A miracle happened recently! A local Cleveland area hospital laboratory added fentanyl screening to their Urine Drug Screen panel! Good news for patient care in light of the following case scenario involving a death at another local hospital:
A 25-year-old man with a history of opiate (heroin) substance use disorder is found by a relative unresponsive and not breathing at home surrounded by drug paraphernalia. The relative reported that he had “snorted something” earlier. The man was found in cardiorespiratory arrest by paramedics and resuscitative efforts were begun and continued en route to the hospital. Intravenous fluids and doses of Narcan were given. A urine drug screen was negative. The man expired despite nearly 2 hours of resuscitative efforts. While a drug overdose was suspected, the exact cause of his death was unknown. The death was reported and accepted by the local Medical Examiner. An autopsy was performed. Hospital admissions samples were obtained for postmortem forensic toxicological testing which later revealed the presence of fentanyl.
Standard urine drug screens used by many hospitals do not include screening for fentanyl. It appears that this is finally slowly changing in response to the alarming death trends broadcasted in statistical reports generated by the Centers for Disease Control and Prevention and more locally by Medical Examiners’ and Coroners’ offices (1, 2,3, 4). Clinicians need to be cognizant of the scope and limitations of urine and blood drug screening tests used their hospital laboratories ( 5).
The opioid crisis is still raging shattering families and exacting a serious toll on medical first responders, police, social services, clinical practitioners, the non-medical workforce, and Medical Examiner’s and Coroner’s Offices. Novel, clandestinely manufactured, potent, and deadly fentanyl analogues continue to be discovered by forensic toxicology laboratories (6).
Next on Doc4N6’s Wish-List: the hospital Blood and Urine Fentalogue Screening Panel.
- Arditi L. As overdoses surge, many R.I. hospitals start testing for fentanyl in ERs. April 4, 2017. Providence Journal. Available at: http://www.providencejournal.com/news/20170404/as-overdoses-surge-many-ri-hospitals-start-testing-for-fentanyl-in-ers .
- Hedegaard H, Warner M, Minino A. Drug Overdose Deaths in the United States 199-2016. December 2017. NCHS Data Brief. No. 294. Available at: https://www.cdc.gov/nchs/data/databriefs/db294.pdf .
- Heroin/Fentanyl/Cocaine-Related Deaths in Cuyahoga County 2017. Available at: http://medicalexaminer.cuyahogacounty.us/pdf_medicalexaminer/en-US/HeroinFentanylReports/100517-HeroinFentanylCocaine-Sept2017.pdf.
- Waite K, Deeken A, Perch S, Kohler L. Carfentanil and current opioid trends in Summit County, Ohio. December 2017. Acad. Forensic Pathology. Available at: http://journals.sagepub.com/doi/pdf/10.23907/2017.053 .
- Hill J. The urine drug screen. Know thy limitations. February 2016. Available at: http://www.tamingthesru.com/blog/intern-diagnostics/uds-know-thy-limitations .
- National Drug Early Warning System (NDEWS) Special Report. Fentanyl and Fentanyl Analogues. December 2015. Available at: http://pub.lucidpress.com/NDEWSFentanyl/ .