James Miller, Houston Forensic Science Center’s Controlled Substances Section Manager:
It was about 10 years ago while testifying in court that I started to think of gloves as a tool that protects me as much as it does the evidence.

A defense attorney had asked if I wore gloves during analysis to prevent cross-contamination. I thought about my response for a moment, and then acknowledged that, yes, that was part of the reason for using gloves.

But added that wearing gloves also protected me from the evidence.

It was the first time I had really thought of it that way.

As scientists we are accustomed to wearing lab coats, gloves and safety glasses to prevent exposure to chemicals. As forensic analysts we are often more focused on protecting the evidence from change or contamination.

Today, however, with the influx of dangerous fentanyl analogs, my first thought is about the personal protection of my staff when I consider the tools they need to safely perform analysis.

Evidence protection is still important, but now I am keenly aware that extra steps have to be taken to keep analysts safe from exposure.
Consider this: A lethal dose of carfentanil, the elephant tranquilizer that has made a debut on city streets, is so small it cannot be seen with the naked eye.

Added to the danger is the various ways it can get into the body: accidentally ingested by putting a finger in the mouth after handling it, through a mucus membrane by rubbing your eye or nose, or inhaled if it’s a powder that becomes airborne.

Latex, we have learned, may not be a strong enough barrier to prevent a dose of carfentanil from being absorbed through the skin. And even though we believe a much larger amount is needed for absorption through an epidermal layer to be deadly, we can’t take the risk.

So now we are using nitrile gloves exclusively, with the exception of a few people who are allergic, and providing long-cuff gloves for analysts handling suspected fentanyls.

Until a couple of months ago, we used simple surgical masks to protect our nose and mouth from exposure to the substances we handled, but that is no longer enough.

We have moved to N95 particulate respirators for routine use, a 5000 series disposable respirator for vapors and particulates and an N100 respirator for our high-risk cases.

Analysts now have closed containers for carrying samples outside their work areas, and biohazard containers have been placed in all work areas so analytical waste and other items that might come in contact with a case sample can be directly disposed.

Evidence confirmed as fentanyl or a fentanyl analog is repackaged and sealed in an additional container and marked as a “hazardous material” before it is returned to the submitting agency.

None of this, however, is as significant as the naloxone or Narcan doses we now have scattered throughout the lab.

We have trained our staff to recognize the signs of opioid overdose and how to administer the Narcan and provide first aid until paramedics arrive.

In the past, a second analyst had to be present if someone was testing evidence. Now three analysts need to be present so two can assist if the third is exposed: one to administer Narcan while the other seeks additional assistance.

And to think, it was only 10 years ago that I first really thought of personal protective equipment, or PPE, as something designed to protect me from the evidence.  

Dr. Peter Stout, Houston Forensic Science Center’s CEO and President:
I, too, remember the days when we all thought of PPEs first as a way to protect and preserve the evidence.

I remember when smoking was still allowed in the laboratory, mouth pipetting was commonplace and people routinely ate and drank while performing forensic analysis.

Slowly, all of that disappeared.

It was the onset of HIV and hepatitis B that brought on rapid change. The technology for DNA analysis had simultaneously become far more sensitive and so the evidence also needed to be better protected.   

People started wearing gloves and protective goggles. And laboratories limited access to areas for DNA testing. The opioid crisis and the dangerous drugs being seen now are having a similar impact on the controlled substances discipline.

So while James has focused on his section and his people, I have thought more broadly about the entire lab and all the staff. Together with James and the expertise of his analysts, we determined how and where to limit access to the controlled substances laboratory.

Just a few weeks ago, analysts from other sections could pass through the controlled substances lab freely.

That is no longer the case.

Red tape marks the area at the entrance where folks who don’t belong to the section have to wait until someone from the lab grants them access, assists them with putting on appropriate PPE and can escort them through the area. Entrance to the area is now on a “must enter” basis.

If work is being performed on a substance that remains unknown, analysts will close it up until the visitors have left.

And we have distributed Narcan to other sections that might come in contact with fentanyl, such as latent print examiners and crime scene investigators.

We have shared the dangers of handling unknown substances with local law enforcement and prosecutors, making clear that the only protection we can truly give to first responders is to stop them from opening the packaging to begin with. There is no way to look at a substance and know just how harmful it might be.

As a result, Houston has stopped all field testing of drugs, and the Harris County District Attorney’s Office is allowing charges based on numerous factors, including experience and appearance, until lab confirmation is available.

The Houston Police Department has distributed Narcan to all its narcotics officers and is seeking funding to provide the antidote to all patrol officers.

To me, the next step is to treat carfentanil as a “biohazardous waste” although that is not a requirement under federal guidelines.

Doing so, however, will provide a safer path for the handling and destruction of the evidence. It will require us to double bag the substances and label them as biohazards.

Once again, this is no longer to protect the evidence.

It’s all about the people. This is now truly personal protective equipment.