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Fentanyl-contaminated cocaine outbreak with laboratory confirmation in New York City in 2019

  • Philip DiSalvo
    Correspondence
    Corresponding author at: 455 1st Ave., Rm 123, New York 10016, USA.
    Affiliations
    Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 455 1st Ave, Rm 124, New York, NY 10016, USA

    Department of Health and Mental Hygiene, New York City Poison Control Center, 455 1st Ave, Rm 124, New York, NY, 10016, USA
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  • Gail Cooper
    Affiliations
    Department of Forensic Toxicology, Office of Chief Medical Examiner, 520 First Avenue, New York 10016, USA
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  • Jessica Tsao
    Affiliations
    Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 455 1st Ave, Rm 124, New York, NY 10016, USA
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  • Michelle Romeo
    Affiliations
    Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 455 1st Ave, Rm 124, New York, NY 10016, USA
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  • Larissa K. Laskowski
    Affiliations
    Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 455 1st Ave, Rm 124, New York, NY 10016, USA
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  • Gregg Chesney
    Affiliations
    Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 455 1st Ave, Rm 124, New York, NY 10016, USA
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  • Mark K. Su
    Affiliations
    Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 455 1st Ave, Rm 124, New York, NY 10016, USA

    Department of Health and Mental Hygiene, New York City Poison Control Center, 455 1st Ave, Rm 124, New York, NY, 10016, USA
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Published:December 07, 2020DOI:https://doi.org/10.1016/j.ajem.2020.12.002

      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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