decontamination procedure can beemployed using a non-alcohol-based,low pH wipe to remove as muchpotential contamination as possible. Itshould be noted that the efficacy ofwipes for removing threat materials,including synthetic opioids, has notbeen well characterised.

Harsh oxidising chemicals likebleach or peracetic acid should not beapplied directly to the skin. Avoid anysoaps or solutions at basic pH (pH > 7)as the increased pH will increase skinabsorption. Avoid any wipes or solutionsthat are alcohol-based as alcohol hasalso been shown to double the rate ofskin absorption.4 Furthermore, avoidwipes with any other solvents present asthere is little information availableabout their performance and effects onfentanyl skin permeation. Once dry,provide clean clothes or a temporarygarment and monitor for any clinicalsymptoms of fentanyl exposure.

PPE, sensitive equipment, andevidence packagingFirst, ensure the PPE, sensitiveequipment and evidence packaging isnot a source of contamination spread.Consider performing an initial grossdecon using a highly absorbent wipe to remove any obvious signs ofcontamination from the PPE or equipment.

The next step is to select thedecontamination agent and use atechnical decontamination process toreduce contamination to a level that isnon-detectable. At present the mostappropriate solutions are thosecontaining a surfactant and oxidant,specifically 4–5% peracetic acid or 8-10% hydrogen peroxide. They can beutilised to destroy residual amounts ofsynthetic opioids as long as the pH ismodified to between five and seven. ThepH modification will ensure that thematerial is not destructive to thesensitive equipment and materials, andwill provide a secondary vapoursuppression capability.5

Based on published data on theDahlgen Decon product3, the solutionshould remain in contact with the PPEor sensitive equipment for five minutesto ensure complete destruction of allfentanyl and fentanyl analogues. Inaddition, the solutions should be usedwithin six to 12 hours of mixing tomaintain appropriate concentrationsand their effectiveness. Avoid usingsolutions at the pH extremes as they canbe harsh on sensitive equipment andPPE materials.

If in doubt about the success of theprocess, it can be repeated. Sensitiveequipment, PPE areas where highlevels of contamination are visible orareas within three to four inches (76-

102mm) of an interface that will beopened when doffing the gear can alsobe wiped to remove any residualdecontaminant. Trace detectiontechniques can be used to monitordecontamination effectiveness.

Any potential evidence should becaptured and managed followingevidentiary best practice. The outsideof the evidence packaging containershould be decontaminated as if it weresensitive equipment (see process above)to minimise any potential forsecondary contamination.

Surfaces/areaFollowing a synthetic opioid response,there are likely to be areas within afacility or in the environment where theresponse entity must destroy anyresidual materials to ensure continuedpublic safety.

First, if possible prevent the surfacefrom being a source of contaminationspread. Then consider an initial grossdecon step using a highly absorbentwipe to remove any obvious signs ofcontamination from the surface. This islikely to be most useful for small areasof contamination.

As for decontamination of PPE,sensitive equipment and evidencepackaging, select the decontaminationagent and use a technicaldecontamination process to reduce the

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surface contamination to a non-detectable level. Select the appropriateoxidising decontaminant solution todecontaminate areas where there is bulkmaterial, or where trace material wasthought to be, present. A variety ofoxidising decontamination solutions areavailable6, each with its own benefitsand challenges (see Table 1). Be sure tokeep hypochlorite anddichloroisocyanuric acid solutionsseparate as they can react violentlywhen mixed.

For peracetic acid-based solutions,studies have shown that thedecontamination solution should stay inplace for a minimum of 10 minutes forbulk contamination and at least fiveminutes for trace contamination priorto removal.3 Note that the contact timesare determined based upon residualmaterial on a surface. If bulk materialremains, required contact times willincrease and volumes ofdecontamination solution should beincreased to ensure that thedecontamination solution can penetratethrough the materials.

The selection of suitable criteria forwhat is clean and for re-occupancyshould also be determined prior tostarting decontamination. Unlike withmethamphetamines there is,unfortunately, little informationavailable about suitable reoccupancycriteria after decontamination, so youshould seek assistance from your localpublic health unit. All personnel shouldbe appropriately protected whencarrying out decontamination.

The complexity of decontaminatingsurfaces is highlighted in a recent case.

In November 2017 a 69-year-oldwoman’s death in Pennsylvania wasbelieved to have been due to lethalopioid exposure while cleaning up afterher 45-year-old son’s overdose theprevious day.7 This highlights a numberof issues including what is clean andwhat is a suitable health-basedreoccupancy value especially for siteswhere there are sensitive populations,like children. As similar incidentsbecome more prevalent, it will likely fallupon the emergency response

community to decontaminate thesescenes prior to allowing reoccupation. Itis important to consult your local publichealth unit prior to such activities.

Based on the current state ofknowledge regarding suitabledecontaminants for situations asdescribed above, the following tablesummarises the decontaminationguidance provided. Green representssuitable solutions, yellow representspotential solutions and red representssolutions that should not be attempted.

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1. Baxter, C and Logan, M (2017) Synthetic Opioids in Operational Environments – Part I: Detection, CBRNe World,December 2017: 25-30.2. Roy, S and Flynn, G (1990) Transdermal Delivery of Narcotic Analgesics; pH, Anatomical, and Subject Influences onCutaneous Permeability of Fentanyl and Sufentanil, Pharmaceutical Research, 7(8): 842-847.3. Durnal, E and Kelsey, P (2017) Fentanyl HCl Decontamination Study, MRI Global Project No 311493.4. Grond, S, Radbruch, L, and Lehman, K (2000) Clinical Pharmacokinetics of Transdermal Opioids: Focus on TransdermalFentanyl. Clin Pharmokokinet, 38: 59-89.5. Donabed, J, Harvey, M, and Howarth, J (2016) The Effects of pH Adjustment on Peracetic Acid Vapor Production.EnviroTech White Paper.6. Qi, L, Cheng, Z, Zuo, G, Li, S, and Fan, Q (2011) Oxidative Degradation of Fentanyl in Aqueous Solutions of Peroxides andHypochlorites. Defence Science Journal, 61(1): 30-35.7. Fox News (2017) Woman Dies After Cleaning up Son’s Fatal Drug Overdose, Coroner Says (http://www.foxnews.com/health/2017/11/15/woman-dies-after-cleaning-up-sons-fatal-drug-overdose-coroner-says.html)

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Table 1. Decontamination solutions for synthetic opioids

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