Customs and Border Protection (CBP) has implemented its first internal policy covering staff access to naloxone. While it revolves entirely around perceived fentanyl “exposure,” there’s little to no inflammatory language and all but one of the factual errors are minor.
For several years, the Department of Homeland Security has been bugging CBP about establishing workplace safety protocols for handling fentanyl and protecting staff from “exposure.” In 2020, an amendment to the Homeland Security Act required that CBP create a policy establishing safety protocols for staff (and canines) handling “potential synthetic opioids.” It also required provision of personal protective equipment, and mandatory staff trainings on how to “access and administer opioid receptor antagonists, including naloxone,” following “exposure to potential synthetic opioids.” The DHS Office of the Inspector General (OIG) would then conduct an audit within three years to determine compliance.
The OIG did conduct the audit, and found that CBP had not created the policy. The resulting OIG report was published in October 2023, which brings us up to the CBP Directive on Administration of Nasal Naloxone Programs, published November 5.
This is a departure from CBP’s public rhetoric around fentanyl.
Given CBP’s frequent collaborations with the Drug Enforcement Administration and its general pretext for existing in the first place, the tone of the new directive is surprising. It characterizes the risk of fentanyl overdose via skin contact or passive inhalation as “extremely low,” “low, but not zero,” “unlikely” and “an infrequent and exceptional circumstance.”
The risk is zero. But this is still a departure from CBP’s public rhetoric around fentanyl as a sort of malevolent airborne virus, which the agency can and will defeat with continued funding. The whole directive is relatively even-keeled, except for an abrupt left turn halfway through when it claims that naloxone “could take up to 20 minutes or longer to take effect.”
This is a wildly inaccurate estimate—naloxone takes two or three minutes to take effect. That wouldn’t make it stand out on its own, because naloxone misinformation is so normalized in these kinds of government safety resources. But usually that consists of the same handful of false claims that are cited over and over, which is why the “20 minutes or longer” claim is notable—literally no one says this. CBP did not respond to Filter‘s short-notice inquiry about the source of the claim.
Conceivably it could have been a typo, and CBP meant “2 minutes or longer.” Or it could have come from the claim that naloxone starts to wear off after 20 minutes, which various agencies do sometimes make. It’s more common that they cite 30 minutes, but either way in it’s in service of the idea that fentanyl these days is too potent for naloxone—which it’s not. Naloxone, like any other substance that enters your system, does wear off, but the perception that someone revived with naloxone will be walking and talking and then succumb to residual opioids does not reflect how overdose actually works.
The issue seemed to be that CBP never put anyone in charge of implementing the changes.
According to the OIG report, CBP initially contested the Act’s requirements by saying that it already had the equivalent of a naloxone policy, even though those requirements didn’t apply to Air and Marine Operations (AMO) or to Border Patrol. It also noted that CBP officials had previously confirmed that they did in fact know about the Act, “but they could not say why they did not fully comply with it.” The issue basically seemed to be that CBP never put anyone in charge of implementing the changes.
CBP did provide AMO and its Office of Field Operations with the required naloxone trainings, and the canine training academies had trained handlers in how to administer naloxone to dogs, but no training was required for Border Patrol.
The audit had also found that while most CBP field offices were in compliance with the naloxone access requirements, some had expired naloxone (which would have still worked). Others had no naloxone on the premises, or naloxone that was not accessible due to CBP storing it in combination-lock boxes that staff were unable to open.
Image (cropped) via United States Customs and Border Protection