On a crisp December morning in my small Southern hometown, my mother found my brother unresponsive in his bed. She knew she was too late. His body was cold, stiff and blue. Blood had pooled on one side of his face, causing it to swell. After her initial panic and calls to my father and 911, she was alone with my brother. She instinctively did what any mother would do: She covered him with blankets and lay down with him. She wanted to hold her son one more time.
When law enforcement officers arrived, they performed testing to confirm fentanyl overdose was the cause of death. When the test turned positive, they informed my parents that it was unsafe to enter my brother’s room. They instructed my parents to schedule expensive decontamination cleaning and provided contact information for a “bio cleaning” agency that deals with hazardous substances and environments.
The following day at the funeral home, where my brother’s body awaited cremation, my family and I were told that we would not be allowed to be in the same room with him because of the risk of fentanyl exposure and accidental overdose. It was unsafe for us to breathe the air in the room of someone who died “that way,” we were told. A funeral home employee told stories of family members who had lost consciousness after viewing loved ones who had died from fentanyl overdose, and of one family member who overdosed and died after visiting a deceased relative.
I was intent on seeing my brother. And as a physician who cares for patients who use fentanyl, I knew these claims were incorrect. I informed the employees that their policy was based on false information and incomplete anecdotes, and that they are needlessly depriving families of opportunities to see their loved ones. They relented only when we accepted responsibility for any potential exposure.
Spending time with my brother’s body was painful for all of us, but it was important for our grief process. We said goodbye through tears and held my brother’s hand one last time. Most important, it allowed my mother to see him resting peacefully, providing an alternative final image she can carry.
For the past few years, over 70,000 overdose deaths in the United States have involved synthetic opioids, primarily fentanyl and its analogues. Most families grieving these deaths won’t have a doctor in the family to dispute misconceptions perpetuated by law enforcement, funeral homes and others. How many American families are being unnecessarily deprived of a somber, sacred moment based on stigma and rumors?
The funeral home policy my family encountered is certainly not without precedent. Sensationalist reports on social media and TV news and materials distributed by the Drug Enforcement Administration and Department of Justice websites have perpetuated the rumor that it is unsafe to come into contact with small amounts of fentanyl. The internet is rife with reports and videos of emergency workers losing consciousness after contacting a patient who overdosed or encountering substances present at an emergency scene. Firsthand accounts describe a feeling of dread, and secondhand observations are of panicked people with dilated pupils, rapid heart rates and rapid breathing.
These symptoms are the opposite of what people experience with a fentanyl overdose. People experiencing a fentanyl overdose have pinpoint pupils, slow breathing and drowsiness. People who use fentanyl and other opioids often describe a “rush” after consumption. Fentanyl is used medically not only to treat pain but also to treat shortness of breath in end-of-life care.
There is no evidence that you can overdose on fentanyl by touching a person who overdosed. Experts agree that absorbing fentanyl powder through the skin is exceedingly unlikely. Despite efforts by toxicologists and addiction medicine experts to refute these myths, such stories are shared 15 times as frequently as correct information about the risk of fentanyl exposure.
Baseless fear of accidental overdose dehumanizes victims and denies families important moments in their grieving process. However, a much worse possibility exists: Emergency medical workers might delay administering lifesaving naloxone to victims by spending time on unnecessary additional protective gear or avoiding contact altogether. I am unable to find any evidence that this question has been studied, but it must be asked: Have any overdose victims died because naloxone administration was delayed by emergency medical workers fearful of accidental fentanyl exposure?
Corrective steps can and should be taken. The D.E.A., together with several other federal agencies, issued updated guidance for emergency workers (including the use of gloves, masks and eye protection in the presence of fentanyl) in line with other expert recommendations. But the agency has yet to remove outdated and conflicting information from its website and affiliated government sites about accidentally contacting small amounts of fentanyl.
Some educational interventions can help. For example, SHIELD, a simple harm reduction and occupational training program, was administered to the Indiana Law Enforcement Academy, and shown, at least in the short term, to improve police officers’ understanding of the risks of fentanyl overdose from skin contact. More police departments should take up this training.
All of us, when encountering false information about the risks of fentanyl contact, can call it out. And the National Funeral Directors Association should distribute reliable information about the lack of risk associated with accidental fentanyl exposure to its many members.
I will never get my brother back, and my mother will never be rid of the trauma of finding her son’s body in her home. But there was no reason for emergency workers and the funeral home to add unnecessary fear and stigma to my family’s grief. This nonsense must end.
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