Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 19;5(4):e13235.
doi: 10.1002/emp2.13235. eCollection 2024 Aug.

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

Siri Shastry  1 , Jonathan Lin  1 , Kim Aldy  2   3 , Jeffrey Brent  4 , Paul Wax  2   5 , Alex Krotulski  6 , Sharan Campleman  2 , Shao Li  2 , Alison Meyn  2 , Stephanie Abston  2 , Barry Logan  6   7 , Alexandra Amaducci  8 , Bryan Judge  9 , Michael Levine  10 , Diane Calello  11 , Joshua Shulman  12 , Adrienne Hughes  13 , Rachel Culbreth  2 , Evan Schwarz  14 , Alex F Manini  15 ; Toxicology Investigators Consortium Fentalog Study Group
Affiliations

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

Siri Shastry et al. J Am Coll Emerg Physicians Open. .

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.

Keywords: fentanyl; heroin; opioids; overdose.

PubMed Disclaimer

Conflict of interest statement

The authors declare no commercial conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Cases of suspected opioid overdose identified during subgroup analysis of the Toxicology Investigators Consortium (ToxIC) Fentalog Study. Cases were further categorized by self‐reported heroin use.
FIGURE 2
FIGURE 2
Confirmed serum analytes among patients with self‐reported heroin use (N = 168).
See this image and copyright information in PMC

References

    1. U.S. overdose deaths in 2021 increased half as much as in 2020–but are still up 15%. May 11, 2022. Accessed August 23, 2023. https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm#p...
    1. McKnight C, Weng CA, Reynoso M, Kimball S, Thompson LM, Jarlais DD. Understanding intentionality of fentanyl use and drug overdose risk: findings from a mixed methods study of people who inject drugs in New York City. Int J Drug Policy. 2023;118:104063. doi:10.1016/j.drugpo.2023.104063 - DOI - PMC - PubMed
    1. Amaducci A, Aldy K, Campleman SL, et al. Naloxone use in novel potent opioid and fentanyl overdoses in emergency department patients. JAMA Netw Open. 2023;6(8):e2331264. doi:10.1001/jamanetworkopen.2023.31264 - DOI - PMC - PubMed
    1. Han Y, Yan W, Zheng Y, Khan MZ, Yuan K, Lu L. The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies. Transl Psychiatry. 2019;9(1):282. doi:10.1038/s41398-019-0625-0 - DOI - PMC - PubMed
    1. Daniulaityte R, Carlson RR, Juhascik MP, Strayer KE, Sizemore IE. Street fentanyl use: experiences, preferences, and concordance between self‐reports and urine toxicology. Int J Drug Policy. 2019;71:3‐9. doi:10.1016/j.drugpo.2019.05.020 - DOI - PMC - PubMed

LinkOut - more resources