The San Diego County Sheriff's Department released more body-worn camera footage from a fentanyl seizure turned into a controversial PSA about the dangers of the synthetic opioid.
In the highly produced PSA video released by the department last week, the SDSO claimed Deputy David Faiivae overdosed twice -- once after coming into contact with the dangerous drug on the job and again in an ambulance on the way to the hospital.
The PSA included body camera footage from Corporal Scott Crane, Faiivae's supervisor that day, and department-produced interviews with Gore, Crane and Faiivae.
Experts strongly challenged Gore's finding after the dramatic video was released saying it fueled misunderstanding and unsubstantiated fears about the danger posed by very limited contact with fentanyl.
In an interview with the San Diego Union-Tribune, Gore told the paper that he, not a doctor, diagnosed Faiivae's overdose. On Thursday the department confirmed the hospital did not take a toxicology sample from Faiivae.
NBC 7 reached out to the SDSO on Monday for a response to the criticism from medical experts and was told the next day Gore wasn't available. When NBC 7 asked the department on Tuesday for confirmation of the statements Gore made to the newspaper, a spokesperson responded in an email two days later, "I don't have a written statement on that? Maybe it's something that was misquoted on the news?"
Why are experts pushing back?
Experts have long said overdosing from skin contact or inhalation of fentanyl is extremely unlikely.
“It just didn’t feel right, didn’t sound right,” Gretchen Bergman, the executive director and co-founder of A New Path, told NBC 7 Monday. A New path is an organization aimed at reducing the stigma associated with substance abuse disorders and drug use and advocates for therapeutic, rather than punitive, drug policies.
Bergman said there are no known cases of airborne fentanyl overdoses and that the trainee would not overdose by simply touching it.
”He had gloves on,” Bergman said. “But even if he had gotten it on his skin, he would have had to take his hand to his mouth or nose. It doesn’t seep into your pores.”
Bergman worries that misinformation contained in the video may deter first-responders and others from stepping in to help, afraid of getting too close to fentanyl and the person who is overdosing.
Gore told the San Diego U-T his department assumed such exposure could result in an overdose.
“If we were misinformed, so be it. We are trying to correct (it),” he told the newspaper.
Researchers who have studied reported overdoses from fentanyl exposure among emergency responders found cases can best be attributed to the “nocebo effect,” a phenomenon in which they believe they encountered a toxic substance and therefore experience expected symptoms. The nocebo effect is laid out in a study by medical experts published last year in the Harm Reduction Journal.
“When individuals are already operating under acute stress and with few mental health reserves, fear of overdose from touching fentanyl could serve as an additional stressor,” the authors state.
Gore, a former FBI official who is not seeking a fourth term next year, said he had concluded after seeing the body-worn camera footage that the deputy exhibited “classic signs of fentanyl overdose.”
“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 overdose from the drug, from fentanyl,” Gore told the paper.
An online petition organized by Dr. Ryan Marino, a toxicology expert and assistant professor at Case Western Reserve University School of Medicine, and Lucas Hill, clinical assistant professor at the University of Texas, Austin College of Pharmacy, urged news organizations to correct what it said was the sheriff department's erroneous account. They said it was signed by more than 350 drug experts, including health professionals.
“This is dangerous misinformation that can cause harm to both people who use opioids and to members of the law enforcement community,” the petition reads.
The Drug Policy Alliance, a group that advocates for decriminalization and safe drug use policies, called the video irresponsible.
“Content like this simply creates more fear and irrational panic that fuels further punitive responses to the overdose crisis, instead of the public health approach we need,” said Kassandra Frederique, the group’s executive director.
Two professional groups — the American College of Medical Toxicology and the American Academy of Clinical Toxicology — said in a joint statement in 2017 that the risk of significant exposure to fentanyl is “extremely low” for emergency responders. The authors noted reports of responders feeling dizzy or like the body was shutting down or dying, but finds, “Toxicity cannot occur from simply being in proximity to the drug.”
During the search of a vehicle last month in San Marcos, Deputy Faiivae reported his face came within about 6 inches (15 centimeters) of a white, powdery substance that tested positive for fentanyl.
In the PSA video, Faiivae, a trainee, approaches the white powder found in a Jeep's back storage area in the San Diego suburb of San Marcos.
According to an incident report, Faiivae wore gloves and safety glasses but not a mask. He said remembered feeling light-headed before collapsing.
The video from Crane's police body-worn camera shows Faiivae stagger backward, fall to the ground and struggle to breathe.
"It was in an instant. It's as though my lungs locked up. I couldn't breathe. I was trying to grasp for breath but I couldn't breathe at all," Faiivae said in the PSA.
Crane can be heard telling Faiivae, "I'm not going to let you die."
“This stuff’s no joke. It is super-dangerous,” Cpl. Scott Crane says before Faiivae collapses.
Faiivae is administered naloxone nasal spray, which reverses the effects of a drug overdose, after he is shown on the ground. Crane tells the deputy he won’t let him die.
The deputy later recounts what it was like, unable to breathe, gasping for air and then passing out.
“It’s an invisible killer,” Crane said in the PSA video. “He would have died in that parking lot if he was alone.”
Gore struck a somber note at the end of the public service announcement to emphasize the dangers of opioids, saying to the camera that exposure “to just a few small grains of fentanyl could have deadly consequences.”