Professional Documents
Culture Documents
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U.S. Department of Justice
Drug Enforcement Administration
Fentanyl
FURANYL-FENTANYL·ACRYL-FENTANYL·ACETYL-FENTANYL
A Briefing Guide
for First
Responders
CONTENTS
History of Fentanyl 3
Fentanyl Detection 17
Resources 19
Disclaimer
This document contains recommendations on potential best practices for first responders that
may encounter, test and transport exhibits that could contain fentanyl-related substances. It
also contains recommendations for handling and processing of crime scenes and non-drug
evidence, like money, that could be contaminated. This interim guidance is intended for
educational and awareness purposes only, and should not to be treated as technical guidance
related to the handling and processing of fentanyl.
UNCLASSIFIED 1
EXECUTIVE SUMMARY
In the last several years, U.S. Law Enforcement has seen a dramatic increase in the availability
of dangerous synthetic opioids. A large majority of these synthetic opioids are structural
derivatives of the synthetic drug “fentanyl.” Fentanyl is a synthetic opioid currently listed as a
Schedule II prescription drug that mimics the effects of morphine in the human body, but has
potency 50–100 times that of morphine. Due to the high potency and availability of fentanyl,
both transnational and domestic criminal organizations are increasingly utilizing these
dangerous synthetic opioids as an adulterant in heroin and other controlled substances. The
presence of these synthetic opioids in the illicit U.S. drug market is extremely concerning as the
potency of these drugs has led to a significant increase in overdose incidents and overdose-
related deaths throughout the nation.
WARNING
There is a significant threat to law enforcement personnel, and other first responders, who
may come in contact with fentanyl and other fentanyl-related substances through routine
law enforcement, emergency or life-saving activities. Since fentanyl can be ingested orally,
inhaled through the nose or mouth, or absorbed through the skin or eyes, any substance
suspected to contain fentanyl should be treated with extreme caution as exposure to a small
amount can lead to significant health-related complications, respiratory depression, or death.
UNCLASSIFIED 2
UNCLASSIFIED 3
for Disease Control (CDC) reported 33,091 processing and distribution. Seizures
deaths in 2015 which were the result of indicate that China supplies lower volumes
opioid overdoses alone. Of those deaths, of high-purity fentanyl, whereas fentanyl
9,580 were caused by synthetic opioids seizures from Mexico are higher volume but
other than methadone, which includes lower in purity. Fentanyl is also routed and
fentanyl and fentanyl-related substances - smuggled through Canada. China-based
an increase of 72.2 percent over previous trafficking organizations have also been
years. known to use the internet to distribute
fentanyl, fentanyl-related substances, and
synthetic opioids globally.
“… (CDC) reported
Given China’s role as an exporter of illicit
33,091 deaths in 2015
fentanyl products destined for the United
which were the result
States, DEA officials recently met with
of opioid overdoses Chinese officials in Beijing. This meeting
alone. Of those prompted China to regulate four fentanyl-
deaths, 9,580 were related substances under Chinese law,
caused by synthetic effective March 1, 2017, in an effort to help
opioids …” stem the flow of these dangerous synthetic
opioids into the United States.
While pharmaceutical fentanyl in the form In 2014, the DEA established the Heroin-
of transdermal patches or sublingual tablets Fentanyl Task Force (HFTF). The HFTF
is diverted on a small scale, the current consists of several government agencies
increase in opioid-related deaths appears to working together to facilitate a “whole of
be driven by illicitly produced fentanyl government” approach to the fentanyl and
products. synthetic opioid epidemic in the United
States.
Due to the high potency of fentanyl and
other synthetic opioids, transnational The HFTF currently consists of personnel
criminal organizations across the globe are from the DEA, HSI, CBP, FBI, USPIS, and the
competing for the U.S. market. China and IRS. The HFTF is using every available
Mexico appear to be the main source resource to support U.S. law enforcement
countries for illicit fentanyl smuggled into agencies in their respective synthetic opioid
the United States for domestic-based investigations.
UNCLASSIFIED 4
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
Canada
U n ited States
C hina
Mexico
2.
1
Fentanyls in powder form and pill presses are shipped via mail service .s
T h e powder fentanyls are processed and m ixed with heroin, or sold
as heroin, or pressed into pills and sold in the C anadian drug market.
2 a Som e fentanyl products are smuggled from C anada into the United
States for sale, on a smaller scale .
4
T h e powder fentanyls are processed and mixed with heroin . or sold
as heroin, or pressed into pills and sold in the United States drug market.
Th e powder fentanyls are cut and diluted for further sm ugglin g , or
pressed into counterfeit prescription p ills .
4a
Diluted powder fentanyls and counterfeit prescription pilI s containing
fentanyl are sm uggled from Mexico into the United States .
5
6
Precursors for manufacturing fentanyls are shipped via mail services .
Precursors are used to manufacture fentanyls in clandestine laboratories .
P recursors are sm uggled across the Southwest border into Mexico
7
to manufacture fentanyls.
8
Precursors are used to manufacture fentanyls in clandestine laboratories.
SECTION II
Description of Fentanyl-Related
Fentanyl and fentanyl-related substances
Substances
have potency much greater than that of
morphine, but effects can vary greatly
Legal forms of fentanyl are prescribed depending on the identity, potency, and
with, or as a replacement for, morphine and purity level of the substances encountered.
are used in both human and veterinary
medicine as an anesthetic during surgery, to While fentanyl may be 50-100 times more
manage pain after surgery, and to treat potent than morphine, and 30-50 times
chronic pain in patients physically tolerant more potent than heroin, carfentanil, which
to other pain killers. is structurally related to fentanyl, is up to
10,000 times more potent than morphine.
Illicit forms of fentanyl have been, and The toxic dose of carfentanil in humans is
continue to be, identified in conjunction unknown. Regardless, any substance
with heroin, as a replacement for heroin, or suspected to contain fentanyl should be
in the production of counterfeit treated with extreme caution as exposure
pharmaceutical tablets which mimic to a small amount can lead to significant
oxycodone, hydrocodone, and alprazolam health-related complications, or death.
products.
UNCLASSIFIED 5
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
SECTION III such as heroin, cocaine, and
Common Illicit Forms of Fentanyl methamphetamine. In addition, fentanyl
and fentanyl-related substances have been
and Synthetic Opioids
identified in counterfeit pharmaceutical
products, such as tablets that mimic
There are currently numerous fentanyl-
oxycodone, hydrocodone, and alprazolam.
related substances available on the illicit
domestic market including, but not limited
Fentanyl and fentanyl-related substances
to, 4-fluoroisobutyryl fentanyl, furanyl-
are increasingly also found as a component
fentanyl, acryl-fentanyl, acetyl-fentanyl,
of “speedball” mixtures with stimulants
carfentanil, and 3-methylfentanyl, as well as
such as cocaine.
other synthetic opioids such as U-47700.
More recently, fentanyl and fentanyl-
Fentanyl and carfentanil are currently listed
related substances have been combined
under Schedule II of the Controlled
with heroin and other synthetic opioids,
Substances Act (CSA) meaning they have a
such as U-47700, to create a deadly opioid
currently approved medical use and a high
mix called “Grey Death,” due to the unique
potential for abuse which may lead to
grey, concrete colored appearance.
severe psychological and/or physical
dependence.
Other illicit opioids, including several “…fentanyl and fentanyl-
fentanyl-related substances, AH-7921, and related substances have
U-47700, are found in Schedule I of the CSA. been combined with
This means they have no currently accepted heroin and other
medical use in the United States, a lack of synthetic opioids, such as
accepted safety for use under medical
U-47700, to create a
supervision, and a high potential for abuse.
deadly opioid mix called
While fentanyl and some fentanyl-related
“Grey Death,”
substances (such as alfentanil, carfentanil,
remifentanil, and sufentanil) can have a
legitimate medical use, other illicit forms, Further, information gleaned from recent
both imported and clandestinely seizures and arrests nationwide have
manufactured have been used as an indicated that some criminal organizations
adulterant in other controlled substances are importing and distributing pure fentanyl
UNCLASSIFIED 6
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
UNCLASSIFIED 7
During the 1st quarter of 2017, the DEA laboratory system had 230 identifications of fentanyl,
fentanyl-related substances, and other synthetic opioids based on seized drug evidence.
Fentanyl accounted for approximately 58 percent of the identifications. The second most
prominent fentanyl-related substance was furanyl-fentanyl, which accounted for 26 percent of
the identifications. Of all 230 exhibits, heroin was found in combination with fentanyl in 61
percent of the identifications, while U-47700, alprazolam, ketamine and cocaine were found in
other fentanyl-related exhibits in varying degrees.
OPIOIDS/
ANALGESICS
THERE WERE 230 IDENTIFICATIONS OF FENTANYL, FENTANYL-
RELATED SUBSTANCES, AND OTHER SYNTHETIC OPIOIDS. FENTANYL
ACCOUNTED FOR APPROXIMATELY 58% OF THE IDENTIFICATIONS.
THE NEXT MOST PROMINENT FENTANYL-RELATED SUBSTANCE,
FURANYL FENTANYL, ACCOUNTED FOR 26% OF THE
IDENTIFICATIONS. NO NEW OPIOIDS WERE IDENTIFIED THIS QUARTER.
OF THE 134 FENTANYL IDENTIFICATIONS, FENTANYL WAS FOUND AS THE
ONLY CONTROLLED SUBSTANCE IN APPROX 28%
OF THE
IDENTIFICATIONS AND WAS FOUND IN COMBINATION WITH HEROIN
4-ANPP 2
Acetylfentanyl 5
Other controlled substances identified
with fentanyl this quarter include
Carfentanil 6 U-47700, alprazolam , heroin,
ketamine, and cocaine.
Acryl fentanyl 9
U-47700 14
Furanyl fentanyl 60
Fentanyl 134
UNCLASSIFIED 8
“…accidental exposure by PPE D E FIN E D :
evidence (e.g., drug proceeds, pill presses, L e v e l A PPE: Level “A ” su it and a self-
scales, or drug paraphernalia) which may be contained breathing
apparatus
contaminated with these substances.
Due to the high potency of fentanyl and
fentanyl-related substances, exposure to
small quantities can cause serious negative
health effects, respiratory depression, and
even death.
UNCLASSIFIED 9
Level “B” Suits
Individual PPE Kits
Example:
First responders who may encounter
fentanyl or fentanyl-related substances
Personnel are utilizing:
should maintain an individual (personal)
PPE kit, which includes:
● Level B PPE to conduct initial breach
● Level A PPE for on-site assessment
● Nitrile gloves
● Level C PPE for stand-by assistance
● N-95 dust masks
● Sturdy eye protection
● Paper coveralls - shoe covers
● Naloxone Injector(s)
UNCLASSIFIED 10
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
General Safety Recommendations Law enforcement personnel, as well as first
responders, should exercise appropriate
Due to the hazardous nature of the safety precautions at all times when
synthetic opioids described in this overview, fentanyl or fentanyl-related substances are
law enforcement personnel, or any first suspected.
responders, who encounter fentanyl or
fentanyl-related substances should NOT If the presence of fentanyl or any synthetic
take samples or otherwise disturb any opioid is suspected, personnel should
powdered substances without employing immediately contact the appropriate
proper PPE, as this could lead to accidental officials within their agency who have been
exposure. trained to handle hazardous materials, or
contact the nearest DEA field office for
assistance. Having specially trained law
enforcement (or hazardous materials
“…law enforcement
“HAZMAT” incident response team)
personnel, or any first
professionals equipped with the necessary
responders, who
equipment, to include Level “A” PPE, on-site
encounter fentanyl or to assess the situation prior to exposure or
fentanyl-related contamination is recommended. This
substances should NOT includes situations involving unknown
take samples or otherwise powdered substances and/or pill milling or
disturb any powdered encapsulating operations.
substances without
When encountering unknown powders,
employing proper PPE…”
personnel should use, at the minimum,
Personal PPE to include nitrile gloves, N-95
dust mask, eye protection, disposable paper
suit, or paper coveralls, and shoe covers.
Further, it is possible that illicit fentanyl or Naloxone should also be readily available
fentanyl-related substances could be mixed for administration.
with other drugs or concealed in innocuous
devices (such as nasal spray or eye dropper To limit the potential for exposure,
bottles) in varying amounts and purities, personnel should refrain from eating,
thus causing unintentional exposure. drinking, or smoking while in the presence
of any suspected fentanyl-related
substance.
UNCLASSIFIED 11
Incidents of Overdose and Death After assessing the scene, should fentanyl
be suspected, on-site personnel should
First responders should always employ employ the above described safety
universal safety precautions and use, at a protocols referenced under General Safety
minimum, Personal PPE when they arrive at Recommendations as appropriate,
a scene where there has been a suspected depending on the potential level of
overdose incident, or suspected overdose contamination.
death.
First responders should also be mindful of
Assessment the potential “Fentanyl Footprint” in their
respective jurisdictions, which are clusters
Upon arrival, personnel should carefully of overdoses and overdose deaths occurring
examine the environment and situation within a small geographic area, within 48-72
before proceeding in order to detect any hours. Based on incident reporting and
signs of fentanyl contamination. analysis, this could possibly indicate
fentanyl or fentanyl-related substances
Indicators being present.
Personnel should look for any cyanosis Routine Activity
(turning blue or bluish color) of victims,
including the skin or lips, as this could be a Due to the current opioid crisis and
sign of fentanyl overdose caused by prevalence of fentanyl and fentanyl-related
respiratory arrest. Further, before substances on the domestic market, law
proceeding, personnel should examine the enforcement personnel and first responders
scene for any loose powders (no matter should look for any fentanyl indicators such
how small), as well as nasal spray bottles, as powders, pills, or capsules when conducting
these could be signs of fentanyl use. their respective activity such as motor
vehicle stops, or responding to calls for
Opened mail and shipping materials located service. If observed, personnel should
at the scene of an overdose with a return utilize, at a minimum, nitrile gloves, eye
address from China could also indicate the protection, and N-95 dust mask (which
presence of fentanyl, as China-based should be part of their Personal PPE kit).
organizations may utilize conventional
and/or commercial means to ship fentanyl
and fentanyl-related substances to the
United States.
UNCLASSIFIED 12
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
Drug Related Evidence Collection: recommended that Level “A” PPE be
utilized.
Do NOT attempt to collect or otherwise
disturb any suspected fentanyl, fentanyl- If an exigent situation exists where drug-
related substance, synthetic opioid or related material might be disturbed and/or
unknown powdered substance without collected in order to protect life, personnel
employing proper PPE as this could cause should employ, at a minimum, the above-
an unintentional exposure during the referenced Personal PPE to include nitrile
evidence collection process. gloves, an N-95 dust mask, eye protection,
disposable paper suit or paper coveralls.
NOTE: Personal PPE should only be used
when a valid urgent or emergency situation
exists and/or the evidence is located in
small amounts which can easily be
contained and sealed without risk of
spillage. This PPE and collection method
however, should not be employed where
there is loose powder, liquid, and/or gross
contamination. Any situation involving a
large-scale accidental spill or release of a
Due to the high risk potential associated fentanyl-related substance is a public health
with these substances, only law emergency which requires law enforcement
enforcement personnel employing the personnel to immediately vacate the area
proper PPE (from Personal PPE to Level “A” and call a HAZMAT incident response team.
PPE) as referenced under General Safety
Recommendations should consider Non-Drug Related Evidence Collection
handling any substance suspected to
contain fentanyl or a fentanyl-related It is possible that fentanyl residue could be
substance. present on items of non-drug evidence such
as currency, money counters, cellular
If feasible, personnel should contact the telephones, or drug paraphernalia which
appropriate officials within their agency could create an additional vulnerability to
who have been trained to handle hazardous law enforcement. Thus, personnel should
materials, or contact the nearest DEA field always follow the above described universal
office for assistance. For any situations safety precautions to avoid accidental
involving gross contamination, it is highly exposure.
UNCLASSIFIED 13
Once collected, properly packaged, and
removed from the scene, all items of non-
drug evidence which have been
contaminated should be handled and
processed by personnel using, at a
minimum, Personal PPE in an area
specifically designated to process such
tainted evidence with plenty of fresh air or
while employing a dedicated fume hood.
NOTE: If feasible, while employing Level “A”
PPE, safely remove any excess or noticeable
When packaging evidence which has
gross contamination from non-drug
evidence prior to packaging. potentially been contaminated, a notation
should be made on the outer evidence
packaging and evidentiary custody forms
that the item of non-drug evidence in
question has potentially been exposed to
fentanyl.
UNCLASSIFIED 14
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
Packaging of Drug Evidence Transportation (DOT) compliant, level 4G
(non-crush) fiberboard shipping boxes. For
Any suspected fentanyl or fentanyl-related added safety evidence exhibits could
substance should be processed per the instead be placed inside a reusable
above safety guidelines while employing “Pelican” style case which can be locked
the proper PPE. and can maintain an air-tight seal.
Any suspected fentanyl-related exhibit SECTION V
should be “double bagged” by placing the Exposure Risks and Treatment
exhibit within two agency-approved
evidence envelopes. The inner envelope Due to their hazardous nature, fentanyl and
could be a non-labeled version, while the fentanyl-related substances pose a
outer evidence envelope should contain a significant threat to law enforcement
standard evidence label with the required personnel and to other first responders,
information needed for documentation and including fire and emergency medical
tracking purposes per agency policy and personnel.
procedure. Both evidence envelopes should
be clearly marked “Suspected Fentanyl.” As matter of reference it has been
determined that it would only take 2-3
The evidence should be transported directly milligrams of fentanyl to induce respiratory
to the requisite forensic laboratory, depression, arrest and possibly death (see
ensuring all evidence exhibits are clearly photo of penny). When visually compared,
marked as “Suspected Fentanyl.” 2 to 3 milligrams of fentanyl is about the
same as five to seven individual grains of
If suspected fentanyl or fentanyl-related table salt.
drug evidence must be transported back to
an agency’s office prior to submission to a
laboratory, personnel should secure the
evidence in the agency’s designated drug
vault and/or secure drug processing area,
not on work desks, in conference rooms or
other public areas.
When transporting exhibits, evidence
should be placed in sturdy, crush-proof
boxes such as a U.S. Department of
UNCLASSIFIED 15
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
Fentanyl can be ingested orally, inhaled naloxone by personnel trained in its use.
through the nose or mouth, or absorbed Naloxone is an antidote for opioid
through the skin or eyes. Overdose overdose. Immediately administering
symptoms can include drowsiness, naloxone can reverse an opioid overdose.
disorientation, sedation, pinpoint pupils,
skin rash, clammy skin, and respiratory Depending on the drug’s purity and potency
depression or arrest. The onset of these multiple doses of naloxone may be required
symptoms usually occurs within minutes. to stabilize the victim. Continue to
administer a dose of naloxone every 2-3
UNCLASSIFIED 16
UNITED STATES DRUG ENFORCEMENT ADMINISTRATION
UNCLASSIFIED 17
UNCLASSIFIED 18
RESOURCES
www.dea.gov
www.deadiversion.usdoj.gov
www.cdc.gov
www.cdc.gov/drugoverdose/opioids/fentanyl.html
www.emergency.cdc.gov/han/han00384.asp
www.cdc.gov/niosh/
www.drugabuse.gov
www.drugabuse.gov/publications/drugfacts/fentanyl
www.drugabuse.gov/drugs-abuse/fentanyl
UNCLASSIFIED 19