Is Fentanyl a Weapon of Mass Destruction?

By Lynn Webster, MD, PNN Columnist

Usually we think of bombs, missiles, rockets and dangerous chemicals as weapons of mass destruction (WMD). However, the military website Task & Purpose recently reported that James McDonnell, who heads the Department of Homeland Security’s WMD division, wants to classify fentanyl as a WMD.

McDonnell proposed this in a February memo to then-DHS Secretary Kirstjen Nielsen. The drug’s “high toxicity and increasing availability” make it “attractive to threat actors seeking nonconventional materials for a chemical weapons attack,” according to the memo.

There isn’t much evidence for classifying fentanyl as a WMD, but McDonnell’s suggestion could still find support for reasons that have more to do with politics than science.

According to federal law, weapons that can kill or severely injure "through the release, dissemination, or impact of toxic or poisonous chemicals, or their precursors" fall into the category of weapons of mass destruction.

McDonnell thinks fentanyl fits the definition. It is not clear that he is correct. And he neglected to mention that fentanyl has a legitimate medical use, too.

History of Fentanyl

Fentanyl is a powerful synthetic opioid typically prescribed to patients in acute pain or during surgeries. According to data from the National Center for Health Statistics, 48 million surgical inpatient procedures were performed in the United States in 2009. Most of those procedures involved administering fentanyl intravenously as an analgesic. 

Fentanyl was developed in 1960 by Belgian chemist Dr. Paul Janssen. The patent for fentanyl was obtained under his company name, Janssen Pharmaceutica. Fentanyl was first approved by the Food and Drug Administration in 1968 and introduced into the marketplace as an analog for Demerol, with plans that it would be used only for palliative care.

In 1978, I coauthored with my professor mentor, Dr. T.H. Stanley, a manuscript titled “Anesthetic Requirements and Cardiovascular Effects of Fentanyl” that described the use of high dose fentanyl for cardiac anesthesia.

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The anesthetic technique we described allowed patients to undergo coronary artery bypass and valve replacement surgery more safely and with greater success because of fentanyl's unique pharmacologic properties. The technique was considered a seminal event in anesthesia for cardiac surgery.

Since the publication of that paper, millions of people have successfully undergone heart operations. The advance of using fentanyl in anesthesia may have helped some of those patients survive their heart operations.

It wasn’t until the late 1980s that testing was done for delivering fentanyl through a transdermal patch for the treatment of cancer-related pain and noncancer chronic pain. Later, oral transmucosal delivery of fentanyl was made available for cancer breakthrough pain. Each of these new uses of fentanyl exposed millions of Americans to the drug without evidence of an inordinate degree of harm if it was used as directed.

In contrast, nonpharmaceutical fentanyl has caused enormous harm. But as illicit use of the drug proliferates, so do myths about its dangers. McDonnell’s memo fits into an overarching narrative that bestows almost magical properties on fentanyl.

What's Behind the Fentanyl Panic?

The opioid crisis is real and the use of illicit fentanyl is often lethal. But mischaracterizing the effects of fentanyl may be only a political maneuver. 

In New York Magazine, Sarah Jones wrote about a 2017 Bloomberg News story that claimed fentanyl “is so potent that even a small amount — the equivalent of a few grains of salt — can be lethal.” 

“This isn’t really true,” wrote Jones. “You can’t get high or become ill simply by touching fentanyl, but police departments often claim otherwise. They report dramatic, but varied, symptoms that don’t mesh with established scientific evidence about fentanyl and the way it’s absorbed by the human body.” 

As Jones points out, Homeland Security’s WMD division has experienced a decline in funding because of the Trump administration’s focus on immigration and building a wall at the border. One way to reclaim some of that money for the WMD division is to build a case against fentanyl. 

Other drugs, such as ricin, pose greater risks and are probably more lethal than fentanyl as WMD’s. However, the word "fentanyl" packs a far larger emotional punch than ricin does because of the public's familiarity with it.  

WMDs are meant to kill the maximum number of people is the shortest amount of time. On the other hand, fentanyl -- even when it is laced with heroin -- is not intended to kill people. Drug cartels want to make money. Their goal isn't to murder their customers

Protecting Access to Legitimate Fentanyl 

The opioid crisis is now largely driven by nonpharmaceutical fentanyl and fentanyl analogs, not prescription fentanyl. Solving the opioid problem will require greater efforts to reduce the illegal production and distribution of illicit fentanyl. 

Could fentanyl be weaponized and used to attack citizens? Maybe, but not easily.  

The Pentagon realized the harm that an opioid attack could cause when the Russian military used aerosolized carfentanil -- a highly potent fentanyl analog --  against terrorists who had taken over a theater in Moscow in 2002. The drug killed dozens of innocent hostages and their captors, and it put the U.S. on notice that opioids could be weaponized.  

Before we classify fentanyl as a WMD, we need to know what that would mean for its legitimate use during surgery, or for cancer and chronic pain patients. Access to the medication for the treatment of pain must be part of the calculus in assessing if a relatively safe and effective drug should be classified as a WMD. 

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Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is a former president of the American Academy of Pain Medicine and the author of “The Painful Truth.”

You can find Lynn on Twitter: @LynnRWebsterMD. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Fentanyl May Be Classified as Weapon of Mass Destruction

By Pat Anson, PNN Editor

The Trump Administration is considering labeling fentanyl as a weapon of mass destruction, according to an internal Homeland Security memo obtained by the military news website Task & Purpose.

"Fentanyl's high toxicity and increasing availability are attractive to threat actors seeking nonconventional materials for a chemical weapons attack," wrote James McDonnell, a DHS assistant secretary, in a February 22, 2019 memo to then-DHS Secretary Kirstjen Nielsen.

According to the memo, the FBI considers fentanyl “a viable option for a chemical weapon attack by extremists or criminals.”  The idea of labeling fentanyl a weapon of mass destruction (WMD) is also under consideration by the Department of Defense.

“Within the past couple years, there has been reinvigorated interest in addressing fentanyl and its analogues as WMD materials due to the ongoing opioid crisis,” McDonnell wrote.

DEA IMAGE

DEA IMAGE

Fentanyl is a synthetic opioid, 50 to 100 more potent than morphine, that is legally prescribed to treat severe chronic pain. In recent years, bootleg versions of fentanyl and its chemical cousins have flooded the black market, where they are often added to heroin and cocaine to boost their potency or used in the manufacture of counterfeit medication.

According to the CDC, fentanyl is involved in more overdoses than another drug and was linked to 18,835 drug deaths in 2016.

Most of the black market fentanyl is produced by drug labs in China and then smuggled into the U.S. from Mexico or shipped through the mail.  

Designating fentanyl as a WMD would enable Homeland Security to increase funding for sensors and other technology that can detect fentanyl being smuggled in vehicles, packages and shipping containers.

A WMD expert told Task & Purpose the idea of fentanyl being used as a weapon was a “fringe scenario” because there are dozens of toxic chemicals that can be easily weaponized.

"It reads like somebody is laying the administrative background for trying to tap into pots of money for detecting WMD and decontaminating WMD," said Dan Kaszeta. "It's an interdepartmental play for money, that's all it is."

An unnamed senior defense official quoted by Task & Purpose was also skeptical.

"Anybody with a college level degree in chemistry can manufacture chemical weapons agents," the defense official said. “I cannot see any scenario where a nation-state would use fentanyl on the battlefield, or for that matter, a terrorist using a really toxic chemical like fentanyl in an attack when they could just sell it for funding the purchase of firearms and explosives or steal an industrial chemical instead.”

China recently agreed to ban all “fentanyl-related substances” by listing them as controlled substances. The move is meant to close a loophole that allowed drug labs to make novel variations of fentanyl that are not technically illegal.

Fentanyl Myths

While fentanyl is a scourge on the black market, drug experts say it’s not nearly as hazardous as it is often portrayed. Reports of first responders becoming severely ill after skin contact with fentanyl are likely the result of panic attacks.

“One of the issues with this dramatization of fentanyl toxicity is that it further stigmatizes substance users as contagious and dangerous. That can potentially delay care to those who need prompt rescue and treatment,” emergency medicine physicians Lewis Nelson, MD, and Jeanmarie Perrrone, MD, wrote in STAT News.

There is no documented evidence of responders becoming ill after skin contact with fentanyl.
— Health Canada

“There is clear evidence that passive exposure to fentanyl does not result in clinical toxicity. Descriptions of the signs and symptoms of those who have supposedly experienced passive toxicity vary widely. They include dizziness, blurry vision, pallor, weakness, sweatiness, high blood pressure, chest pain, heart palpitations, anxiety, and occasionally seizure-like activity. These findings are usually transient and resolve on their own, often far faster than would be expected, and are incompatible with the known duration of the drug’s effect.”

A fact sheet released by Health Canada also dispels some of the myths about fentanyl, telling first responders that skin exposure is “extremely unlikely to immediately harm you” and “there is no documented evidence of responders becoming ill after skin contact with fentanyl.”

Fentanyl has been used in at least one terrorist incident —- by law enforcement. In 2002, Russian police pumped an aerosol version of fentanyl into a Moscow theater where terrorists were holding hundreds of hostages. The gas inadvertently killed 117 of the hostages.