Fentanyl, a synthetic opioid 50 times stronger than heroin, is now the leading cause of overdose deaths in the United States. In reporting on the opioid crisis The Washington Post described its impact this way: “Fentanyl has played a key role in reducing the overall life expectancy for Americans.”

While the overall opioid crisis has left its mark on the workplace by increasing substance abuse and leading to lost productivity, the presence of fentanyl has made this crisis deadly.

Fentanyl, A Powerful Synthetic Painkiller

When a person feels severe or chronic pain and no longer gets relief from other painkillers, their doctor may prescribe a stronger painkiller like fentanyl. Among the most powerful opioid painkillers, fentanyl is addictive and extremely dangerous when abused.

The CDC reports that “fentanyl is 50 times more potent than heroin and 100 times more potent than morphine.” Even with a very small dose, its effects can be felt. This potency increases the risk of overdose and death when fentanyl is misused.

Prescribed fentanyl can be administered a number of ways. It can be a transdermal patch, tablet, lozenge, or nasal spray. (Learn more in How Prescription Opioids Affect the Workplace).

In addition to prescribed fentanyl, a street version referred to as illicitly manufactured fentanyl (IMF) is available. IMF is often administered as a pill or mixed with heroin or cocaine. Since it’s difficult for the user to know the effective dose they’re taking with IMF, the risk of overdose is higher than with prescribed fentanyl. Add to this that IMF is often mixed with other drugs and it makes effectively treating an overdose of IMF much more difficult.

Signs and Symptoms of Fentanyl Abuse

Fentanyl abuse shows itself through a wide range of physical and behavioral symptoms that can escalate over time. These behaviors in the workplace are, at a minimum, disruptive.

Physical symptoms of fentanyl abuse include:

• Drowsiness
• Problems breathing
• Unconsciousness
• Dizziness
• Dry mouth
• Headache
• Itching
• Shaking
• Nausea

• Constipation or urine retention

Behavioral symptoms to look for include:

• Euphoria
• Confusion
• Depression
• Delusions
• Personality changes
• Social withdrawal
• Paranoia

• Hallucinations

In the long term, fentanyl abuse undermines the person’s judgment, leads to organ damage, and worsens already-present mental health conditions. With its strong potency, the risk of overdose and death cannot be overstated for people who abuse fentanyl.

Testing for Fentanyl

The presence of fentanyl can be determined through a urine test. Employers can include fentanyl in the panel being reported out.

Fentanyl can be prescribed and has legitimate uses. Because of this, the mere presence of fentanyl in a urine specimen won’t necessarily trigger all the consequences of violating a workplace drug and alcohol policy.

The presence of fentanyl needs to be handled like any other opioid or drug that can be legally prescribed. This includes possible accommodations under the ADA. Written workplace drug policies need to clearly state any prohibitions and explain the consequences of violations related to a positive result for fentanyl in a drug screen.

Addressing Fentanyl in the Workplace

Because of its deadly nature, workplace procedures for dealing with suspected fentanyl abuse need to go beyond the standard response. Fentanyl misuse raises the risk of overdose in the workplace.

The first thing to do when faced with a possible overdose is to immediately call 911. Every minute counts when trying to reverse a fentanyl overdose.

Naloxone can be used to counter an opioid overdose. This drug helps restore breathing and counter nodding off. It’s given either as an injection or a nasal spray. Because of fentanyl’s high potency, more than one dose of naloxone might be needed to counter an overdose.

Employers need to consider whether to keep a naloxone kit available in their workplace for use in an emergency. Even though some are urging employers to stock naloxone and use the antidote for opioid overdose, this is not a decision to take lightly. There are legal and liability issues to consider along with policies and training to put in place.

The National Institute for Occupational Safety and Health (NIOSH) outlines these steps for establishing a naloxone program in the workplace:

• Conduct a risk assessment of the risk of overdose in the workplace
• Consider and address possible liability and legal issues
• Identify and establish the requirements for records keeping and records management related to handling overdoses in the workplace
• Clearly define staff roles and responsibilities when responding to a suspected overdose
• Train staff to know how to respond and stay safe
• Decide which form of naloxone to purchase
• Set up secure storage for naloxone, personal protective equipment, and other needed equipment, like sharps disposal containers
• Develop a plan for immediate follow-up care for the person who overdosed

• Re-evaluate your program regularly and make any necessary changes or updates

Where Employers Go from Here

As the impact of the opioid crisis on workplace safety continues to grow more lethal, employers need to stay informed. (Learn more in Positive Proactive Steps Employers Can Take To Deal With Opioids In The Workplace). Comprehensive workplace drug policies and testing programs provide a strong baseline. With fentanyl and its potentially deadly consequences, employers may be pushed to take their workplace drug abuse programs to a whole new level.