the opioid crisis and workplace safety

Opioid abuse is not only causing an alarming number of deaths among users, but its effects also now stretch to those who simply come into contact with the drugs. This has led to a nationwide effort by public safety agencies to revise policies and procedures to minimize the risk of exposure to these very powerful drugs.

the risk

According to the Centers for Disease Control and Prevention (CDC), fentanyl is a synthetic drug 50 to 100 times more powerful than morphine and heroin. Fentanyl acts quickly to depress central nervous system and respiratory function. Exposure to just a quarter of a milligram may be fatal – and some of its analogs are even stronger at even smaller doses. In September 2016, the U.S. Drug Enforcement Agency issued a critical statement to the public and law enforcement personnel warning of serious effects after unintended contact with carfentanil which causes major effects at just one microgram.
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A recent White House Commission study found over 100 Americans die each day from opioid-related overdoses. US Department of Health and Human Services reports the greatest numbers of deaths occur in Massachusetts, Pennsylvania, Oklahoma, and Colorado.

for the employer

Death care professionals know of Occupational Safety and Health Administration’s (OSHA) specific workplace safety standards for bloodborne pathogens and hazardous chemicals. Although opioid exposure poses a serious health risk, OSHA does not currently have an opioid exposure standard. However, under the OSHA's General Duty Clause, an employer aware of the risks of exposure to opioids who doesn't provide training could be cited in the event an employee is exposed and requires medical treatment. This article is not a substitute for actual training, rather to provide some guidance based on recommendations to law enforcement and emergency medical service (EMS) personnel.

HAZARD ASSESSMENT
To address this safety challenge, follow the same process used for other workplace hazards. First, perform a hazard assessment (or include it in your annual workplace hazard assessment) to identify the tasks that expose or may expose employees to the drugs. For example, assessing the remains and surroundings before transfer to a stretcher, searching pockets for material before moving the remains, removing and storing the deceased's clothing and personal effects, etc. The assessment should also include personal protective equipment (PPE) best suited to protect workers against unintended exposure.

EXPOSURE CONTROL PLAN
After the assessment, create an exposure control plan. This includes developing the work practice controls such as policies and procedures when employees know or suspect the drugs are present on or near the remains. The exposure control plan must also include a training program. Training will include the hazard assessment, all written procedures for minimizing exposure, use of proper personal protective equipment (PPE), recognizing effects of the drugs, and procedures for obtaining medical assistance in the event of exposure.

Of course, not all unidentified substances found on or near human remains will be an opioid drug or even dangerous. Unfortunately, it is difficult to determine the risk of an unidentified substance by sight. Thus all material should be considered hazardous until identified. When unidentified material is suspected to be an opioid, or is an employee exhibits symptoms of exposure, notify the local law enforcement agency immediately. Given recent advisories to law enforcement and EMS agencies, this may result in a hazmat treatment for the material, especially if staff develop signs of exposure at the funeral home/crematory.
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The signs and symptoms of opioid exposure will depend on the purity, amount, and route of administration. The onset of symptoms can range from immediate to being delayed by minutes, hours, or even days. Watch for:

• Altered Level of Consciousness: Excessive drowsiness; difficulty thinking, speaking or walking; confusion; lack of response to pain or someone’s voice; coma; seizures; pinpoint pupils.
• Breathing: Trouble breathing – may sound like snoring; slow shallow breathing; blue lips and fingernails; respiratory arrest.
• Altered Vital Signs: Slowed heart rate; low blood pressure; dizziness; cold, clammy skin.
• Airway: Choking or vomiting.

for the employee

Observing standard operating procedures in every case ensures the safety of you, your colleagues, and your loved ones. Contribute to a safe and healthy work environment by wearing necessary PPE, participating in risk assessment and planning, and notifying your superior of any signs of non-compliance or exposure. Keep yourself informed about the potential for contamination—reading this article is a great start!—and stay alert for dangerous situations.
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This article is not a substitute for actual training, rather to provide some guidance based on recommendations to law enforcement and emergency medical service personnel.

cdc guidelines

The CDC issued guidelines to protect law enforcement and EMS personnel from exposure to fentanyl or any drug in the opioid classification. Recommended personal protective equipment: respiratory protection, gloves, eye protection, coveralls, shoe covers, and protective sleeves.

Complete information may be found at the CDC website: https://www.cdc.gov/niosh/topics/fentanyl
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INDUSTRY PARTNERS’ RESOURCES
​For more information on this and related topics connected to the opioid crisis, take a look at:

• Order of the Golden Rule (OGR) book: www.ogr.org/opioid
• National Funeral Directors Association (NFDA) resources for funeral directors: www.nfda.org/resources/business-technical/the-opioid-epidemic
• Answering Services for Directors (ASD) resources: www.myasd.com/blog/funeral-homes-and-opioid-crisis-resources-and-examples-follow

Members can read the full article in Vol. 53, No. 3 Issue of The Cremationist.

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Paul Harris is President and Compliance Director of Regulatory Support Services, Inc., a company founded in 1994 and specializing in regulatory compliance consultation to the death care profession. He holds a North Carolina Funeral Service license and prior to joining the company was the Executive Director of the North Carolina Board of Funeral Service from 2004 until early 2012. Additionally, Paul served as the OSHA compliance officer for a large North Carolina-based funeral home and has eighteen years of first-hand knowledge of regulatory compliance issues.

CANA members receive a 10% discount on annual contract for OSHA and other training, services, and guidance with Regulatory Support Services.
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