Threat potential of pharmaceutical based agents

ABSTRACT

The potential use of ‘pharmaceuticals’ has been identified by civilian law enforcement agencies, and counter-terrorism responders, as a threat that fills the gap between physical restraint and lethal weapons. This rise in availability of synthetic opiates reassessment of the overall public health threat from pharmaceutical based agents. The large quantities of illicitly synthetized novel opioids create a significant risk of accidental exposures or, potentially, a major deliberate release, and represents a global health security concern. Here we present a health security risk assessment of PBAs and approaches to threat prevention or mitigation, gaps in research, and medical countermeasure considerations.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. BMA, The Use of Drugs as Weapons, 5.

2. Ibid., 1–2.

3. Ibid., 7–8.

4. Morrison, Fentanyl Opens a Grave New Health Security Threat.

5. DEA, DEA Intelligence Brief.

6. Banks, Medical Management of Chemical Casualties Handbook.

7. Gryphon Scientific LLC, Risk & Benefit Analysis of Gain of Function Research, 1–8; and National Science Advisory Board for Biosecurity, Recommendations for the Evaluation and Oversight of Proposed Gain-of-Function Research, 4–7.

8. Blain, “Human Incapacitants.”

9. Ibid., 661.

10. Banks, Medical Management of Chemical Casualties Handbook (Fifth Edition). Chapter 12.

11. See note 9 above.

12. See note 4 above.

13. Arce, Major Fentanyl Shipment from China Seized in Mexico.

14. Valdez et al., “An Efficient, Optimized Synthesis of Fentanyl and Related Analogs,” 2.

15. See note 9 above.

16. Ibid.

17. See note 5 above.

18. Chauhan et al., “Chemical Warfare Agents.”

19. See note 11 above.

20. Valdez et al., “An Efficient, Optimized Synthesis of Fentanyl and Related Analogs,” 3–4.

21. Gupta and Pande, “A Convenient One Pot Synthesis of Fentanyl.”

22. See note 5 above.

23. BMA, The Use of Drugs as Weapons, 1–2.

24. Banks, Medical Management of Chemical Casualties Handbook (Fifth Edition). Chapter 12,, 419.

25. Riches et al., “Analysis of Clothing and Urine from Moscow Theatre Siege Casualties Reveals Carfentanil and Remifentanil Use.”

26. See note 19 above.

27. Turner, Homeland Security is Reportedly Considering Labeling Fentanyl as a Weapon of Mass Destruction.

28. Borden Institute (U.S.) and U.S. Army Medical Research Institute of Chemical Defense, Field Management of Chemical and Biological Casualties Handbook.

29. See note 11 above.

30. Chilcott and Amlôt, Primary Response Incident Scene Management (PRISM) Guidance for Chemical Incidents Vols 1–3.

31. Ibid.

32. Amlot et al., “Comparative Analysis of Showering Protocols for Mass-casualty Decontamination”; Carter et al., “Emergency Responders’ Experiences of and Expectations Regarding Decontamination”; Chilcott et al., “The United Kingdom’s Initial opeRational Response and Specialist Operational Response to CBRN and HazMat Incidents”; Egan and Amlôt, “Modelling Mass Casualty Decontamination Systems Informed by Field Exercise Data”; Monteith and Pearce, “Self-care Decontamination within a Chemical Exposure Mass-casualty Incident”; and Singh et al., “Decontamination of Chemical Warfare Agents.”

33. Kumar et al., “Chemical, biological, radiological, and nuclear decontamination.”

34. Ibid.

35. Capoun and Krykorkova, “Comparison of Selected Methods for Individual Decontamination of Chemical Warfare Agents.”

36. Banks, Medical Management of Chemical Casualties Handbook; and Borden Institute (U.S.) and U.S. Army Medical Research Institute of Chemical Defense, Field Management of Chemical and Biological Casualties Handbook.

37. Chilcott, “Managing Mass Casualties and Decontamination”; Krieger et al., “Understanding Public Responses to Chemical, Biological, Radiological and Nuclear Incidents-Driving Factors, Emerging Themes and Research Gaps”; Lake and Divarco, Guidelines for Mass Casualty Decontamination During an Hazmat/Weapon of Mass Destruction Incident: Volumes I and II; SBECOM, Updated Guidelines for Mass Casualty Decontamination During a HAZMAT/Weapon of Mass Destruction Incident, Volumes I and II; Singh et al., “Decontamination of Chemical Warfare Agents”; and US Department of Homeland Security and US Department of Health and Human Services, Patient Decontamination in a Mass Chemical Exposure Incident.

38. International Standards Organization (ISO), Risk Management: Principles and Guidelines.

39. Rasmussen, “Risk Management in a Dynamic Society”; and CDC, Hierarchy of Risk Controls.

40. Centers for Disease Control, Fentanyl – Preventing Occupational Exposure to Emergency Responders.

41. See note 14 above.

Additional information

Notes on contributors

D. J. Heslop

Assoc Prof D. J. Heslop, FAFOEM FRACGP MBBS PhD (Medicine) MPH BSc (Adv) Hons I. Associate Professor David Heslop is the Director of Health Management at the School of Public Health and Community Medicine, at UNSW Sydney and is a practising General Practitioner and Occupational and Environmental Physician. He has senior advisory responsibilities in CBRNE and Occupational Medicine in Army Headquarters, Australian Defence Force. He has published in the areas of epidemic modeling, disaster management, CBRNE medicine, and military health systems. His current research effort and interests focus on complexity science, agent-based and deterministic modelling, emergent complex adaptive systems phenomena, test and evaluation of systems, policy research, epidemic modelling, exotic and emerging infections, disaster preparedness and response, organisational resilience in health care, development of robust socio-technical systems in health care, and the modelling, simulation and investigation of public health interventions and systems.

P. G. Blain

Prof P. G. Blain CBE, BMedSci MB BS PhD (Neurotoxicology) FBTS FRBS FFOM FRCP(Lon) FRCP(Edin). Professor Peter Blain is Director of the Medical Toxicology Centre at Newcastle University UK. He is a clinical professor and hospital physician with over 30 years’ experience in the application of medical knowledge to intelligence, security and operational issues, including high value asset protection for UK Government. He is a recognized international expert in clinical medicine and medical research, and provides high-level expert advice in CBRN medicine, related sciences, and emergency response medicine to both UK and US Governments and major international bodies. He has received in excess of £11M in funding over the last decade for research into toxic mechanisms, diagnostic biomarkers, role of pluripotent stem cells in health protection, CBRN medical countermeasures and novel medical interventions. He was awarded a CBE in 2002 for services to medicine and defence.