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The instant that the Chief of the Houston Police Department repeated a story during a press conference that a security guard working during the Astroworld tragedy had been injected with drugs, had become unconscious, received Narcan (a form of naloxone, the highly effective opioid antidote), and was revived, I knew the story was highly inaccurate if not a complete fabrication.
The story has now been walked back. It didn’t happen as reported. The guard was tracked down and interviewed by the police. He clarified that he was struck in the head, not injected in the neck with any substance. If the guard received any Narcan—that part of the story might still be true—it certainly had nothing to do with his recovery. As irresponsible as it was for the Chief to have initially spread this story based on hearsay, credit him for doing what few others in his position have done: he set the story straight.
How did I and other experts know from the get-go that the original story was bupkis? Because the offered account had nothing in common with the clinical trajectory of genuine opioid overdoses and everything in common with a growing number of “episodes”—an entire genre, really—that primarily afflict law enforcement officers who are understandably under a lot of stress while performing their duties. The basic story goes like this: an officer touches—or enters the same ZIP code—as fentanyl, a potent synthetic opioid. When they realize this or are informed of the fact, they immediately become light-headed and lose consciousness. A partner springs into action, delivering Narcan. The victim comes around, sometimes after a few doses. The stories are then repeated to the media without scrutiny. Narcan and the partner get credit for reviving what are most likely to have been panic attacks.
Nobody seems to care that opioid toxicity (overdose) presents nothing like this. Patients who overdose, whether intentionally or by accident, typically become lethargic. They may slur their words. They may have gastrointestinal upset. When the dose is high enough, they usually sit or lie down, as settling in for a nap. In extreme cases, their breathing slows down. Most opioid overdose patients can actually be roused for a few seconds at a time with verbal stimulus (yelling “wake up” often works remarkably well for a few seconds before they doze back off and resume shallow breathing) or tactile stimulus (tapping a shoulder, or pinching the skin also works temporarily, and can buy time while we prepare the naloxone antidote). For individuals who have taken a dangerously high dose, respiratory rates drop below 6 to 8 breaths per minute. A person breathing that slowly has a life-threatening condition and needs naloxone immediately. Respiratory depression is the sine qua non of a life-threatening opioid overdose. Fortunately, that’s never what happens in the law enforcement passive exposure cases.
The main hole in most of these stories, as I first wrote over 4 years ago, is that fentanyl (or carfentanil, an even more potent opioid) can’t be absorbed through the skin. These compounds can’t even cause clinical effects if somehow passively inhaled, outside the context of a coordinated large-scale weapons-grade attack.
But in the Astroworld version of this now-tired fable, we were meant to believe that some crazed fiend was on the loose injecting strangers with a valuable substance that people pay good money (and risk legal consequences) to obtain. (At least we don’t have to debunk the skin or passive exposure myth this time.) But why would anyone do this? What would have been the desired effect? Randomly tunnelling opioids into the neck of an unwilling stranger does not seem like the best way to recruit new users. Was the intent to cause mischief? To kill? Why would someone attack a stranger, literally in front of thousands of people?
And even if they did, how would the perpetrator even achieve the precisely desired effect? And that’s another way that it was patently obvious that the Astroworld story was nonsense. Injecting opioids into an unwitting victim is not quite so easy as it may sound. You need to find a vein and you need to get the liquid in without blowing that vein open (and therefore not delivering the medication efficiently). Sure, a shot in the muscle can cause clinical effects, but not immediately. Also, a reasonable volume of liquid would typically be needed, if going the muscular route. It’s not easy to inject such exact quantities of medicine into a willing recipient, let alone into a security guard in a poorly contained near-stampede environment. And even if a highly potent opioid like carfentanil were used, and therefore only a small amount was needed to deliver a clinical effect, don’t we find it odd that in these stories, the effect is always just enough to make the guy pass out? Nobody ever seems to receive only enough drug so as to get the euphoric high that opioid users seek. And, of course, thankfully no one actually ever dies in these stories. Yes, we always hear about the cases where Narcan was on hand and in which apparently life-saving doses were heroically given “just in the nick of time”; but if this type of thing were really happening, surely there would be times when Narcan wasn’t present or not given in time. Good news: as far as I am aware, no law enforcement officer has ever died, let alone required intensive care, from on-the-job opioid exposure. Meanwhile, fentanyl shows up on dollar bills, and nobody seems to notice.
Left unexplained is why “medical staff” initially reported that the guard had markings on his neck that were similar to a prick that an injection might leave. Let me suggest a few possibilities: a birthmark, a freckle, a recent cut from shaving, a bug bite. The human mind, including that of a medical professional or a detective, is highly suggestible. A marking noticed on the neck after someone claims a stabbing occurred? The eyewitness mind fills in the blanks. We believe what we think we saw. But we have no idea what we saw. It’s not malicious, usually. It’s human. The world is full of dizzying details, terabytes of information passing through our viewfinders in chaotic moments. In order to make sense of anything—just to maintain even the vague illusion that our lives exist as a linear narrative—our brains filter almost everything out, relying on context and previous experiences to complete the picture. Often, what we think we saw was not there. That’s why eyewitness accounts like the ones from Astroworld should always be carefully assessed before, say, repeating them at a live media press conference.
I’ve lost track of how many patients I have revived from near-fatal opioid overdoses by administering naloxone. But I’ve never once had a patient who, once revived, didn’t know how they ended up under my care. There remains an opioid epidemic in this country. Fortunately, there’s not an epidemic of random would-be murderers trying to kill strangers with opioids. We have enough real problems. We don’t need to invent any fake ones.
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