Abstract
Background
Illicitly manufactured fentanyl and fentanyl analogues (IMFs) are being increasingly
suspected in overdose deaths. However, few prior outbreaks have been reported thus
far of patients with laboratory-confirmed IMF toxicity after reporting intent to use
only nonopioid substances. Herein we report a case series of nine patients without
opioid use disorder who presented to two urban emergency departments (EDs) with opioid
toxicity after insufflating a substance they believed to be cocaine.
Case reports
Over a period of under three hours, nine patients from five discrete locations were
brought to two affiliated urban academic EDs. All patients denied prior illicit opioid
use. All patients endorsed insufflating cocaine shortly prior to ED presentation.
Soon after exposure, all developed lightheadedness and/or respiratory depression.
Seven patients received naloxone en route to the hospital; all had improvement in
respiratory function by arrival to the ED. None of the patients required any additional
naloxone administration in the ED. All nine patients were discharged home after observation.
Blood +/− urine samples were obtained from eight patients. All patients who provided
specimens tested positive for cocaine metabolites and had quantifiable IMF concentrations,
as well as several detectable fentanyl derivatives, analogues, and synthetic opioid
manufacturing intermediates.
Discussion
IMF-contamination of illicit drugs remains a public health concern that does not appear
to be restricted to heroin. This confirmed outbreak demonstrates that providers should
elevate their level of suspicion for concomitant unintentional IMF exposure even in
cases of non-opioid drug intoxication. Responsive public health apparatuses must prepare
for future IMF-contamination outbreaks.
Keywords
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Article Info
Publication History
Published online: December 07, 2020
Accepted:
December 1,
2020
Received:
November 16,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
