UMD Researchers Find Overdose Patients Rarely Tested for Fentanyl

With Epic Research, the Center for Substance Abuse Research’s latest study finds only 5% of overdose-related emergency visits have fentanyl toxicology screening done

Overdoses, often from substances laced with fentanyl, and other unintentional injuries are now the top cause of death for Americans ages 1 to 44. Yet—finds a new report by the University of Maryland’s Center for Substance Abuse Research (CESAR) and Epic Research—most Emergency Departments (ED) are completing limited toxicology testing on patients that present for an overdose, and often aren’t screening for synthetic opioids like fentanyl.

This nationwide collaboration builds on CESAR’s earlier work with ED physicians on multiple studies of fentanyl toxicology in the greater Baltimore area, the latest of which was featured as a CDC Morbidity and Mortality Weekly Report. It was conducted as part of CESAR’s Emergency Department Drug Surveillance (EDDS) system, which recently received additional funding from Maryland’s Opioid Operational Command Center (OOCC) to expand their work with 39 hospitals nationwide to include 20 Maryland hospitals in the nation’s first statewide EDDS system.

“Our earlier, limited, region-specific research on this topic suggested a lack of fentanyl screening across the country,” said Eric Wish, Ph.D., director at CESAR and co-author on the study. “In this study, we had the unique opportunity to confirm this finding in many more hospitals.

Using Epic’s deidentified Cosmos data to study patterns in toxicology screenings from more than 315,000 emergency department (ED) overdose visits across the U.S. that occurred between 2017 and August 2022, CESAR and Epic researchers found that compared to the 50% of overdose-related emergency visits that are screened for opiates, such as morphine (an indicator of heroin use), just 5% of visits are screened for fentanyl, a synthetic opioid.

Taken with the fact that there were more than 56,000 overdose deaths from fentanyl and fentanyl analogs in 2020—accounting for over 82% of opioid-involved deaths that year—the researchers find this concerning.

“Comprehensive toxicology screenings are critical to both lifesaving treatments in the ED and effective public health efforts in the community,” said Dave Little, MD, director of clinical informatics at Epic and co-author of the study. “We need to know precisely how people are struggling so that we can help them before their lives are on the line.”

In looking at the toxicology results of the patients who were tested for fentanyl, the researchers found that the positivity rate exceeded 40%—more than three times that of opiates like morphine, heroin, and codeine. For perspective, the positivity rate for opiates has decreased since 2017 to below 14%, suggesting that heroin users may now instead be exposed to fentanyl.

“Our joint findings highlight the need for a centralized overdose surveillance system and a nationwide standard for toxicology screenings in overdose treatment in order to track drug epidemics,” added Wish. “This will give medical personnel the information they need to accurately diagnose and treat overdoses and other related problems and improve patient outcomes.”

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Published on Fri, Aug 26, 2022 - 10:07AM