Sheriff ‘shocked’ by pushback from medical experts over fentanyl video
Toxicology experts say they don’t believe deputy suffered fentanyl overdose; sheriff vows to release more information about incident
SAN DIEGO — Sheriff Bill Gore said Monday that the dramatic video his department publicized last week, intending to highlight the danger of fentanyl to law enforcement, was produced without any input from physicians.
Gore said he, not a doctor, concluded that Deputy David Faiive suffered an overdose from incidental contact with fentanyl in the July 3 incident featured in the video. It showed Faiive collapsing in a San Marcos parking lot after handling suspected narcotics found in a vehicle.
Medical professionals have pushed back, saying there is no evidence that incidental contact — drugs coming in contact with skin or through inhalation — with fentanyl can trigger an overdose. A couple hundred signed an online petition calling for retraction of the video and the news coverage that focused on it.
“I saw the video. Everybody that saw the video saw him seize up, go down, fall on his head,” Gore said. “The drugs tested for fentanyl. It was classic signs of fentanyl overdose — that’s why we called it that.”
The sheriff said he was “shocked” to hear pushback from toxicologists and members of the medical community. Gore pledged to release full, unedited body-worn video of the incident and to seek medical records of the deputy.
The backlash from many people who saw the sheriff’s video was swift and sharp. On social media, toxicologists, doctors and others said an overdose couldn’t have happened the way the Sheriff’s Department had described. They said what they saw in the video did not look at all like an opioid overdose.
UC San Diego associate professor of medicine Leo Beletsky researches opioid overdoses and said the video “adds unnecessary stress to an already strained profession. Inadvertently, in an intention to protect law enforcement, it does harm.”
Several people noted the video was edited and wanted to see the raw footage of what happened.
Gore also took exception to allegations that the department had faked the video.
“We were not trying to deceive anybody, trying to hype the issues,” he said.
The San Diego Union-Tribune’s reporting on the video last week also came under fire for not questioning the Sheriff’s Department’s contention that the deputy had overdosed from fentanyl exposure. Critics noted that reporters failed to talk to toxicologists or other medical professionals.
“It makes me upset with the media that reported it,” said Dr. Andrew Stolbach, a medical toxicologist and an emergency physician at Johns Hopkins Hospital in Baltimore. “If you are going to do that story, you need to talk to at least one physician.”
Although fentanyl and other drugs designed to mimic its effects have fueled an overdose epidemic in North America, “the risk of clinically significant exposure to emergency responders is extremely low,” according to the statement by the American Academy of Clinical Toxicology and the American College of Medical Toxicology.
Gore said Monday he was surprised that medical professionals had contended that the risk to law enforcement in handling and inhaling fentanyl was overblown.
“I’m sorry, my mind didn’t go to, oh our deputy fainted, our deputy had a panic attack. It just didn’t go there. What was the other logical explanation— to my mind it was an overdose from the drug, from fentanyl.”
Before the deputy fell ill, he and another deputy arrested a suspect on suspicion of drug possession. That person appeared to have a seizure and was taken to a hospital, according to a Sheriff’s Department report.
According to the Sheriff’s Department, they tested the contents of three plastic baggies found at the scene. One tested positive for methamphetamine. The other two were a mix fentanyl and fluorofentanyl.
One of the incident reports the department released Monday contains a description of the deputy’s account of what happened to him.
According to the report, the deputy said he bent down to grab an evidence bag and his face came within 6 inches of where he had been testing the substance. His training officer told the deputy not to get too close, and when he stood up “he felt light-headed and fell down.”
The next thing he remembered was someone spraying naloxone up his nose and then being loaded into an ambulance.
Some toxicologists said that believing a substance can harm you can serve as a “nocebo” — the opposite of a placebo — meaning if you think it will harm you, you feel an effect.
“A nocebo effect could explain what is going on in this incident,” said Dr. Ryan Marino, medical director of toxicology at University Hospitals in Cleveland. “I can say from watching that video he is not having an overdose.”
Marino said that is not to suggest what happened wasn’t real, but rather was “most likely caused by the fear and anxiety caused by this narrative. … it’s a self-fulfilling prophecy.”
Marino said the biggest harm in the narrative of the video was that people who see it will believe the myth that exposure is harmful and won’t want to help people in the midst of a true overdose.
Gore said the deputy, who is out of the country right now, has agreed to sign a release of his records, but said there was a chance there might not have been a toxicology test taken. “If there was no toxicology done at Palomar (Medical Center), I don’t know where that’s going to leave us,” Gore said.
He said the department has operated under the assumption that inhalation or touching it could cause an overdose.
“If we were misinformed so be it we are trying to correct (it),” he said.
In the days since the story broke, a group of health professionals, public health researchers, first responders and others signed a request calling for a retraction of the video and for news outlets to correct the record. They said the Union-Tribune story on Friday perpetuates a myth that casual contact with potent synthetic opioids such as fentanyl poses a health risk to first responders. More than 200 people signed the document.
“This is dangerous misinformation that can cause harm both to people who use opioids and to members of the law enforcement community,” the online petition said.
Spreading such misinformation, the petition says, can stigmatize people who need support in the midst of a public health crisis. It may delay a timely overdose response — either because bystanders will wait for first responders to arrive or because first responders will be delayed as they don unnecessary personal protective equipment. And, they say, it it might cause first responders to suffer emotional trauma if they believe that passive exposures put their lives at risk.