ORD 22-931 - Relating to Reckless use of Fentanyl in Public SpacesORDINANCE NO. 22-931
AN ORDINANCE of the City of Federal Way, Washington, relating to
public exposure to fentanyl smoke and adding new section to Chapter
6.35 FWRC.
WHEREAS, the right of the inhabitants of the City of Federal Way to personal safety and
security while in public spaces is of the utmost importance and essential to a healthy, safe, and
prosperous community; and
WHEREAS, fentanyl is a dangerous substance, classified as a Schedule II drug, capable of
causing serious physical injury or death to a person through exposure to even very small amounts of
the substance. According to the United States Drug Enforcement Administration, just 2 milligrams —
the size of about 5 grains of salt — of fentanyl can be fatal. The National Institute for Occupational
Safety and Health has stated that illicit fentanyl sold in the illegal drug market is commonly mixed
with other illicit drugs to increase the potency of the other drugs such as heroin, methamphetamine,
and cocaine, which in turn increases the risk of a fatal interaction of the mixed drugs or an overdose
of the fentanyl itself; and
WHEREAS, data from the 2021 WA State Syringe Service Program Health Survey shows
fentanyl overtook methamphetamine as the drug most involved in overdoses in Washington state in
2020, in part due to its potency and widespread availability, a trend that continues; and
WHEREAS, studies have shown consumption by smoking of narcotics, opiates, and other
dangerous drugs is increasing, posing increased risk of second-hand exposure to innocent members
of the public; and
Ordinance No. 22-931 Page 1 of 4
WHEREAS, due to its potency, high levels of toxicity, and potentially lethal effects in small
amounts, second-hand exposure to fentanyl can pose significant risks of physical injury and even
death of uninvolved, innocent bystanders.
NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF FEDERAL WAY,
WASHINGTON, DO ORDAIN AS FOLLOWS:
Section 1. The Council hereby finds that smoking fentanyl or drugs laced with fentanyl in
public where innocent bystanders can be exposed to potentially toxic amounts of the substance
constitutes a serious threat of harm or death to the public; the Council further finds that intentionally
exhaling fentanyl fumes is a behavior so careless of others' safety that no reasonable person would
engage in it.
Section 2. Chapter 6.35 of the Federal Way Revised Code is hereby amended to add a new
section 6.35.015 to read as follows:
Reckless Use of Fentanyl.
(1) A person is guilty of Reckless Use of Fentanyl if the person:
(a) Intentionally combusts or exhales the smoke of a substance the person knew or reasonably
should know contains, or is contaminated with, fentanyl; and
(b) The combusted or exhaled substance does, in fact, contain fentanyl as determined by a
presumptive drug test, such as a "NIK" test; or testing by a lab; and
(c) Does so while in a public space and within 10 feet of another person, or while inside an
enclosed public space with another person.
Ordinance No. 22-931 Page 2 of 4
(2) For the purposes of this section, "public space" includes, but is not limited to, a public
conveyance, park, transit stop, or other place open to the public.
(3) Reckless Use of Fentanyl is a gross misdemeanor, punishable by up to 364 days in jail, a $5,000
fine, or combination of both.
Section 3. Severability. Should any section, subsection, paragraph, sentence, clause, or phrase
of this ordinance, or its application to any person or situation, be declared unconstitutional or invalid
for any reason, such decision shall not affect the validity of the remaining portions of this ordinance
or its application to any other person or situation. The City Council of the City of Federal Way
hereby declares that it would have adopted this ordinance and each section, subsection, sentence,
clauses, phrase, or portion thereof, irrespective of the fact that any one or more sections, subsections,
sentences, clauses, phrases, or portions be declared invalid or unconstitutional.
Section 4. Corrections. The City Clerk and the codifiers of this ordinance are authorized to
make necessary corrections to this ordinance including, but not limited to, the correction of
scrivener/clerical errors, references, ordinance numbering, section/subsection numbers and any
references thereto.
Section 5. Ratification. Any act consistent with the authority and prior to the effective date of
this ordinance is hereby ratified and affirmed..
Section 6. Effective Date. This ordinance shall take effect and be in force thirty (30) days
from and after its passage and publication, as provided by law.
PASSED by the City Council of the City of Federal Way this 3rd day of May, 2022.
[signatures to follow]
Ordinance No. 22-931 Page 3 of 4
CITY OF FEDERAL WAY:
ATTEST:
�#S� ukv&
P ANIE COURTNEY, V
C, CITY CLERK
APPROVED AS TO FORM:
r�
J. RYAN CALL, CITY ATTORNEY
FILED WITH THE CITY CLERK: 04/20/2022
PASSED BY THE CITY COUNCIL: 05/03/2022
PUBLISHED: 05/06/2022
EFFECTIVE DATE: 06/05/2022
ORDINANCE NO.: 22-931
References:
1. Facts about Fentanyl, U.S. Drug Enforcement Administration (DEA),
htttis://www.dea.�,yov/resources/facts-about-fentanvl.
2. See Fentanyl: Incapacitating Agent, National Institute for Occupational Safety and
Health (NIOSH),
https://www.cdc.;;ov/niosli/ersildb/eniergencyresponsecard 29750022.html.
3. Syringe program user surveys shows `stunning' fentanyl surge, UW Medicine
Newsroom, March 8, 2022: https://neNN=sroom.uw.edu/news/syrin�-,e-pro< ram-user-survey-
shows-stunnin�-,-fentanvl-sur�ze.
4. Kingston S, Newman A, Banta -Green C. Results from the 2021 WA State Syringe Service
Program Health Survey. Seattle, WA: Addictions, Drug & Alcohol Institute, Department
of Psychiatry & Behavioral Sciences, University of Washington, February 2022,
httvs://adai .uw.edu/svri mge-survev-2021 /.
Ordinance No. 22-931 Page 4 of 4
https://www.dea.gov/resources/facts-about-fentanyl
Facts about Fentanyl
fentanyl cc
Forms of Fentanyl Citrate
Fentanyl is a synthetic opioid typically used to
treat patients with chronic severe pain or severe
pain following surgery. Fentanyl is a Schedule II
controlled substance that is similar to morphine
but about 100 times more potent. Under the
supervision of a licensed medical professional,
fentanyl has a legitimate medical use. Patients
prescribed fentanyl should be monitored for
potential misuse or abuse.
Illicit fentanyl, primarily manufactured in foreign
clandestine labs and smuggled into the United
States through Mexico, is being distributed
across the country and sold on the illegal drug market. Fentanyl is being mixed in with other
illicit drugs to increase the potency of the drug, sold as powders and nasal sprays, and
increasingly pressed into pills made to look like legitimate prescription opioids. Because
there is no official oversight or quality control, these counterfeit pills often contain lethal
doses of fentanyl, with none of the promised drug.
There is significant risk that illegal drugs have been intentionally contaminated with
fentanyl. Because of its potency and low cost, drug dealers have been mixing fentanyl with
other drugs <https://www.dea.gov/factsheets/fentanyl> including heroin, methamphetamine, and
cocaine, increasing the likelihood of a fatal interaction.
Producing illicit fentanyl is not an exact science. Two milligrams of fentanyl can be lethal
depending on a person's body size, tolerance and past usage. DEA analysis has found
counterfeit pills ranging from .02 to 5.1 milligrams (more than twice the lethal dose) of
fentanyl per tablet.
• 42% of pills tested for fentanyl contained at least 2 mg of fentanyl, considered
a potentially lethal dose.
• Drug trafficking organizations typically distribute fentanyl by the kilogram.
One kilogram of fentanyl has the potential to kill 500,000 people.
It is possible for someone to take a pill without knowing it contains fentanyl. It is also possible
to take a pill knowing it contains fentanyl, but with no way of knowing if it contains a lethal
dose.
According to the CDC, synthetic opioids (like fentanyl) are the primary driver of overdose
deaths in the United States. Comparison between 12 months -ending January 31, 2020 and the
12 months -ending January 31, 2021 during this period:
• Overdose deaths involving opioids rose 38.1 percent.
• Overdose deaths involving synthetic opioids (primarily illicitly manufactured
fentanyl) rose 55.6 percent and appear to be the primary driver of the increase
in total drug overdose deaths.
Unless a drug is prescribed by a licensed medical professional and dispensed by a
legitimate pharmacy, you can't know if it's fake or legitimate. And without laboratory
testing, there's no way to know the amount of fentanyl in an individual pill or how
much may have been added to another drug. This is especially dangerous because of
fentanyl's potency.
How does fentanyl affect the body?
lie every day from
in opioid overdose
3indvding Bx qn{J WiO opioic9i_
Fentanyl, similar to other commonly used opioid analgesics (e.g., morphine), produces effects
such as:
• euphoria
• pain relief
• relaxation
• sedation
• confusion
• drowsiness
• dizziness
• nausea
• vomiting
• urinary retention
• pupillary constriction
What are the overdose effects?
Overdose may result in:
0 stupor
e changes in pupillary size
e cold and clammy skin
cyanosis -blue discoloration of the skin
respiratory failure leading to death
• coma
Overdose Reversal Information <https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-
reversaknaloxone-narcan-evzio>
Resources
Finding Treatment
,#1 ro Control and Disease
Prevention
https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750022.htm1
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Fentanyl: Incapacitating Agent
The information and recommendations below were developed to address a wide area release of fentanyl as a weapon of terrorism,
and are not specifically intended to address exposures associated with fentanyl use as an illicit drug. NIOSH is currently in the process
of reviewing more recent research and publications regarding appropriate emergency response guidelines for fentanyl. Consequently,
some of the guidelines presented on this page may be different than recommendations for emergency response personnel
responding to fentanyl used as an illicit drug. Please see this website for information for emergency response personnel responding
to fentanyl as an illicit drug: https://www.cdc.gov/niosh/topics/fentanyl/risk.html.
CAS #: 437-38-7 Common Names:
RTECS #: UT5550000 • Not established/determined
UN#:UN2811
Agent Characteristics
• APPEARANCE: Crystals or crystalline powder.
DESCRIPTION: Fentanyl is a member of the class of drugs known as fentanyls, rapid -acting opioid (synthetic opiate) drugs that
alleviate pain without causing loss of consciousness (analgesic). Fentanyl depresses central nervous system (CNS) and respiratory
function. Exposure to fentanyl may be fatal. Fentanyl is estimated to be 80 times as potent as morphine and hundreds of times more
potent than heroin. It is a drug of abuse. Fentanyl (and other opioids) could possibly be used as an incapacitating agent to impair a
person's ability to function. In October 2002, the Russian military reportedly used "a fentanyl derivative" against terrorists holding
hostages in a Moscow theater; 127 of the hostages died. (It is unclear whether the gas used also included other chemical agent(s).)
Fentanyl is odorless.
• METHODS OF DISSEMINATION:
o Indoor Air: Fentanyl can be released into indoor air as fine particles or liquid spray (aerosol).
• Water: Fentanyl can be used to contaminate water.
• Food: Fentanyl can be used to contaminate food.
• Outdoor Air: Fentanyl can be released into outdoor air as fine particles or liquid spray (aerosol).
• Agricultural: If fentanyl is released into the air as fine particles or liquid spray (aerosol), it has the potential to contaminate
agricultural products.
• ROUTES OF EXPOSURE: Fentanyl can be absorbed into the body via inhalation, oral exposure or ingestion, or skin contact. It is not
known whether fentanyl can be absorbed systemically through the eye. Fentanyl can be administered intravenously (IV),
intramuscularly (IM), or as a skin patch (transdermally).
Personal Protective Equipment
GENERAL INFORMATION: First Responders should use a NIOSH-certified Chemical, Biological, Radiological, Nuclear (CBRN) Self
Contained Breathing Apparatus (SCBA) with a Level A protective suit when entering an area with an unknown contaminant or when
entering an area where the concentration of the contaminant is unknown. Level A protection should be used until monitoring results
confirm the contaminant and the concentration of the contaminant.
NOTE: Safe use of protective clothing and equipment requires specific skills developed through training and experience.
LEVEL A: (RED ZONE): Select when the greatest level of skin, respiratory, and eye protection is required. This is the maximum
protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than the AEGL-2.
o A NIOSH-certified CBRN full -face -piece SCBA operated in a pressure -demand mode or a pressure -demand supplied air hose
respirator with an auxiliary escape bottle.
o A Totally -Encapsulating Chemical Protective (TECP) suit that provides protection against CBRN agents.
o Chemical -resistant gloves (outer).
o Chemical -resistant gloves (inner).
o Chemical -resistant boots with a steel toe and shank.
o Coveralls, long underwear, and a hard hat worn under the TECP suit are optional items.
• LEVEL B: (RED ZONE): Select when the highest level of respiratory protection is necessary but a lesser level of skin protection is
required. This is the minimum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH
or greater than AEGL-2. It differs from Level A in that it incorporates a non -encapsulating, splash -protective, chemical -resistant splash
suit that provides Level A protection against liquids but is not airtight.
o A NIOSH-certified CBRN full -face -piece SCBA operated in a pressure -demand mode or a pressure -demand supplied air hose
respirator with an auxiliary escape bottle.
• A hooded chemical -resistant suit that provides protection against CBRN agents.
• Chemical -resistant gloves (outer).
• Chemical -resistant gloves (inner).
o Chemical -resistant boots with a steel toe and shank.
o Coveralls, long underwear, a hard hat worn under the chemical -resistant suit, and chemical -resistant disposable boot -covers
worn over the chemical -resistant suit are optional items.
• LEVEL C: (YELLOW ZONE): Select when the contaminant and concentration of the contaminant are known and the respiratory
protection criteria factors for using Air Purifying Respirators (APR) or Powered Air Purifying Respirators (PAPR) are met. This level is
appropriate when decontaminating patient/victims.
o A NIOSH-certified CBRN tight -fitting APR with a canister -type gas mask or CBRN PAPR for air levels greater than AEGL-2.
• A NIOSH-certified CBRN PAPR with a loose -fitting face -piece, hood, or helmet and a filter or a combination organic vapor, acid
gas, and particulate cartridge/filter combination or a continuous flow respirator for air levels greater than AEGL-1.
• A hooded chemical -resistant suit that provides protection against CBRN agents.
o Chemical -resistant gloves (outer).
• Chemical -resistant gloves (inner).
o Chemical -resistant boots with a steel toe and shank.
o Escape mask, face shield, coveralls, long underwear, a hard hat worn under the chemical -resistant suit, and chemical -resistant
disposable boot -covers worn over the chemical -resistant suit are optional items.
• LEVEL D: (GREEN ZONE): Select when the contaminant and concentration of the contaminant are known and the concentration is
below the appropriate occupational exposure limit or less than AEGL-1 for the stated duration times.
o Limited to coveralls or other work clothes, boots, and gloves.
Emergency Response
• CHEMICAL DANGERS:
o Hazardous polymerization will not occur.
• EXPLOSION HAZARDS:
o Not established/determined
• FIRE FIGHTING INFORMATION:
o Burning may produce carbon monoxide, carbon dioxide, and nitrogen oxides.
• INITIAL ISOLATION AND PROTECTIVE ACTION DISTANCES:
o If a tank, rail car, or tank truck is involved in a fire, isolate it for 0.5 mi (800 m) in all directions; also consider initial evacuations
for 0.5 mi (800 m) in all directions.
o This agent is not included in the DOT ERG 2004 Table of Initial Isolation and Protective Action Distances.
o In the DOT ERG 2004 orange -bordered section of the guidebook, there are public safety recommendations to isolate a fentanyl
(Guide 111) spill or leak area immediately for at least 330 ft (100 m) in all directions.
• PHYSICAL DANGERS:
o Not established/determined
• NFPA 704 Signal:
o Health:4 O
• Flammability.1
o Reactivity.0
o Special:
• SAMPLING AND ANALYSIS-
o OSHA: Not established/determined
• NIOSH: Not established/determined
• ADDITIONAL SAMPLING AND ANALYSIS INFORMATION:
References are provided for the convenience of the reader and do not imply endorsement by NIOSH.
• AIR MATRIX
Heusler H [1985]. Quantitative analysis of common anaesthetic agents. J Chromatogr: Biomed Appl 340:273-319.Suzuki S [1989].
Spectrometric discrimination of five monomethylated fentanyl isomers including fentanyl by gas chromatography/Fourier
transform -infrared spectrometry. Forensic Sci Int 43(1):15-19.
• OTHER
No references were identified for this sampling matrix for this agent.
• SOIL MATRIX
No references were identified for this sampling matrix for this agent.
• SURFACES
Henderson GL, Harkey MR, Jones AD [1990]. Rapid screening of fentanyl (China White) powder samples by solid -phase
radioimmunoassay. J Anal Toxicol 14(3):172-175.Lambropoulos J, Spanos GA, Lazaridis NV [2000]. Development and validation of
an HPLC assay for fentanyl, alfentanil, and sufentanil in swab samples. J Pharm Biomed Anal 23(2-3):421-428.
• WATER
Bjorkman S, Stanski DR [1988]. Simultaneous determination of fentanyl and alfentanil in rat tissues by capillary column gas
chromatography. J Chromatogr B: Biomed Sci Appl 433:95-104.Bjorksten AR, Chan C, Crankshaw DP [2002]. Determination of
remifentanil in human blood by capillary gas chromatography with nitrogen -selective detection. J Chromatogr B 775(1):97-
101.Caldwell R, Challenger H [19891. A capillary column gas -chromatographic method for the identification of drugs of abuse in
urine samples. Ann Clin Biochem 26(5):430-443.
Choi HS, Shin HC, Khang G, Rhee JM, Lee HB [2001]. Quantitative analysis of fentanyl in rat plasma by gas chromatography with
nitrogen -phosphorus detection. J Chromatogr B: Biomed Sci Appl 765(1):63-69.
Cooper D, Jacob M, Allen A [1986]. Identification of fentanyl derivatives by IR, NMR, and mass spectral analysis. J Forensic Sci
31(2):511-528.
Drummer OH [19991. Chromatographic screening techniques in systematic toxicological analysis. J Chromatogr B: Biomed Sci
Appl 733(1-2):27-45.
Fryirsa B, Woodhouse A, Huang JL, Dawson M, Mather LE [1997]. Determination of subnanogram concentrations of fentanyl in
plasma by gas chromatography --mass spectrometry: comparison with standard radioimmunoassay. J Chromatogr B: Biomed Sci
Appl 688(1):79-85.
Guitton J, D?sage M, Alamercery S, Dutruch L, Dautraix S, Perdrix JP, Brazier JL [1997].Gas chromatographic -mass spectrometry
and gas chromatographic -Fourier transform infrared spectroscopy assay for the simultaneous identification of fentanyl
metabolites. J Chromatogr B: Biomed Sci Appl 693(1):59-70.
Hammargren WR, Henderson GL [1988]. Analyzing nor -metabolites of the fentanyls by gas chromatography -electron -capture
detection. J Anal Toxicol 12(4):183-191.
Heusler H [1985]. Quantitative analysis of common anaesthetic agents. J Chromatogr: Biomed Appl 340:273-319.
Hill DW, Langner KJ [1987]. High performance liquid chromatography photodiode array UV detection for toxicological drug
analysis. J Liq Chromatogr 10(2-3):377-409.
Hu N, Guo H, Lin S [1994]. Adsorptive stripping voltammetry of a fentanyl derivative at a mercury electrode. Talanta 41(8):1269-
1274.
Kastrissios H, Hung MF, Triggs EJ [19921. High-performance liquid chromatographic method for the quantitation of bupivacaine,
2,6-pipecoloxylidide and 4'-hydroxybupivacaine in plasma and urine. J Chromatogr: Biomed Appl 577(1):103-107.
Kintz P, Mangin P, Lugner AA, Chaumont AJ [1989]. Simultaneous determination of fentanyl and its major metabolites and
fentanyl analogues using gas chromatography and nitrogen -selective detection. J Chromatogr B: Biomed Sci Appl 489(2):459-461.
Kowalski SR, Gourlay GK, Cherry DA, McLean CF [1987]. Sensitive gas liquid chromatography method for the determination of
fentanyl concentrations in blood. J Pharmacol Methods 18(4):347-355.
Kumar K, Ballantyne JA, Baker AB [1996]. A sensitive assay for the simultaneous measurement of alfentanil and fentanyl in
plasma. J Pharm Biomed Anal 14(6):667-673.
Kumar K, Morgan DJ, Crankshaw DP [1987]. Determination of fentanyl and alfentanil in plasma by high-performance liquid
chromatography with ultraviolet detection. J Chromatogr: Biomed Appl 419:464-468.
Levi V, Scott JC, White PF, Sad?e W [1987]. Improved radioreceptor assay of opiate narcotics in human serum: application to
fentanyl and morphine metabolism. Pharm Res 4(1):46-49.
Lillsunde P, Korte T [1991 ]. Comprehensive drug screening in urine using solid -phase extraction and combined TLC and GC/MS
identification. J Anal Toxicol 15(2):71-81.
Lurie IS, Allen AC [1984]. Reversed -phase high-performance liquid chromatographic separation of fentanyl homologues and
analogues. II. Variables affecting hydrophobic group contribution. J Chromatogr A 292(2):283-294.
Moore JM, Allen Ac, Cooper DA, Carr SM [1986]. Determination of fentanyl and related compounds by capillary gas
chromatography with electron capture detection. Anal Chem 58(8):1656-1660.
Neill GP, Davies NW, McLean S [1991]. Automated screening procedure using gas chromatography -mass spectrometry for
identification of drugs after their extraction from biological samples. J Chromatogr 565(1-2)207-224.
Peng LJ, Wen ML, Yao Y [2002]. Potentiometric determination of fentanyl in pharmaceutical formulations. J Pharm Biomed Anal
30(3):667-673.
Szeitz A, Riggs KW, Harvey -Clark C [1996]. Sensitive and selective assay for fentanyl using gas chromatography with mass
selective detection. J Chromatogr B: Biomed Sci Appl 675(1):33-42.
Tobin T, Kwiatkowski S, Watt IDS, Tai HH, Tai CL, Woods WE, Goodman JP, Taylor DG, Weckman TJ, Yang JM, Tai JD, Stanley SD,
Wood T, Chang SL, Blake JW, McDonald J, Wie S, Prange CA, Uboh CE [1989]. Immunoassay detection of drugs in racing horses.
ELISA and RIA detection of fentanyl, alfentanil, sufentanil and carfentanil in equine blood and urine. Res Commun Chem Pathol
Pharmacol 63(1):129-152.
Tobin T, Tai HH, Tai CL, Houtz PK, Dai MR, Woods WE, Yang JM, Weckman TJ, Chang SL, Blake JW, McDonald J, Gall R, Wiedenbach
P, Bass VD, Deleon B, Ozog FJ, Green M, Brockus C, Stobert D, Wie S, Prange CA [1988]. Immunoassay detection of drugs in racing
horses. IV. Detection of fentanyl and its congeners in equine blood and urine by a one step ELISA assay. Res Commun Chem
Pathol Pharmacol 60(1):97-115.
Watts V, Caplan Y [1988]. Determination of fentanyl in whole blood at subnanogram concentrations by dual capillary column gas
chromatography with nitrogen sensitive detectors and gas chromatography/mass spectrometry. J Anal Toxicol 12(5):246-254.
Wilson TD, Maloney T, Amsden WB [19881. High-performance liquid chromatographic determination of fentanyl citrate in a
parenteral dosage form. J Chromatogr A 445:299-304.
Yuansheng L, Yutian W, Jing Z, Zhenxing Z, Zhanxi Q, Shen G, Quinghong K, Xinhua W [1996]. Capillary GC determination of
fentanyl and midazolam in human plasma. Microchem J 53(1):130-136.
Signs/Symptoms
• TIME COURSE: Peak analgesia occurs within several minutes of intravenous (IV) administration. The duration of analgesia is 30 to 60
minutes after a single dose of up to 100 pg. Dermal exposure to fentanyl results in absorption over hours to days. Oral exposure
occurs in two phases. Initial exposure will occur within in a few minutes, with absorption through the intestinal tract occurring over 2
hours. Inhalation of fentanyl results in rapid absorption.
• EFFECTS OF SHORT-TERM (LESS THAN 8-HOURS) EXPOSURE: Fentanyl can produce delayed reduced respiratory function (respiratory
depression) and respiratory arrest. With rapid intravenous (IV) administration, rigidity of the chest muscles ("wooden chest
syndrome") may be produced, which interferes with normal breathing. A rise of blood pressure within the brain (intracranial
hypertension) and muscle rigidity and spasms have been reported following fentanyl use.
• EYE EXPOSURE:
o Irritation may occur.
• INGESTION EXPOSURE:
o Contracted or pinpoint pupils (miosis) (may later become dilated), reduced level of consciousness (CNS depression), reduced
respiratory function (respiratory depression), reduced blood oxygen content (hypoxia), accumulation of acid in the blood
(acidosis), low blood pressure (hypotension), slow heart rate (bradycardia), shock, slowing of muscular movement of the
stomach (gastric hypomotility) with intestinal obstruction due to lack of normal muscle function (ileus), accumulation of fluid in
the lungs (pulmonary edema), lethargy, coma, and death.
• INHALATION EXPOSURE:
o See Ingestion Exposure.
• SKIN EXPOSURE:
• See Ingestion Exposure.
• Absorption through the skin may contribute to whole -body (systemic) toxicity.
• Absorption increases with skin temperature (based on medical use of transdermal patch).
Decontamination
• INTRODUCTION: The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic
substances quickly and effectively. Care should be taken during decontamination, because absorbed agent can be released from
clothing and skin as a gas. Your Incident Commander will provide you with decontaminants specific for the agent released or the
agent believed to have been released.
• DECONTAMINATION CORRIDOR: The following are recommendations to protect the first responders from the release area:
o Position the decontamination corridor upwind and uphill of the hot zone. The warm zone should include two decontamination
corridors. One decontamination corridor is used to enter the warm zone and the other for exiting the warm zone into the cold
zone. The decontamination zone for exiting should be upwind and uphill from the zone used to enter.
o Decontamination area workers should wear appropriate PPE. See the PPE section of this card for detailed information.
o A solution of detergent and water (which should have a pH value of at least 8 but should not exceed a pH value of 10.5) should
be available for use in decontamination procedures. Soft brushes should be available to remove contamination from the PPE.
Labeled, durable 6-mil polyethylene bags should be available for disposal of contaminated PPE.
• INDIVIDUAL DECONTAMINATION: The following methods can be used to decontaminate an individual:
o Decontamination of First Responder:
■ Begin washing PPE of the first responder using soap and water solution and a soft brush. Always move in a downward
motion (from head to toe). Make sure to get into all areas, especially folds in the clothing. Wash and rinse (using cold or
warm water) until the contaminant is thoroughly removed.
■ Remove PPE by rolling downward (from head to toe) and avoid pulling PPE off over the head. Remove the SCBA after other
PPE has been removed.
■ Place all PPE in labeled durable 6-mil polyethylene bags.
o Decontamination of Patient/Victim:
■ Remove the patient/victim from the contaminated area and into the decontamination corridor.
■ Remove all clothing (at least down to their undergarments) and place the clothing in a labeled durable 6-mil polyethylene
bag.
■ Thoroughly wash and rinse (using cold or warm water) the contaminated skin of the patient/victim using a soap and water
solution. Be careful not to break the patient/victim's skin during the decontamination process, and cover all open wounds.
■ Cover the patient/victim to prevent shock and loss of body heat.
■ Move the patient/victim to an area where emergency medical treatment can be provided.
First Aid
• GENERAL INFORMATION: Treatment consists of administration of the antidote and aggressive support of respiratory function.
• ANTIDOTE: Naloxone (Narcan) in doses of 0.4 to 2.0 mg has been recommended for treatment of opioid overdose. Naloxone is
commonly given intravenously. The onset of effect following IV naloxone administration is 1 to 3 minutes; maximal effect is observed
within 5 to 10 minutes. Doses may be repeated as needed to maintain effect. Administration of naloxone may also reverse the
"wooden chest syndrome:"
• EYE:
Immediately remove the patient/victim from the source of exposure.
o Immediately wash eyes with large amounts of tepid water for at least 15 minutes.
* Seek medical attention immediately.
• INGESTION:
o Immediately remove the patient/victim from the source of exposure.
o Ensure that the patient/victim has an unobstructed airway.
a Do not induce vomiting (emesis).
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.............. .......,..... .... _. r..�..._........ ___..... — ..1 ............o ..rr.._....._ _..._ r......_.... ___ ..........._ ..___......
o Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children
(1 to 12 years), and 1 g/kg in infants less than 1 year old.
o Seek medical attention immediately.
• INHALATION:
• Immediately remove the patient/victim from the source of exposure.
o Evaluate respiratory function and pulse.
• Ensure that the patient/victim has an unobstructed airway.
o If shortness of breath occurs or breathing is difficult (dyspnea), administer oxygen.
• Assist ventilation as required. Always use a barrier or bag -valve -mask device.
• If breathing has ceased (apnea), provide artificial respiration.
• Monitor the patient/victim for signs of whole -body (systemic) effects and administer symptomatic treatment as necessary.
o If signs of whole -body (systemic) poisoning appear, seethe Ingestion section for treatment recommendations.
• Seek medical attention immediately.
• SKIN:
o Immediately remove the patient/victim from the source of exposure.
• See the Decontamination section for patient/victim decontamination procedures.
o Monitor the patient/victim for signs of whole -body (systemic) effects.
• If signs of whole -body (systemic) poisoning appear, seethe Ingestion section for treatment recommendations.
• Seek medical attention immediately.
Long -Term Implications
• MEDICAL TREATMENT: Patient/victims exhibiting significantly reduced respiratory function (respiratory depression), recurrent
sedation, or any other complicating factors of opioid toxicity should be admitted for a minimum of 12 to 24 hours of observation.
Heart function should be monitored, and the patient/victim should be evaluated for low blood pressure (hypotension), abnormal
heart rhythms (dysrhythmias), and reduced respiratory function (respiratory depression). Accumulation of fluid in the lungs
(pulmonary edema) is a common aftereffect (sequela), and patient/victims should be monitored for its development and treated
accordingly.
• DELAYED EFFECTS OF EXPOSURE: Not established/determined
• EFFECTS OF CHRONIC OR REPEATED EXPOSURE: It is unknown whether chronic or repeated exposure to fentanyl increases the risk of
carcinogenicity, reproductive toxicity, or developmental toxicity.
On -Site Fatalities
• INCIDENTSITE:
o Consult with the Incident Commander regarding the agent dispersed, dissemination method, level of PPE required, location,
geographic complications (if any), and the approximate number of remains.
o Coordinate responsibilities and prepare to enter the scene as part of the evaluation team along with the FBI HazMat Technician,
local law enforcement evidence technician, and other relevant personnel.
o Begin tracking remains using waterproof tags.
• RECOVERY AND ON -SITE MORGUE:
o Wear PPE until all remains are deemed free of contamination.
• Establish a preliminary (holding) morgue.
• Gather evidence, and place it in a clearly labeled impervious container. Hand any evidence over to the FBI.
• Remove and tag personal effects.
• Perform a thorough external evaluation and a preliminary identification check.
o See the Decontamination section for decontamination procedures.
• Decontaminate remains before they are removed from the incident site.
See Guidelines for Mass Fatality Management During Terrorist Incidents involving Chemical Agents, U.S. Army Soldier and Biological
Chemical Command (SBCCOM), November, 2001 for detailed recommendations.
Occupational Exposure Limits
• NIOSH REL:
o Not established/determined
• OSHA PEL:
o Not established/determined
• ACGIH TLV:
o Not established/determined
• NIOSH IDLH: Not established/determined
• DOE TEEL:
o TEEL-0: Not established/determined
o TEEL-1: Not established/determined
o TEEL-2: Not established/determined
o TEEL-3: Not established/determined
• AIHA ERPG:
o ERPG-1: Not established/determined
o ERPG-2: Not established/determined
o ERPG-3: Not established/determined
• Mallinckrodt Inc. lists Occupational Exposure Guidelines (OEG): 0.7 pg/m3 as an 8-hour time -weighted -average.
Mallinckrodt Inc. lists Short -Term Exposure Guidelines (STEG): 2 pg/m3 as a 15-minute average.
Acute Exposure Guidelines
5 min 10 min 30 min 1 hr 4 hr 8 hr
AEGL 1 Not Not Not Not Not Not
(discomfort, non -disabling) — mg/m3 established/ established/ established/ established/ established/ established/
determined determined determined determined determined determined
AEGL 2 Not Not Not Not Not Not
(Irreversible or other serious, long-lasting established/ established/ established/ established/ established/ established/
effects or impaired ability to escape) — mg/m3 determined determined determined determined determined determined
AEGL 3 Not Not Not Not Not Not
(life -threatening effects or death) — mg/m3 established/ established/ established/ established/ established/ established/
determined determined determined determined determined determined
Decontamination (Environment and Equipment)
• ENVIRONMENT/SPILLAGE DISPOSAL: The following methods can be used to decontaminate the environment/spillage disposal:
• Do not touch or walk through the spilled agent if at all possible. However, if you must, personnel should wear the appropriate
PPE during environmental decontamination. See the PPE section of this card for detailed information.
o Keep combustibles (e.g., wood, paper, and oil) away from the spilled agent. Use water spray to reduce vapors or divert vapor
cloud drift. Avoid allowing water runoff to contact the spilled agent.
o Do not direct water at the spill or the source of the leak.
o Stop the leak if it is possible to do so without risk to personnel, and turn leaking containers so that gas rather than liquid
escapes.
o Prevent entry into waterways, sewers, basements, or confined areas.
o Isolate the area until gas has dispersed.
o Ventilate the area.
• EQUIPMENT: Agents can seep into the crevices of equipment making it dangerous to handle. The following methods can be used to
decontaminate equipment:
o Not established/determined
Agent Properties
• Chemical Formula:
�22n281'42U
• Aqueous solubility:
Slightly soluble
• Boiling Point:
Not established/determined
• Density:
Not established/determined
• Flammability:
Not established/determined
• Flashpoint:
Not established/determined
• Ionization potential:
Not established/determined
• Log Kbenzene- ater:
Not established/determined
• Log K. (estimated):
4.05
• Melting Point:
181.4° to 183.2°F (83° to 84°C)
• Molecular Mass:
336.47
• Soluble In:
Not established/determined
• Specific Gravity:
Not established/determined
• Vapor Pressure:
Not established/determined
• Volatility:
Not established/determined
Hazardous Materials Warning Labels/Placards
• Shipping Name:
Toxic solid, organic, N.O.S. (Propanamide, N-phenyl-N-[1-(2-phenylethy)-4-piperomdonyl]-)
• Identification Number:
UN 2811
• Hazardous Class or Division:
6.1
• Subsidiary Hazardous Class or Division:
Not applicable
• Label:
Poison (Toxic)
• Placard Image:
PP1S0•
6
TpxIL
Trade Names and Other Synonyms
• DEA#9801 (Controlled Substances
Schedule II)
• Duragesic
• Fentanest
• Fentanil
• Fentanila (Spanish)
• Fentanylum (Latin)
• Leptanal
• Pentanyl
• 1-Phenethyl-4-(N-
phenylpropionamido)piperidine
• 1-Phenethyl-4-(phenylpropionylamino)
piperidine
• N-(1-Phenethyl-4-
piperidyl)propionanilide
• N-Phenethyl-4-(N-
propionylanilino)piperidine
• 1-Phenethyl-4-N-
propionylanilinopiperidine
• Phentanyl
• N-Phenyl-N-[1-(2-phenylethyl)-4-
piperidinyl]propanamide
• Propanamide, N-phenyl-N-(1-(2-
phenylethyl)-4-piperidinyl)
• Propionanilide, N-(1-phenethyl-4-
piperidyl)-
• R 4263
• Sentonil
Who to Contact in an Emergency
In the event of a poison emergency, call the poison center immediately at 1-800-222-1222. If the person who is poisoned cannot wake up,
has a hard time breathing, or has convulsions, call 911 emergency services.
For information on who to contact in an emergency, see the CDC website at emergency.cdc.gov or call the CDC public response hotline at
(888) 246-2675 (English), (888) 246-2857 (Espanol), or (866) 874-2646 (TTY).
Important Notice
The user should verify compliance of the cards with the relevant STATE or TERRITORY legislation before use. NIOSH, CDC 2003.
Page last reviewed: May 12, 2011
https: //newsroom.uw. edu/news/syringe-program-user-survey-shows-stunning-fentanyl-surge
UW Medicine I Newsroom
206.543.3620 1 mediarelations@uw.edu
News and information forjournalists
NEWS RELEASE
March 8, 2022 For immediate release
Syringe program user survey shows 'stunning'fentanyl
surge
In Washington state, 42% of respondents said they had used the dangerous opioid in the previous 3
months.
MEDIA CONTACT: Brian Donohue - 206.543.7856, bdonohue@uw.edu
Getty Images
81 % of survey respondents said they had smoked a drug (excluding tobacco and cannabis) in the previous three months.
Use of the illicitly produced opioid fentanyl has surged by a "stunning" extent in Washington, said the lead
researcher involved in a survey of nearly 1,000 people who use syringe -service program sites across the
state.
According to the newly published survey findings, 42% of the respondents said they had used fentanyl in
the previous three months, up from 18% in 2019.
"I've been doing drug -trends research for 20 years, and fentanyl's growth is the biggest, fastest shift we've
ever seen —and also the most lethal," said Caleb Banta -Green. He is principal research scientist at the
Addictions, Drug & Alcohol Institute (ADAI) in the University of Washington School of Medicine.
The biennial Syringe Service Programs health survey is Washington state's primary source for
understanding substance -use patterns, health behaviors and needs of people who use syringe -service
programs. This report's detailed data, collected in fall 2021, reflects the habits and lives of 955 respondents
whom Banta -Green describes as "a diverse group of people who use drugs for an array of reasons, with a
range of severity."
Illegally manufactured fentanyl is often counterfeited to resemble oxycodone pills. It is fast -acting and
dangerously potent: 50 to 100 times stronger than morphine. In 2020, fentanyl overtook
methamphetamine as the drug most involved in overdoses in Washington state.
According to the new survey results, among the respondents who reported using fentanyl in the three
months prior, two-thirds said they had used it knowingly. This is a significant change from several years ago,
when most fentanyl use was unintentional, Banta -Green said.
Another important part of this shift is that the majority of people who use fentanyl today smoke it. This
aligns with respondents' reported high rate of smoking drugs broadly: 81 % of respondents said they had
smoked a drug (excluding tobacco and cannabis) in the previous three months.
"This matters because the majority of people dying now from overdoses are smoking drugs. Yet almost all
of our harm -reduction services have been aimed at people who inject drugs. So we need to figure out how
to recast harm -reduction programs to engage with people who smoke drugs," Banta -Green said.
Last year the Washington Legislature passed a law that changed criminal penalties for drugs and
decriminalized possession of drug -smoking equipment. This poses an opportunity, Banta -Green said, to
make people who smoke drugs aware of other healthcare services and, subsequently, to introduce them
to addiction treatment.
"Smoking drugs means they will inject less often, which also means there's less syringes and syringe litter
in the community. By providing more comprehensive services and supplies to those who use drugs we are
able to engage with and support a much larger proportion of the population," Banta -Green said.
Due to the nature of the survey, he hastened to add, the findings do not represent the volumes of people
who have successfully stopped using drugs, are in treatment and who are in recovery.
"This report is not the sum total of what's going on among people using substances. Some people go back
and forth between being in treatment and using drugs; it's fluid and dynamic. Providing medication at
syringe -exchange sites has been incredibly fruitful. We've gotten a lot of people stabilized on treatment
medications and greatly improved people's access to naloxone (the overdose antidote)."
The project team's qualitative interviews last year provide insights into why and how people want to reduce
their substance use.
Related links:
• www.stopoverdose.org
• www.learnaboutreatment.org
https://adai. uw.edu/syrin,,
Addictions, Drug &Alcohol Institute
> ADAI News & Events > Results from the 2021 WA State Syringe Service Program Health Survey
Results from the 2021 WA State Syringe Service
Program Health Survey
G• in = V
The biennial WA State Syringe Service Program
Health Survey is the state's primary source of
data on the substance use patterns, health
behaviors, and health care needs of people
who use drugs and utilize syringe service
programs (SSPs). The University of
Washington's Addictions, Drug & Alcohol
Institute (ADAI) conducts the survey in
collaboration with Public Health -Seattle & King
County (PHSKC) and the statewide SSP
network.
The results of the survey provide important
findings for those planning state and local
services and policies, especially around
fentanyl use and interest in safer smoking
supplies.
Resources & Webinar
Full report (pdf)
Watch the recording of our webinar about
the report (March 10, 2022).
UW News press release
This year's survey included responses from 955
SSP participants at 21 organizations in 20
counties.
Respondents by ZIP Code and site
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+
t
lhsotin
Benton
l .
Clallam
• +
+
Clark
•. y;
Cowlitz
Grant
Island
Jefferson
l(ing
Lewis
Mason
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• •
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Pend Oreille
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Pierce
► ►
Skagit
Snohomish
Spokane
• Tom`
Thurston
• Walla Walla
Whalcom
• Yakima
Dots randomly placed in reported ZIP
16 (of 955) missing due to missing or unmatchable ZIP
Key Findings
• More respondents had used methamphetamine by itself than heroin by itself (86% versus 69%),
yet almost half (48%) had used both mixed together (as a "goofball"). Goofball was the third
most common "main" drug (21 %), after heroin (41 %) and methamphetamine (29%).
• Polysubstance use was particularly high among those whose main drug was goofballs or
fentanyl.
• Almost half (42%) reported using fentanyl in the past three months. Two thirds of these
respondents said they had last used fentanyl "on purpose." Most often that fentanyl was in pill
form. The remaining third reported the fentanyl they used, unintentionally, was most often
mixed in with another drug.
Form of last fentanyl used
The last time you used fentanyl was it on purpose?
What did that fentanyl look like?
2%
Yes
n=266 67% 23% 9%
No
n= 18% 8% 74%
❑ Pill ❑ Powder ❑ Patch ❑ Mixed with other drugs
• Those who had used fentanyl in the past three months were more likely to have had an opioid
overdose in the past 12 months than those who had not used fentanyl (27% vs 20%, p<0.05).
• Rates of drug smoking were high. About three in four respondents who had injected any drug in
the past three months also reported smoking a drug in the same period. Rates of drug injecting
and smoking varied widely by drug type.
Route of ingestion of drug used in past 3 months
Goofball (n=458) 61% 35% J4°/ai
Fentanyl (n=394)
23% 24%
48%
Heroin (n=648)
45%
47%
6%
Meth (n=815) 18% 1 52% 1 28%
❑ Injection only ❑ Smoke and inject ❑ Smoke only
• The majority (72%) of respondents who had injected a drug in the past three months said they
would like to get safer drug smoking supplies. Of those, about two thirds (64%) thought they
would inject less often if they could get safer smoking supplies.
• COVID-19 vaccination rates were generally low (37% statewide) but varied by county. A quarter
of people expressed interest or ambivalence in getting vaccinated.
Acknowledgements
ADAI would like to thank the many SSP staff and volunteers who helped administer this survey and
the SSP participants who agreed to be surveyed. We also gratefully acknowledge our partners at
Public Health - Seattle & King County and the WA State Department of Health's Drug User Health
Team for their contributions and the Washington State Division of Behavioral Health and Recovery
for its funding support.
Citation: Kingston S, Newman A, Banta -Green C. Results from the 2021 WA State Syringe Service
Program Health Survey. Seattle, WA: Addictions, Drug & Alcohol Institute, Department of Psychiatry
& Behavioral Sciences, University of Washington, February 2022.
Download the report here.
Related Resources:
• Previous reports based on this survey_
StopOverdose.org
Lea rnAboutTreatment.org