Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose
Abstract Background United 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. H...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-08-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.13235 |
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| author | Siri Shastry Jonathan Lin Kim Aldy Jeffrey Brent Paul Wax Alex Krotulski Sharan Campleman Shao Li Alison Meyn Stephanie Abston Barry Logan Alexandra Amaducci Bryan Judge Michael Levine Diane Calello Joshua Shulman Adrienne Hughes Rachel Culbreth Evan Schwarz Alex F. Manini the Toxicology Investigators Consortium Fentalog Study Group |
| author_facet | Siri Shastry Jonathan Lin Kim Aldy Jeffrey Brent Paul Wax Alex Krotulski Sharan Campleman Shao Li Alison Meyn Stephanie Abston Barry Logan Alexandra Amaducci Bryan Judge Michael Levine Diane Calello Joshua Shulman Adrienne Hughes Rachel Culbreth Evan Schwarz Alex F. Manini the Toxicology Investigators Consortium Fentalog Study Group |
| author_sort | Siri Shastry |
| collection | DOAJ |
| description | Abstract Background United 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. Hypothesis We hypothesized that the proportion of fentanyl and fentanyl analogs would be higher than that of confirmed heroin. Methods This 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. Results Of 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 (p < 0.0001). In contrast, only 46 of the 168 patients with reported or documented heroin overdose (27%) were found to have heroin biomarkers present. Conclusion The 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. |
| format | Article |
| id | doaj-art-b1c6f7f325f64a079155bc23176638db |
| institution | Kabale University |
| issn | 2688-1152 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-b1c6f7f325f64a079155bc23176638db2025-08-20T03:24:33ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522024-08-0154n/an/a10.1002/emp2.13235Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdoseSiri Shastry0Jonathan Lin1Kim Aldy2Jeffrey Brent3Paul Wax4Alex Krotulski5Sharan Campleman6Shao Li7Alison Meyn8Stephanie Abston9Barry Logan10Alexandra Amaducci11Bryan Judge12Michael Levine13Diane Calello14Joshua Shulman15Adrienne Hughes16Rachel Culbreth17Evan Schwarz18Alex F. Manini19the Toxicology Investigators Consortium Fentalog Study GroupIcahn School of Medicine at Mount Sinai New York New York USAIcahn School of Medicine at Mount Sinai New York New York USAAmerican College of Medical Toxicology Phoenix Arizona USAUniversity of Colorado School of Medicine Aurora Colorado USAAmerican College of Medical Toxicology Phoenix Arizona USACenter for Forensic Science Research and Education, Fredric Rieders Family Foundation Willow Grove Pennsylvania USAAmerican College of Medical Toxicology Phoenix Arizona USAAmerican College of Medical Toxicology Phoenix Arizona USAAmerican College of Medical Toxicology Phoenix Arizona USAAmerican College of Medical Toxicology Phoenix Arizona USACenter for Forensic Science Research and Education, Fredric Rieders Family Foundation Willow Grove Pennsylvania USALehigh Valley Health Network/USF Morsani College of Medicine Allentown Pennsylvania USACorewell Health Michigan State University Grand Rapids Michigan USAUniversity of California‐Los Angeles Los Angeles California USARutgers New Jersey Medical School Newark New Jersey USAUniversity of Pittsburgh School of Medicine Pittsburgh Pennsylvania USAOregon Health and Science University Portland Oregon USAAmerican College of Medical Toxicology Phoenix Arizona USAWashington University School of Medicine St Louis Missouri USAIcahn 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 USAAbstract Background United 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. Hypothesis We hypothesized that the proportion of fentanyl and fentanyl analogs would be higher than that of confirmed heroin. Methods This 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. Results Of 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 (p < 0.0001). In contrast, only 46 of the 168 patients with reported or documented heroin overdose (27%) were found to have heroin biomarkers present. Conclusion The 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.https://doi.org/10.1002/emp2.13235fentanylheroinopioidsoverdose |
| spellingShingle | Siri Shastry Jonathan Lin Kim Aldy Jeffrey Brent Paul Wax Alex Krotulski Sharan Campleman Shao Li Alison Meyn Stephanie Abston Barry Logan Alexandra Amaducci Bryan Judge Michael Levine Diane Calello Joshua Shulman Adrienne Hughes Rachel Culbreth Evan Schwarz Alex F. Manini the Toxicology Investigators Consortium Fentalog Study Group Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose Journal of the American College of Emergency Physicians Open fentanyl heroin opioids overdose |
| title | Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose |
| title_full | Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose |
| title_fullStr | Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose |
| title_full_unstemmed | Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose |
| title_short | Heroin or fentanyl: Prevalence of confirmed fentanyl in ED patients with suspected heroin overdose |
| title_sort | heroin or fentanyl prevalence of confirmed fentanyl in ed patients with suspected heroin overdose |
| topic | fentanyl heroin opioids overdose |
| url | https://doi.org/10.1002/emp2.13235 |
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