Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose

Author:

Shastry Siri1,Lin Jonathan1ORCID,Aldy Kim23,Brent Jeffrey4,Wax Paul25,Krotulski Alex6,Campleman Sharan2,Li Shao2,Meyn Alison2,Abston Stephanie2,Logan Barry67,Amaducci Alexandra8,Judge Bryan9,Levine Michael10,Calello Diane11,Shulman Joshua12,Hughes Adrienne13,Culbreth Rachel2,Schwarz Evan14,Manini Alex F.15,

Affiliation:

1. Icahn School of Medicine at Mount Sinai New York New York USA

2. American College of Medical Toxicology Phoenix Arizona USA

3. Baylor University Medical Center Dallas Texas USA

4. University of Colorado School of Medicine Aurora Colorado USA

5. University of Texas Southwestern Medical Center Dallas Texas USA

6. Center for Forensic Science Research and Education, Fredric Rieders Family Foundation Willow Grove Pennsylvania USA

7. NMS Labs Horsham Pennsylvania USA

8. Lehigh Valley Health Network/USF Morsani College of Medicine Allentown Pennsylvania USA

9. Corewell Health Michigan State University Grand Rapids Michigan USA

10. University of California‐Los Angeles Los Angeles California USA

11. Rutgers New Jersey Medical School Newark New Jersey USA

12. University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA

13. Oregon Health and Science University Portland Oregon USA

14. Washington University School of Medicine St Louis Missouri USA

15. Icahn School of Medicine at Mount Sinai Center for Research on Emerging Substances Poisoning, Overdose, and New Discoveries (RESPOND) NYC Health + Hospitals/Elmhurst New York New York USA

Abstract

AbstractBackgroundUnited States drug overdose deaths are being driven by the increasing prevalence of fentanyl, but whether patients are knowingly using fentanyl is unclear. We examined the analytical confirmation of fentanyl in emergency department (ED) patients with documented heroin overdose.HypothesisWe hypothesized that the proportion of fentanyl and fentanyl analogs would be higher than that of confirmed heroin.MethodsThis is a subgroup analysis from a prospective multicenter consecutive cohort of ED patients age 18+ with opioid overdose presenting to 10 US sites within the Toxicology Investigators Consortium from 2020 to 2021. Toxicology analysis was performed using liquid chromatography quadrupole time‐of‐flight mass spectrometry. De‐identified toxicology results were paired with the clinical database. The primary outcome was the proportion of patients with fentanyl analytes detected in their serum.ResultsOf 1006 patients screened, 406 were eligible, and of 168 patients who reported that they had taken heroin or had a documented heroin overdose, 88% (n = 147) were in fact found to have fentanyl and/or a fentanyl analog present on serum analysis (< 0.0001). In contrast, only 46 of the 168 patients with reported or documented heroin overdose (27%) were found to have heroin biomarkers present.ConclusionThe prevalence of confirmed fentanyl in ED patients with suspected heroin overdose was extremely high, while the prevalence of heroin was very low. There was a high degree of mismatch between the opioids believed to be the overdose agent versus the actual opioids identified on serum toxicology. Clinicians in the United States should presume that fentanyl is involved in all illicit opioid overdoses and should counsel patients on harm reduction measures.

Funder

National Institute on Drug Abuse

Publisher

Wiley

Reference8 articles.

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