

HHE Report No. 2018-0015-3383

August 2021 
A-1

Section A: Workplace Information

At the time of the evaluation, the police department had approximately 1,000 sworn officers. The police 

department was organized into three bureaus: Patrol, Investigations, and Support. Geographically, the 

police department was organized into six districts. Officers assigned to districts for uniform patrol duty 

were generally divided into three shifts. Shift start and end times varied by district. Sworn officers were

covered by a collective bargaining agreement between the police union and the city. 

History of Issue at Workplace

City government managers submitted an HHE request concerning unintentional occupational 

exposures to opioids among police staff. City government and police department managers were

concerned about possible exposures among police officers who encountered illicit drugs, including 

opioids, when completing their work duties. At the time of the request, several police officers had 

reported health effects after possible exposure to suspected opioids at work. City government managers 

requested assistance in assessing these exposures with the goal of preventing additional incidents. 

Workplace and Process Description

Police officers worked in a variety of settings over the course of their shift. For example, officers can

spend time in their district headquarters, outdoors (such as roadside or on bicycle patrol), public or 

private indoor locations (such as when responding to a residential call or when serving a warrant), patrol 

vehicles (such as a motor vehicle or bicycle), and other city and county law enforcement buildings (such 

as the local jail and evidence or property buildings), among others. Some officers were assigned to a 

single location. Most officers were uniformed officers and were assigned to serve a particular 

geographical portion, or district, of the police department’s jurisdiction. Some officers had specialized 

assignments, which included being on teams that address crimes related to drugs and vice (e.g., alcohol, 

prostitution, gambling, pornography, and regulatory violation), or in special weapons and tactics 

(SWAT) and canine units. Some officers were plain-clothed, or nonuniformed, such as when working 

undercover or as a detective. 
B-1

Section B: Methods, Results, and Discussion

Our evaluation objectives consisted of the following: 

• Characterize incidents in which police officers experienced unintentional occupational exposure 

to suspected opioids and developed health effects. 

• Review records about the health effects experienced by police officers. 

• Review materials provided to police officers on workplace procedures to prevent occupational 

exposure to opioids. 

• Make recommendations on how to prevent exposures to illicit drugs among police officers. 

Methods: Incident Characterization 

The city provided the police department’s Investigation of Employee Injury form (incident report) for 

all incidents that the city or police department identified as involving police officers and exposure to 

suspected opioids from 2017 through 2019. The incident reports contained information about the 

officer and the incident. 

We conducted voluntary, confidential interviews in person or by telephone with officers for whom an

incident report was filed. During the interviews, we discussed details about the incident, work practices 

and processes, PPE use, and health information. For two incidents, we also spoke with a coworker who 

was present during the incident. 

In addition, we reviewed the following information when available: 

• Forensic laboratory results for evidence collected during the incident to which the officer may 

have been exposed. 

• Video footage from body cameras worn by officers who were present during the incident. 

• Medical records related to the incident. 

Forensic laboratory reports included a weight and description of the evidence exhibit analyzed. They 

either listed the scheduled substances identified during analysis or indicated the exhibit was “negative 

for any commonly abused substances.” The forensic laboratory did not determine the concentrations of 

substances identified in the sample. The forensic laboratory reports did not include the lowest 

concentration at which a substance could be detected. 

We abstracted information from the incident reports, interviews, forensic laboratory reports, and 

medical records. 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 that was associated with law enforcement activities during 2017–2019 where (1) opioids were 

suspected or known to be present and (2) no other plausible alternative diagnoses were present. A 

health effect was considered present if it was mentioned in the incident report, interview, or medical 

records. Opioids were considered suspected or known to be present if either (1) a forensic laboratory 
B-2

report indicated that a substance present at the location of the incident contained one or more opioids 

or (2) if the officer involved described a substance that their experience suggested was likely to contain 

an opioid but the substance was not collected for analysis. 

For each incident, we categorized the job activities at the time of the suspected exposure into one or 

more categories: traffic stop, search, interaction with suspect, evidence processing, or other. We 

established these categories based on interview responses. We determined whether suspected exposure 

occurred based on when there was (1) handling of or contact with eyes and mouth with suspected 

opioid powder or (2) close proximity to potentially aerosolized powder suspected to contain opioids in 

information from incident reports, interviews, and video footage or medical records if available. We 

evaluated patterns in job activity categories visually with Euler diagrams [Wilkinson 2012]. 

We asked officers whether they handled the suspected opioid. We also inquired about what physical 

form the substance was in, if it was in a closed container or an open container, and if they saw any of 

the material released. We reviewed the body camera footage available for five incidents to identify any 

additional characteristics about possible exposure pathway or routes. Using this data, we established by 

consensus the routes by which the officers could possibly have been exposed from the following 

possibilities: inhalation, dermal, ingestion, mucous membrane contact, or percutaneous exposure 

(e.g., needlestick). 

Results: Incident Characterization 

Incident Characteristics 

The city and police department identified 16 incidents involving 16 police officers with exposure to 

suspected opioids. Among the 16 police officers, 12 met the case definition for possible work-related 

opioid toxicity. The four incidents not included in the analysis included two incidents where no 

symptoms occurred, one incident where the officer’s symptoms were attributed to another medical 

diagnosis, and one incident where the officer did not have symptoms until several hours after the 

incident, which is incompatible with the onset of action of opioids [Suzuki and El-Haddad 2017]. In the 

two incidents where no symptoms occurred, the officers filed an incident report out of concern about a 

possible inhalational exposure. For those two incidents, the forensics laboratory did not identify any 

opioids in the material submitted as evidence. 

Characteristics of the 12 incidents are summarized in Table C1. Most incidents (n = 7; 58%) occurred in 

the field. Uniform patrol was the most common assignment (n = 8; 67%). The first incident identified 

during the period of interest occurred in May 2017. Most incidents occurred in 2017 (n = 7; 58%) 

(Figure B1). 
B-3

Figure B1. Timing of incidents involving possible work-related opioid toxicity, 2017–2019 (n = 12).

Job Activities 

Job activities at the time of the suspected exposure for each incident are shown in Figure B2. Some 

incidents involved multiple job activities. Search was the most common job activity category (n = 8; 

67%). The search involved a location, for example, a residence or vehicle, in four incidents (50%), 

a person in three incidents (38%), and both a location and a person in one incident (12%). Three 

incidents involving searching a location also included evidence gathering. There was overlap between 

search and interaction with a suspect (n = 5, 42%), and traffic stop (n = 2, 17%). Evidence processing 

at police headquarters was a separate category involving two incidents (17%). Officers reported that 

powders suspected to be illicit drugs were visible in 11 incidents (92%). 

0

1

2

3

4

5

January

–March

April

–June

July–September

October–December

January

–March

April

–June

July–September

October–December

January

–March

April

–June

July–September

October–December

2017 2018 2019

Number of incidents

Timing of incident
B-4

Figure B2. Job activities during the time of suspected exposure in incidents involving possible workrelated opioid toxicity, 2017–2019 (n = 12). Numbers in italics indicate the number of incidents in a job 

activity category or job activity category combinations. 

Substances Identified 

Figure B3 summarizes the forensic laboratory testing results for specimens collected at the scene of the 

incident. Of the 12 incidents, specimens were submitted for testing for 11 (92%) incidents. For one

incident, no commonly used substances were identified in the submitted specimen. Opioids were the 

most common type of substance identified (n = 8; 67%), followed by cocaine (n = 7; 58%) and 

marijuana or tetrahydrocannabinol (THC) (n = 2, 17%). Among opioids, fentanyl or a fentanyl analogue 

was the most commonly identified substance (n = 8; 100%), followed by heroin (n = 6; 75%). Within 

the fentanyl or fentanyl analogue category, fentanyl was the most commonly identified substance (n = 8, 

100%). Carfentanil was identified in one incident (13%). 
B-5

Figure B3. Forensic testing results for specimens at the scene of incidents involving possible workrelated opioid toxicity (n = 12). The graph on the left shows the major substances identified in 

specimens from 11 incidents. The middle graph shows the types of opioids found in the 8 incidents 

with opioids. The graph on the right shows the types of fentanyl or fentanyl analogue found in the 

8 incidents with a fentanyl or fentanyl analogue.

* More than one substance was identified for some incidents. Samples submitted to the forensic 

laboratory might be only a subset of substances at the scene per the officers’ descriptions.

Multiple substances were identified in 8 of 10 (80%) incidents where any substance was identified. In 

two incidents, only cocaine or marijuana was identified. When fentanyl was identified, it was always 

along with at least one other substance. In the eight incidents where fentanyl was identified, a fentanyl 

analogue was co-identified in four (50%) incidents. Heroin and cocaine were each co-identified with 

fentanyl in six (75%) incidents (Figure B4). 
B-6

Figure B4. Co-identification of fentanyl with other substances in incidents involving possible workrelated opioid toxicity (n = 8).

The officers’ descriptions of the incidents suggested that samples submitted for forensic testing were 

not necessarily representative of all substances at a scene. For three incidents, the amount of some 

substances might have been too small to be collected for testing. For example, in one incident a suspect 

disposed of a small amount of a powder on a windy day that blew into the officer’s face; the powder 

could not be collected for testing. In a fourth incident, the sample was collected from an impounded car 

where an overdose death occurred prior to the officer’s interaction with the car. 

Exposure Pathways and Routes

We used the officers’ accounts of the incidents and body camera footage when available to

retrospectively identify possible routes of exposure. Of the 12 police officers involved in suspected 

exposure incidents, 4 (33%) described a suspected or confirmed opioid becoming aerosolized. For 

example, a suspect dropped an item from which a powder was dispersed by the wind, or powder was 

released into the air when a container was opened during a search. Of these four incidents, three

officers (25% of 12 incidents) said the material blew into their faces, describing probable inhalational

exposure, mucous membrane exposure, or both. Inhalational exposures were possible in an additional 

3 of 12 incidents (25%) where the officer was either handling suspected opioid in an open container 

(n = 2) or was scraping confirmed opioid from a surface during evidence collection (n = 1). These 

activities may also result in mucous membrane exposure.

Officers reported other activities that pose risk of mucous membrane exposures, such as handling 

evidence without gloves and lack of handwashing before touching the face. In 9 of 12 (75%) incidents, 

13%

13%

25%

25%

50%

75%

75%

U-47700

Buprenorphine

Tramadol

Marijuana/THC

Fentanyl analogue(s)

Cocaine

Heroin

Percentage of incidents

Other substances were co-identifed in incidents involving 

fentanyl
B-7

mucous membrane exposure was possible: material was visibly aerosolized, there was lack of 

handwashing or glove removal after handling suspected illicit drugs, or material was observed on an 

officer’s face. In two incidents, a very small amount of powder was observed on the officer’s lip or 

finger and exposures through both inhalation and mucous membranes were possible. The officers 

described aerosolization or work practices that could contribute to mucous membrane exposure. 

Dermal exposure was possible in 5 of 12 incidents, but the small amount and powder form involved 

was unlikely to lead to health effects through dermal exposure. 

PPE Use

Of the 12 officers involved in suspected exposure incidents, 5 (42%) reported wearing nitrile gloves 

during the incident and 1 (8%) reported putting on gloves after searching a suspect and conducting a 

preliminary search of a vehicle for weapons. The remaining six officers reported not wearing gloves 

during the incident. Regarding wrist and arm protection, three (25%) officers reported wearing longsleeved clothing. The remaining nine (75%) officers reported wearing short-sleeved clothing or had 

sleeves rolled up during the incident. Officers reported not wearing N95 filtering facepiece respirators 

or using eye protection (e.g., safety glasses or goggles) during incidents. However, we did not ask all 

officers specifically if they were wearing eye protection during incidents. Both N95 filtering facepiece 

respirators and eye protection were recommended to officers in health and safety information contained 

in staff notes from May 2018. According to police department managers, goggles and N95 filtering 

facepiece respirators were made available to officers through their supervisors starting in early 2017.

During 2017–2019, only police officers in the criminalistics squad were fit tested for N95 filtering 

facepiece respirators. Since 2020, police officers outside the criminalistics squad have been fit tested and 

provided with N95 filtering facepiece respirators for use against infectious disease exposure. 

Employee Health Assessment 

Of the 12 police officers meeting our case definition, 10 (83%) were male. The median age was 

35.5 years (range: 27–55 years). Officers who met the case definition served in this police department

for a median of 8.5 years (range: 1–32 years). 

Figure B5 shows the health effects mentioned in the incident report, interview, or medical records 

among officers who met the case definition. Lightheadedness was the most common (n = 11), followed 

by palpitations (sensation of rapid or irregular heartbeat) (n = 7) and nausea (n = 5). Four police 

officers reported either having been told by another person present during the incident that they had 

miosis (small or pinpoint pupils) or observing miosis in a mirror. Miosis is a sign associated with opioid 

toxicity. 
B-8

Figure B5. Health effects experienced by police officers meeting the case definition for possible workrelated opioid toxicity (n = 12)

Medical records were available for 11 officers. On the basis of the incident report and interviews with 

officers, 11 officers were evaluated in the emergency department (ED). They arrived in the ED

approximately 20 to 90 minutes after potential exposure. At the time of ED arrival, all officers were 

alert and oriented and seven (64%) reported that their symptoms had mostly or completely resolved. 

Upon arrival at the ED, 10 (91%) officers had elevated blood pressure, defined as blood pressure 

greater than 120/80 millimeters of mercury. One (9%) officer had an elevated heart rate. All had a 

normal temperature. None had respiratory rate of 12 breaths or less per minute, which, if present,

suggests acute opioid intoxication in a nonsleeping person [Boyer 2012]. In three officers for whom 

pupil size was documented at the time of physical examination in the ED, pupil size was normal. 

Otherwise, pupil size was not documented. None had signs of respiratory distress or depression.

Officers were mostly just observed in the ED. None required hospital admission. Blood samples were 

obtained in four officers. Tests for electrolytes performed in four officers, complete blood count

performed in three officers, and troponin (to assess for damage to heart muscle) in two officers were 

unremarkable. Electrocardiograms performed for five officers did not reveal any acute 

electrocardiographic abnormalities. A chest radiograph obtained for one officer was normal.

Urine testing was performed in three officers approximately 1.25–3 hours after symptoms began. All 

testing was negative. Cutoff values were only available for some tests. The substances included in the 

urine testing panel varied slightly. For all three officers, the panel included amphetamine, barbiturates, 

1

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2

2

2

2

3

3

4

4

4

5

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11

Itchy face

Dry mouth

Lower extremity weakness

Chest tightness

Flushing

Clammy skin

Tingling around the mouth

Blurry vision

Tingling in extremities

Difficulty breathing

Mental confusion

Diaphoresis (sweating)

Miosis (small or pinpoint pupils)

Nausea

Palpitations

Lightheadedness

Number of officers

Health effect

Officers experienced a range of health effects 
B-9

benzodiazepines, cocaine, methadone, opiates, oxycodone, and THC. For two officers, the panel also 

included buprenorphine, tricyclic antidepressants, and fentanyl. For the third officer, the panel also 

included phencyclidine (PCP) and propoxyphene. For incidents where officers underwent urine drug 

testing, forensic testing identified heroin, fentanyl and a fentanyl analogue, tramadol, and cocaine in the 

materials collected at the scene of the incident. 

Regarding treatment, 2 of 11 (18%) officers received an antinausea medication: one from emergency 

medical services providers on the way to the ED and the other in the ED. Three (27%) officers 

received intravenous fluids in the ED. None of the officers received naloxone at any point.

Upon subsequent evaluation, all 12 police officers were returned to full duty by a clinician at the city’s 

employee health services clinic. For 11 officers with available information on the date of return to work, 

6 (55%) officers were cleared to return to full duty by the next day. The remaining five (45%) officers 

were cleared to return to duty in 2–14 days. 

Methods: Review of Staff Notes, Training Bulletins, and Sections of the Police 

Handbook and Standard Operating Procedures

We reviewed the weekly staff notes that were distributed to police officers via the department’s intranet

during 2017–2019. Some staff notes contained attached training bulletins, which police officers were 

required to read. When supervisors had to check off that the officers they supervised had reviewed the 

training bulletins, that requirement was stated in the staff notes. We downloaded the staff notes that 

were available on the police department’s website in December 2019. We searched these staff notes and 

their attachments, such as training bulletins, for seven keywords related to opioid exposure: opioid, 

opiate, fentanyl, heroin, respirator, naloxone, and Narcan®. We reviewed staff notes that contained one 

or more keywords for content related to unintentional occupational exposure to opioids and their 

attached training bulletins. 

We also reviewed the following documents from the police department: 

• Safety and Health Management Program [dated 02/27/2017] 

• Standard Operating Procedure for the criminalistics squad respiratory protection program [dated 

01/05/2015] and the Respiratory Hazard Assessment and Selection form [undated] 

• Training Bulletin 2017-03 Safe Handling and Processing of Potential Fentanyl-Related 

Substances [dated 12/2017] and an Addendum [dated 05/2018]

• Sections of the police department’s procedure manual

o Property and Evidence: Confiscation, Accountability, Processing, Storage, and Release 

[dated 8/27/2020] 

o Sick/Injured with Pay, Occupational Exposures, and Special Leaves [dated 06/11/2020]

o Evidence: Submitting for Physical Analysis [dated 08/15/2013] 

o Uniforms, Related Equipment, and Grooming [dated 11/19/2020] 

o Responding to and Investigating Opioid Overdoses [dated 12/15/2016] 
B-10

o Clandestine Lab Team [dated 03/20/2007] 

o Waste and Medical Debris Used at Crime Scenes and Traffic Accidents [dated 5/1996] 

o Training Memos and Videos [dated 10/1995] 

o Material Safety Data Sheets [dated 11/1994] 

Results: Review of Staff Notes, Training Bulletins, and Sections of the Police 

Handbook and Standard Operating Procedures

The weekly staff notes and attached training bulletins were used to refresh officers on department 

policy and training. These informed officers on policy or procedure changes. Starting in March 2017, 

the staff notes periodically included instructions to officers about existing and updated policies on 

topics related to unintentional occupational exposure to opioids, including safe handling and processing 

of evidence (including evidence that may contain fentanyl or other opioids), reporting workplace 

exposures, and record keeping. 

Weekly Staff Notes and Training Bulletins

• In 2017, 52 weekly staff notes were distributed. Seven contained one or more of the keywords

and three included new information, policies, or training bulletins regarding preventing 

occupational exposure to opioids. 

• In 2018, 49 weekly staff notes were distributed. Seven contained one or more of the keywords

and three included information regarding preventing occupational exposure to opioids. 

• In 2019, 52 weekly staff notes were distributed. Four contained one or more of the keywords

and three included information regarding preventing occupational exposure to opioids. 

• A summary of these notes is in Table C2. 

The stated purpose of Training Bulletin 2017-03 was to provide officers with information on the safe 

handling and processing of potential fentanyl and fentanyl-related substances. This training bulletin had

sections on exposure routes, scenarios, risks, control measures, precautions, and PPE. Summarized 

procedures for handling unknown drugs, and what to do if exposed to unknown drugs that could 

contain fentanyl, were also included. 

The May 2018 addendum to Training Bulletin 2017-03 mentioned N95 filtering facepiece respirators 

and goggles. The training bulletin update included the following expectations about when officers 

should wear them: when officers handled potential fentanyl that was loose or uncontained; when 

handling items that contained visible, trace amounts of potential fentanyl; and any time N95 filtering 

facepiece respirator, eye protection, and nitrile glove use would mitigate risk associated with handling 

fentanyl. 

Standard Operating Procedure Manual 

The procedure for Property and Evidence includes instructions for using the ventilated cabinet (“fume 

hood”) located at the evidence storage facility and a warning against using the cabinet to process “small 

amounts of an uncontained substance.” A “small amount” was not defined in the procedure. The 
B-11

procedure also specified that a supervisor will determine if the amount of evidence that was “potential 

fentanyl” was larger than typically handled, which would indicate assistance was required to process the 

evidence. “Larger than is typically handled” was not defined. This procedure describes hazardous 

material as material that is possibly contaminated by blood, body fluid, fentanyl, or fentanyl-related 

substances.

The procedure for Sick/Injured Pay with Occupational Exposure described procedures for officers and 

their supervisors if an officer has occupational exposure to opioids. The procedure specifically 

addressed exposure to a “fentanyl-related substance” and did not address exposure to non-fentanyl 

opioids or non-opioid illicit drugs. The procedure for employees described actions to take for 

immediate removal of the affected employee from the hazard categorized by suspected exposure route. 

The supervisor’s responsibilities outlined in the procedure included ensuring the affected officer 

obtained medical care, the substance was recovered for analysis, the incident was reported and recorded, 

and the occupational health clinic for city employees was notified.

The written respiratory protection program provided by the police department covered officers in the 

criminalistics squad who underwent medical evaluation (frequency unspecified) and annual fit testing

and training. Other police officers were provided optional access to N95 filtering facepiece respirators

per staff notes and a May 2018 training bulletin. They were not included in a department or city 

respiratory protection program and did not undergo medical evaluation or fit testing. Fit testing was 

introduced in 2020, but not specifically to address potential exposures to illicit drugs. 

The procedures we reviewed were last updated from 1 to 26 years before our review. The Material 

Safety Data Sheets section of the procedure manual was last updated in 1994. Processes for revising or 

retiring Safety Data Sheets, known as Material Safety Data Sheets before 2012, did not appear to have 

been in place. 

Discussion 

Background

Ohio, where this city and police department are located, has been severely impacted by the recent 

opioid overdose epidemic. In 2017, Ohio had the second highest number of law enforcement 

encounters with fentanyl per population. There were 4,506 law enforcement encounters with 

carfentanil, a potent synthetic opioid, which was the highest number of carfentanil reports among all 

states in 2017. The U.S. Drug Enforcement Administration (DEA) reported that in Ohio, carfentanil 

reports increased 300% from 2016 to 2017 [U.S. DEA 2019]. From 2018 to 2019, the number of 

fentanyl encounters continued to increase in the Midwest [U.S. DEA 2020]. These trends have raised 

concerns about the possibility of unintentional work-related opioid exposure among police officers. 

Indeed, incident reports have continued to be filed by this city’s police officers since an interim report 

for this HHE was released in May 2018, prompting this updated report.

Health Effects 

In this evaluation, we summarized 12 cases of possible work-related opioid toxicity reported from 2017 

through 2019. None of the officers experienced severe, life-threatening opioid toxicity. Classic signs and 

symptoms of severe opioid toxicity include lethargy or other indications of central nervous system 
B-12

depression, shallow or slow breathing, miosis (small or “pinpoint” pupils), slow heart rate, and low 

body temperature [Boyer 2012; Ropper et al. 2014]. The continuum of signs and symptoms experienced 

upon opioid exposure can include nausea and lightheadedness [Lynch et al. 2018; Suzuki and ElHaddad 2017]. However, not all persons with opioid intoxication consistently experience all of these 

components [Boyer 2012]. Low-dose exposure to opioids might result in milder symptomology; a 

continuum of signs and symptoms upon exposure to opioids has been described [Lynch et al. 2018; 

Suzuki and El-Haddad 2017]. Nonspecific symptoms such as lightheadedness were reported by 11 of 

12 officers. Four officers had noted miosis, a sign of opioid toxicity. Almost all officers had to stop 

performing essential job duties and seek medical attention in the ED during incidents with suspected 

exposure to opioids. 

In our evaluation, it was not possible to conclude whether other factors including perceived risk might 

have impacted the observed health effects. The concept of “perceived risk,” or the subjective judgment 

that individuals make about the type and severity of any risk, has been associated with increased anxiety 

and symptom reporting separate from physical exposure to a hazard [Gallacher et al. 2007]. This 

evaluation was not intended to assess the possible relationships between perceived risk, exposures, and 

the clinical status of the officers discussed in this report. 

The identity of substances suspected to contain illicit drugs often cannot be determined without 

laboratory analysis [Liu et al. 2018]. As a result, there are challenges in characterizing the exposure either 

during incidents or retrospectively and relating exposures to health effects. Forensic laboratory testing 

identified multiple substances in most incidents.

NIOSH has broadened recommendations to protect emergency responders such as police officers from 

a variety of illicit drugs that can be encountered during their job duties, not just fentanyl. In the eight 

incidents when fentanyl was identified, it was always along with at least one other substance, most 

commonly cocaine or heroin. This is consistent with reports that illicit fentanyl and its analogues are 

increasingly being mixed with other drugs, particularly cocaine [CDC 2018]. Exposure to a combination 

of opioids and stimulants such as cocaine might produce health effects not characteristic of a pure 

opioid or a pure stimulant exposure. For example, toxicity from cocaine involves elevated heart rate and 

blood pressure, sweating, nausea and vomiting, and local anesthetic effects such as numbness and 

tingling [Aronson 2015; Brody et al. 1990]. Additionally, nonpharmaceutical grade or illicit drugs might 

contain adulterants or contaminants that might, by themselves or in combination, lead to a variety of 

health effects in exposed individuals [Behrman 2008; Cole et al. 2011]. 

Exposure Pathways and Routes 

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

needlestick) are potential work-related routes of unintentional exposure to illicit drugs among first 

responders. Our evaluation determined that the incidents might have involved inhalation, mucous 

membrane contact, or skin contact. In some incidents, the substance suspected to contain illicit drugs 

became aerosolized in uncontrolled circumstances, such as wind blowing into the officer’s face. Brief 

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

symptoms [Interagency Board 2017; Lynch et al. 2018; Moss et al. 2018], but subsequent hand-to-face 

contact leading to mucous membrane contact or inhalation is another possible route of exposure. 
B-13

Most incidents occurred during law enforcement activities away from police headquarters, such as 

searches, traffic stops, and interacting with a suspect. These patterns suggest that it is important to 

provide officers with training on how to assess their potential for exposure to illicit drugs during 

common law enforcement activities and implement safer work practices. Having recommended PPE 

available when warranted and using it correctly can also reduce potential for exposure. Evidence

processing at police headquarters was a separate category of exposure incidents. Engineering controls 

such as the ventilated cabinet can be employed to further protect officers in this more controlled 

environment.

Exposure assessments in this evaluation were limited to retrospective analysis of reported incidents. The 

materials that officers were possibly exposed to were collected as evidence and subsequently analyzed in 

most but not all the incidents. As of 2019, comprehensive peer-reviewed and gray literature searches

(information or research made available outside of traditional peer-reviewed journals) have yielded no 

evaluations or studies of occupational exposure to illicit opioids among police officers. There were

several evaluations of exposure for two other occupational groups: pharmaceutical workers and forensic 

chemists [NIOSH 2020a,b; Van Nimmen and Veulemans 2004; Van Nimmen et al. 2006]. 

Exposure monitoring could be used to assess current exposure controls and inform changes, 

particularly during routine law enforcement activities, such as evidence processing in a central location. 

However, the unpredictable nature of police work and the identities of drugs to which officers might be 

exposed are barriers to establishing an effective exposure assessment component in a health and safety 

program. Furthermore, occupational exposure limits have not been established for the myriad drugs 

officers may encounter at work. 

The negative urine drug screen results for the three officers tested do not rule out the possibility of 

exposure. The ability to detect synthetic opioids such as fentanyl in blood (or serum) and urine is an 

area of active investigation with known limitations [Armenian et al. 2017; Suzuki and El-Haddad 2017]. 

Only two officers underwent urine testing specifically for fentanyl because current opiate screens do not 

detect synthetic opioids such as fentanyl [Suzuki and El-Haddad 2017]. While the timing of urine 

collection was within the window of detection [NIOSH 2020a], the urine drug screening tests might not 

have sufficient sensitivity to detect relatively low exposure. For example, in a recent NIOSH HHE

report evaluating potential illicit drug exposures among forensic science laboratory staff, levels detected 

in staff urine samples at the end of a shift were below the federal initial drug test cutoff concentrations

[NIOSH 2020a]. Established cutoff levels for urine drug screening tests, such as those used in the EDs 

that evaluated the officers, take into consideration the desirability of avoiding false-positive tests 

[Moeller et al. 2017]; therefore, results lower than established cutoff levels are reported as negative.

Policies, Procedures, and Training 

We reviewed the procedures manual and training bulletins that guided officers’ work tasks, including

several procedures that could contain pertinent guidance regarding exposure to suspected drugs. These 

materials could be clearer in establishing expectations for (1) how officers should evaluate the

environment for risk of exposure to suspected illicit drugs, including fentanyl and (2) what work 

practices, including PPE use, officers should use based on that risk assessment. 
B-14

In particular, one bulletin stated the purpose of the Property and Evidence: Confiscation, 

Accountability, Processing, Storage, and Release procedure was to minimize hazardous drug exposure 

(among other agents). This document, along with Training Bulletin 2017-03, Safe Handling and 

Processing of Potential Fentanyl-Related Substances, act as the main tools for communicating safe 

handling of suspected fentanyl to officers. The definition of hazardous material in the standard 

operating procedures manual (Property and Evidence) is narrow compared to the many potentially 

hazardous substances, such as illicit drugs, that officers may encounter at work as the illicit drug supply 

changes in the future. The Sick/Injured Pay with Occupational Exposure procedure only referred to 

opioids in the title and only to “fentanyl-related substances” in the procedure specifics; it would be 

good practice for this procedure to be expanded to apply to exposures to any suspected illicit drug. This 

procedure required supervisors to ensure the substance the affected officer was possibly exposed to was 

collected. The identity of the substance is an important piece of information when evaluating exposure 

incidents. The sample collection requirement could also be included in other procedures and officer 

trainings and training bulletins for situations when the supervisor is not on site to ensure collection.

Training Bulletin 2017-03 discussed hazard recognition and appropriate PPE use as important to the 

safe handling of unknown substances but did not provide procedures on these topics. The Training

Bulletin included a table from the Interagency Board’s “Recommendations on Selection and Use of 

Personal Protective Equipment for First Responders Against Exposure Hazards to Synthetic Opioids” 

[dated August 2017], which describes recommended PPE by response function [Interagency Board 

2017]. However, the recommended PPE descriptions specify respiratory protection that is not available 

to these officers, such as P100 filtering facepiece respirators and full-facepiece air purifying respirators 

with P100 filters. A visual aid like this table can be an appropriate training tool to show officers the 

proper precautions and PPE to use for a potential anticipated exposure if tailored to the officers’ work 

tasks and to PPE they can access and are trained to use. 

The procedure for Property and Evidence indicates using “PPE appropriate to the hazard.” The 

procedure requires a minimum of nitrile gloves when processing evidence that contains potential 

fentanyl and fentanyl-related substances. This procedure is consistent with NIOSH recommendations 

for preventing illicit drug exposures among emergency responders [NIOSH 2020c]. Recently, empirical 

data supported these recommendations; experiments demonstrated that a fentanyl or carfentanil 

solution did not permeate commercially available nitrile gloves with a minimum thickness of 5 ± 2 mil

[Greenawald et al. 2020]. However, the procedure does not clearly state that all unknown drug 

substances can potentially contain fentanyl or another opioid. Additionally, the procedure could include

instructions for identifying hazards and additional appropriate PPE, other than nitrile gloves, to protect 

officers from these hazards. Inhalation and mucous membrane exposures are thought to be routes with 

higher risk of health effects compared to dermal exposure, but PPE to control these exposures, such as 

respiratory protection, were not required by department policy. 

We found opportunities to better integrate health and safety training and expectations into department

procedures and training. The guidance found in Training Bulletin 2017-03 on handling and processing 

fentanyl is not found in the standard operating procedures manual. Introducing health and safety 

practices into the procedures manual or creating a required supplement that is included in the in-person 

training would benefit both officer trainees and established officers. Integrating health and safety 
B-15

information into department procedures serves several purposes. First, the procedure can serve as a 

single source of information for officers on how to safely conduct their work while preventing and 

reducing exposure to illicit drugs. Second, management’s commitment to the Safety and Health 

Management Program [dated 02/27/2017] would be reflected by the inclusion of health and safety 

information in some department materials. Current procedures could be expanded to include all 

unknown substances that are suspected to be hazardous, so the procedure is not limited to being 

protective from fentanyl exposure but rather all unknown or suspected illicit drugs. Broadening the 

scope of the procedure manual is particularly important because new hazardous drugs or mixtures of 

existing drugs will continue to be introduced into the illicit drug trade [United Nations Office on Drugs 

and Crime 2020]. 

A consensus standard recommends health and safety training be based on a needs assessment, contain 

learning objectives, be delivered in a method appropriate to the stated learning objectives, and include 

information needed to achieve the learning objectives [ANSI/ASSP 2016]. Training is one piece of an 

effective health and safety program that can reduce and prevent occupational injuries and illnesses 

[ANSI/ASSP 2016; Robson et al. 2010]. Although more research is needed on training impact, training

has been found to improve occupational health and safety-related behaviors [Robson et al. 2010]. Some 

research supports the inclusion of behavioral modeling in training as more effective than other types of 

training [Burke et al. 2006]. Behavioral modeling is a hands-on training method that can be used in a 

field or classroom setting. A trainee observes a role model performing a task in a safe manner, practices 

the task, and then receives and incorporates feedback designed to improve safety when performing the 

task. These elements of training can be incorporated into efforts to prevent work-related unintentional 

exposure to illicit drugs among police officers.

Limitations 

Our evaluation had some limitations. First, we were only able to evaluate the incidents where an 

incident report form was filed with the city and police department. There may have been other incidents 

where an incident report was not filed. For example, when we posed a general question to officers 

about whether they would have done anything differently during these incidents, several reported that 

they might not have reported the incident if they had known about the amount of attention they would 

receive after reporting the incident. We do not know how many other police officers might have 

experienced similar incidents, had similar concerns, and did not report them. Second, the evaluation was 

retrospective in nature and the amount of time between the incident and interviewing the officer 

involved varied. This might have resulted in decreased recall of incident details. Third, substances to 

which officers might have been exposed are incompletely characterized. Forensic laboratory testing was

primarily conducted for law enforcement purposes, not as a component of fully characterizing the 

occupational safety and health risks associated with exposure. In addition, not all substances were 

submitted for forensic laboratory testing. Fourth, although we reviewed the ED records for the officers 

when available, we cannot completely rule out the possibility that unrecognized medical conditions 

might have contributed to the health effects observed. 
B-16

Conclusions

During 2017–2019, 12 police officers in a city police department developed health effects shortly after 

law enforcement activities where opioids were suspected or known to be present. None of the officers 

experienced severe, life-threatening opioid toxicity. The symptoms they experienced could be consistent 

with milder toxicity related to drug exposure or other, unidentified causes. The symptoms were severe 

enough that officers required medical attention and were not able to continue performing their essential 

job duties. Incidents occurred during law enforcement activities away from police headquarters or

during evidence processing. Most incidents involved multiple types of substances whose identities were 

unknown at the time, highlighting the need to implement training and ensure safe work practices to 

prevent future exposures to illicit drugs.
C-1

Section C: Tables

Table C1. Characteristics of incidents involving possible workrelated opioid toxicity, 2017–2019 (n = 12) 

Characteristic Number (%)

Location 

Field 7 (58)

Headquarters 2 (17)

County jail 2 (17)

Other 1 (8)

Assignment 

Uniform patrol 8 (67)

Other 4 (33)

Time of day 

12:01 am to 6:00 am 0 (0)

6:01 am to 12:00 pm 1 (8)

12:01 pm to 6:00 pm 8 (67)

6:01 pm to 12:00 am 3 (25)
C-2

Table C2. Summary of staff notes and training bulletin content related to unintentional occupational 

exposure to drugs, 2017–2019

Month Topic(s)

March 2017 Included the written police department Health and Safety Management Program as an 

attachment, which references procedures for responding to a heroin or opiate overdose

and implementation of a respiratory protection program for personnel who were 

exposed to respiratory hazards

August 2017 First mention of avoiding contact with fentanyl and its analogues. The listed protective 

measures included double gloving, using soap and water, avoiding hand sanitizer, 

handling unknown substances only when around another officer, and avoiding pressing 

on baggies (burping). Included a brief summary and attachment of a DEA publication.

December 2017 New training bulletin on safe handling and processing of potential fentanyl-related 

substances was included in the staff notes. Training bulletin referenced the 

police department’s procedures and documents by the DEA, the American College of 

Medical Toxicology and American Academy of Clinical Toxicology, the Interagency 

Board, and NIOSH.

May 2018 Updated training bulletin on the safe handling and processing of suspected fentanyl. 

Updates included implementation of optional N95 filtering facepiece respirator and eye 

protection use in the field. A link to a training video for N95 filtering facepiece 

respirators was included.

July 2018 Revision to procedures for sickness or injury with pay to include the process for 

employee exposures to opioids. Revisions included instructions to avoid alcohol-based 

hand sanitizer and ensure any associated evidence is collected.

November 2018 Revised procedure for evidence processing to include information about labeling 

suspect fentanyl and disposal of potentially contaminated PPE.

January 2019 Revised Property and Evidence procedure to include procedures to use a ductless 

ventilated cabinet (“fume hood”) at a central location for evidence processing with 

permission from the supervisor. Officers were advised not to process small amounts of 

uncontained substances in the fume hood because it could be drawn into the hood.

May 2019 Unspecified revision to sickness or injury with pay procedures. The procedure for 

employees and supervisors after an occupational exposure to opioids was included in 

this procedure and the full text was included in the staff notes.

July 2019 Reminder about narcotic handling procedures, training bulletins, and information from a 

local commission on opioid overdoses. Only gloves are mentioned as appropriate PPE 

when handling suspected fentanyl.
D-1

Section D: References 

Illicit drugs

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and increased usage and mixing with non-opioids. Health Alert Network Update 413. Atlanta, GA: U.S. 

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Public Health Preparedness and Response, https://emergency.cdc.gov/han/han00413.asp. 

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

empirical evidence. Drug Test Anal 3(2):89–96, http://doi.org/10.1002/dta.220. 

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emerging drugs of abuse and their detection methods: an ACLPS critical review. Am J Clin Pathol 

149(2):105–116, https://doi.org/10.1093/ajcp/aqx138. 

NIOSH [2020a]. Evaluation of occupational exposures to illicit drugs at controlled substances 

laboratories. By Broadwater KR, Jackson DA, Li JF. Cincinnati, OH: U.S. Department of Health and 

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https://www.unodc.org/documents/scientific/NPS-Leaflet_WEB_2020.pdf. 
D-2

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narcotic analgesics in pharmaceutical production workers. Ann Occup Hyg 50(7):665–667, 

http://doi.org/10.1093/annhyg/mel028. 
D-3

Training

ANSI/ASSP [2016]. Z490.1-2016. Criteria for accepted practices in safety, health and environmental 

training. Park Ridge, IL: American Society of Safety Engineers.

Burke MJ, Sarpy SA, Smith-Crow K, Chan-Serafin S, Salvador RO, Islam G [2006]. Relative 

effectiveness of worker safety and health training methods. Am J Public Health 96(2):315–324, 

https://doi.org/10.2105/AJPH.2004.059840. 

Robson L, Stephenson C, Schulte P, Amick B, Chan S, Bielecky A, Wang A, Heidotting T, Irvin E, 

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