Airborne fentanyl at some B.C. supportive housing sites a risk to workers, says report

The presence of second-hand fentanyl smoke is so severe at some British Columbia supportive housing facilities that workers cannot escape "substantial exposure," even if they stay in their offices and don't venture into hallways or tenants rooms.

That is the among the findings of tests conducted at 14 British Columbia supportive housing sites, results that contributed to the province's decision to form a working group aimed at tackling safety issues — including second-hand fentanyl exposure.

The assessments, conducted by Sauve Safety Services for B.C. Housing, tested facilities in Vancouver and Victoria — finding elevated levels of airborne fentanyl even in the main office of all three buildings tested in Vancouver. 

In a statement, the B.C. Ministry of Housing and Municipal Affairs said it takes the concerns about possible worker exposure to airborne fentanyl seriously.

"We'll be working with our partners to ensure providers can take fast action to protect staff and tenants in supportive housing," the statement said. 

Medical experts say breathing in the second-hand smoke poses similar risks to breathing in smog, and that the risk of overdose from it is extremely unlikely. 

In June, the province announced the formation of a working group to tackle safety in supportive housing, including second-hand exposure to fentanyl.

The announcement of the group came after a number of recent incidents in the housing units, including a June 11 fire at the former Howard Johnson hotel in Vancouver that injured two people.

The ministry said at the time that testing on the 14 facilities in Vancouver and Victoria showed some may be "more likely to have elevated levels of airborne fentanyl, above the limit WorkSafeBC has established."

Details can be found in more than 600 pages of assessments conducted by Sauve. 

It recommended that all three Vancouver facilities improve ventilation to the main office, as well as mandate workers to wear respiratory protection in some cases and strengthen smoking policy enforcement for tenants.

'Grossly exceeded' regulatory limits

In its assessment of the Osborn facility on West Hastings Street, testers found occupational fentanyl exposures over a 12-hour shift that "grossly exceeded applicable regulatory limits," including WorkSafeBC's limits.

Airborne fentanyl levels at the other facilities in Vancouver — Al Mitchell Place on Alexander Street and Hotel Maple on East Hastings — also exceeded exposure limits in office spaces.

The assessments also found higher concentrations in the air of fluorofentanyl, a "structurally modified" version of fentanyl that can be twice as potent as the original opioid, at all three Vancouver facilities.

In the 11 tested Victoria facilities, some main offices were found to offer "protective environments" or had fentanyl levels below regulatory limits, while others exceeded them and created "significant health risks" for staff.

'Similar to smog pollution'

Dr. Ryan Marino, a medical toxicologist with University Hospitals in Cleveland, Ohio, is an expert on addiction medicine and the medical toxicology of opioids such as fentanyl.

He said that while he had not seen the specifics of the assessments, the main risk from second-hand fentanyl smoke is "breakdown products" that result when the substance is burned, which can be directly noxious or toxic to a person's airway surfaces.

"It's actually very similar to smog pollution and can give people pretty significant irritation, coughing," Marino said. "[It] could exacerbate asthma symptoms, that kind of thing. And so that is a very real concern, I would say."

However, he cautioned against overreacting to the threat of absorbing fentanyl or fluorofentanyl through the air, since the opioid does not suspend in an airborne fashion and any particles in the air must be carried through wind or physical motion.

"For someone who's not using drugs, not ingesting anything in any way, the risk of a second-hand exposure, toxicity, overdose, whatever you want to call it, from fentanyl is pretty close to zero," Marino said.

University of B.C. adjunct Prof. Mark Haden agreed, adding that he believes the problem of tenants smoking fentanyl in supportive housing is a direct symptom of drug prohibition — a more fundamental issue that should be tackled.

"This is a completely predictable outcome of a social policy that we need to fix," said Haden, who referred to fentanyl in a health-care setting as a medicine.

"We wouldn't have people using fentanyl in their rooms if they could go downstairs to some health facility and talk to a health-care worker or a nurse who provided these kind of medicines within the context of a health service."

The province has said it is working with the B.C. Centre for Disease Control, WorkSafeBC and B.C. Housing to develop new exposure reduction guidance at supportive housing facilities, with the focus on protecting the workers and tenants in these buildings.