Most Drug Overdose Patients Not Tested for Fentanyl, Synthetic Opioids

A new study by Epic Research and the University of Maryland’s Center for Substance Abuse Research (CESAR) shows that only 5 percent of drug overdose patients admitted to the emergency department are tested for fentanyl and synthetic opioids, despite these drugs being the leading cause of death for Americans 18 to 45 years.

The Centers for Disease Control and Prevention (CDC) report that synthetic opioids are currently the main driver of drug overdose deaths, which increased by 31 percent from 2019 to 2020. Opioids were involved in 75 percent of all drug overdose deaths in 2020, and 82.3 percent of all opioid overdose deaths involved synthetic opioids.

Researchers sought to evaluate the prevalence of synthetic opioid testing in Eds for overdose patients. Typically, patients visiting an emergency room for a drug overdose or poisoning are given toxicology testing panels, which help identify the drugs in their systems, the research team stated.

These panels usually include screenings for amphetamines, barbiturates, benzodiazepines, cocaine, cannabis, phencyclidine, and opiates. However, synthetic opioids are not usually detected in routine toxicology panels and require separate screenings.

To investigate how often toxicology screenings are performed and which drugs are identified during overdose- and poisoning-related ED visits, the researchers evaluated lab results for 15 drug categories during 315,467 visits from 2017 to 2022.

They found that the screenings consistently tested for opiates nearly half of the time, with the positivity rate of these tests decreasing from 25.2 percent in 2018 to 13.5 percent in 2022. This decrease may indicate a shift from opiates to synthetic opioids, the research team suggested.

The researchers also saw an increase in fentanyl testing over the course of the study, but the screenings only tested for the drug in 5.1 percent of visits, likely because synthetic opioids are not included in routine screenings and require additional testing. This lack of testing comes alongside the finding that in the first quarter of 2022, the positivity rate of fentanyl tests was 41.7 percent, three times that of opiates during the same period.

These findings may be part of larger trends in screening and shifts in drug use, with a significant impact on drug overdose outcomes and deaths, the researchers concluded.

To improve the tracking of these trends, which will aid fentanyl identification and help enhance treatment, they recommend EDs review standard toxicology panels and consider including synthetic opioid testing in their screenings.

These insights come as public health researchers work to improve the response to the opioid epidemic and better forecast drug-related health outcomes.

Researchers from the National Institutes of Health’s National Institute of Drug Abuse argued in June that public health officials had been forced to fight the opioid crisis “blindfolded” because of significant issues with overdose data. They stated that a real-time, comprehensive data strategy is needed and proposed multiple approaches to building this strategy.

Others have attempted to improve opioid crisis management through artificial intelligence.

Last year, researchers developed a predictive analytics model to forecast drug-related fatality rates for the next year by county. Using the model, research teams can assess drug markets, healthcare access, demographics, and the geographic spread of overdoses as predictors to generate risk scores.