Four Penn. First Responders Possibly Exposed to Carfentanil

July 21—Newtown Township, PA

Four emergency first responders were taken to the hospital after an early July incident in Bucks County that may have involved the ultra-deadly narcotic carfentanil, said Evan Resnikoff, chief of the Newtown Ambulance Squad.

None of the four was admitted to a hospital. But publicity this week concerning the July 7 response to a report of a person suffering cardiac arrest inside a vehicle came as the number of carfentanil-related incidents in southeastern Pennsylvania continued to increase. Montgomery County officials last week reported two carfentanil-related deaths. On Wednesday, Chester County District Attorney Tom Hogan said a July 4 overdose death marked the first appearance of a carfentanil death.

Berks County District Attorney John T. Adams said the drug has not appeared in Berks.

The synthetic drug, a derivative of fentanyl, was initially designed to tranquilize large animals. It can kill in amounts as small as the equivalent of six or seven grains of table salt. The Pennsylvania Department of Health issued an advisory that said carfentanil can be absorbed through the skin.

Meanwhile, the American College of Medical Toxicology and American Academy of Clinical Toxicology took the position this month that the risk of significant exposure to first responders involving fentanyl and related substances is extremely low.

Fentanyl and heroin were among many items being sold in a huge online "dark market" shut down in a U.S. Department of Justice-led effort that involved law enforcement agencies in other countries, the department announced Thursday.

The market, called AlphaBay, operated for more than two years and was used to sell stolen and fraudulent identification documents, counterfeit goods, malware, firearms and toxic chemicals.

The department press release said a Canadian citizen living in Thailand, Alexandre Cazes, was arrested by Thai authorities on behalf of the U.S. for his role as creator and administrator of AlphaBay. On July 12, the release said, Cazes apparently took his own life while in custody in Thailand.

Information available on AlphaBay prior to its shutdown included a statement that it had 200,000 users and 40,000 vendors.

"We have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids," the joint statement said. "Incidental dermal absorption is unlikely to cause opioid toxicity."

On Thursday, toxicologist Dr. Philip Moore of Associates in Medical Toxicology in Harrisburg said it is often not obvious in emergencies what specific substance caused a person to overdose.

"If you have someone who is clearly toxic from a very powerful opiate, you treat them with Narcan," he said.

Narcan is a brand name for naloxone, used to reverse the effects of an opioid drug overdose.

On July 7, it was used on the individual who had been reported in cardiac arrest in Newtown Township, Bucks County, Resnikoff said.

Soon afterward, two paramedics, an emergency medical technician and a deputy fire chief started to exhibit signs and symptoms of exposure to a narcotic, Resnikoff said.

Those symptoms included rapid heartbeat, mood changes and high blood pressure, he said. Each of the four was taken to a hospital emergency room, observed for a time, then released.

"I can't say for certain if it was carfentanil, but they truly were exposed to some substance that was on the patient or in the vehicle itself, in powder form," Resnikoff said.

A spokeswoman for Newtown Township police said there was nothing found at the scene of the incident that could be tested.

Reading Eagle, Pa.