Fentanyl as An Agent of Bioterrorism

i-884eb5fc5ab25b1446721361549e13dd-shelley icon.JPG At the beginning of my adventures in blogging (circa 2006) I wrote a short piece for the news site "Mixeye" about the drug fentanyl, and was reminded of it after having a discussion about the drug with some friends. Fentanyl is an extremely potent painkiller, which has unsurprisingly led to its widespread abuse (especially in my neck of the woods, towards Detroit). However, after re-reading my write-up, I was reminded of why I thought this drug was particularly interesting: it has been used in some high-profile bioterrorism strikes and was, for a while, pursued as a chemical weapon by various governments, including our own. i-d56106b48c07d30aeb89cc021bd47f04-fentanyl.bmp

Here is a description of one event:

"On October 23, 2002, in the middle of an evening performance at a Moscow music theater, some 50 Chechen terrorists equipped with firearms as well as large quantities of explosives suddenly seized the venue and the 800 people inside. The terrorists threatened to kill everyone inside unless Russia ended the war in Chechnya. Although the Chechen militants agreed to release some of the hostages during the first couple of days, negotiations with the Russian authorities eventually stalled. Just before dawn on October 26, Russian special police units resorted to using an incapacitating gas based on the drug fentanyl to end the crisis. All of the Chechen militants were killed, and most of the civilian captives survived. But while the operation was largely a success, at least 117 of the hostages died from the effects of the gas."

I happened to notice that an online symposia took place not quite a year ago on the topic of neuro-terrorism called "All in the Mind." The symposia focused on querying experts on neurochemistry and bioterrorism as to whether we should be worried about this new possibility in terror strikes as our understanding of the brain marches on. One of the situations the experts discuss is the use of fentanyl by the Russian government, here is an excerpt:

Natasha Mitchell: Mark Wheelis, remind us of the significance of the Moscow theatre storming. As you suggest, Malcolm, it's understood, not confirmed necessarily, that an opiate chemical fentanyl was used to incapacitate the hostage takers but also the hostages. Remind us of that situation that happened in 2002.

Mark Wheelis: That was in the fall of 2002 in October and about 50 Chechen separatists took somewhere between 800 and 900 theatregoers hostage in the Dubrovka theatre in Moscow. They demanded the withdrawal of Russian forces from Chechnya - a demand that the Russian federation clearly was not willing to meet. The Russian federation stalled for a couple of days and then by a mechanism that is still not well understood but which I think involved tunnelling down to the air-handling systems in the basement of the building, and then introduced this anesthetic agent in aerosol form, probably as a fine powder, into the air-handling equipment. The agent was identified by the Russians as a derivative of the anesthetic fentanyl but they were not more specific than that.

Natasha Mitchell: Over 100 hostages died.

Mark Wheelis: There were about...

Natasha Mitchell: But many more were saved as a result.

Mark Wheelis: 126 or 127 of the hostages died, I suspect it was a combination of fentanyl overdose and airway blockage when they collapsed unconscious. There's an unknown number, but probably quite a large number of survivors who had continuing long-term deleterious health effects.

Natasha Mitchell: What does that event actually raise for you, you have considerable concerns about what that was a harbinger of.

Mark Wheelis: Yeah, two major concerns I have about this. The first is - the one that Malcolm has just suggested - that it provides virtually definitive evidence that the Russian Federation did develop, produce, stockpile and train troops and use this chemical agent as a weapon in this situation. The precedent that one country has actually engaged in developing such a weapon is worrisome because it is likely to stimulate others to do the same.

Check out the rest of the transcript for some fascinating food for thought (although don't blame me if it keeps you up at night.)


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Just to correct a possible misperception here: the drug used could not have been fentanyl, which is a very commonly used anesthetic/analgesic drug. It's just not potent enough to be effective as an aerosol. The sources state "a fentanyl derivative," not fentanyl. It was probably carfentanil, which is 100 times more potent than fentanyl and is never used in human medicine. It is quite popular with veterinarians as a large-animal sedative. I just don't want people thinking that fentanyl is this dangerous "terrorist" drug that can kill by inhalation.

By Barry Zimmerman (not verified) on 05 Mar 2008 #permalink

"...notice that an online symposia took place not quite a year ago on the topic of neuro-terrorism called "All in the Mind."

Just a slight correction here, "All in the Mind" is the name of a weekly radio show available in Australia. The actual episode was titled "Bioterrorism and your brain"

It is available as a podcast and is very good.
Feed is http://www.abc.net.au/rn/podcast/feeds/mind.xml

Thanks both for the corrections! I'll check out the podcast for sure. Wasn't trying to portray fentanyl as 'dangerous per se,' interesting about the fentanyl derivative--I'm going to look into that a bit more.

Hi Shelly,

1 - More on Carfentanil ["short action, easy reversibility and therapeutic index"] wiki.
An alternative is 3-methylfentanyl.
"Opioid antagonists may prevent complications in many of victims."

2 - Scientific American 2008 March has this article White Matter Matters: "White matter, long thought to be passive tissue, actively affects how the brain learns and dysfunctions."
This article includes a relatively new type of imaging diffusion-tensor imaging (DTI) to study white matter.
This may allow for a better understanding of the relation of the cochlea [your interest] to the semicircular canals [my interest]?

I'm probably one of the few who thinks that the use of a chemical like fentanyl would be ideal for this type of situation. I don't buy into the whole idea of an all-out ban on "chemical warfare". It would be much better to use some sort of sedation than to go in guns blazing hoping to kill the right people. Of course, there are problems (as the Moscow case illustrates) but I don't think the strategy is wrong per se. Additionally, I think there is a rapid and efficacious antagonist for opiate overdoes that would have worked in the Moscow case had the medical personnel been notified ahead of time.