Illicit fentanyls as intentional mass casualty threats: The added complexity of transdermal formulations

This study explores the threat of illicit fentanyls weaponized as transdermal agents, focusing on potency, affordability, and adaptability. Illicit fentanyls have favorable physicochemical and pharmacokinetic profiles for transdermal absorption. This paper highlights its potential for harm were it weaponized using pharmaceutical principles. Disaster implications of weaponized transdermal fentanyl exposure are significant. Diagnostic and response challenges would arise due to delayed toxidrome emergence. First responder training, strategic antidote allocation, decontamination and personal protective equipment protocols, and healthcare system surge in mass events must be revised with route- and agent-specific considerations.