Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MD, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
Clin Toxicol (Phila). 2020 Jun;58(6):460-465. doi: 10.1080/15563650.2019.1657583. Epub 2019 Sep 1.
Overdose deaths from fentanyl and its analogs have increased significantly since 2013. There are limited data regarding the prevalence of fentanyl exposure among emergency department (ED) patients with active opioid use. We conducted a cross-sectional study at an urban hospital from May 20 to July 30, 2018. A convenience sample of adult ED patients with active opioid use, defined as opioid use within seven days prior to ED visit, were enrolled. Rapid Response Single Drug Test Strip (BTNX Inc., Markham, Canada) was used to detect fentanyl in urine samples. Information on demographic, substance use history, and knowledge of fentanyl was obtained using a brief survey tool. Our primary outcome was the prevalence of fentanyl exposure; secondary outcomes included patients' knowledge regarding potency, risk of overdose death from fentanyl and intentional purchase of fentanyl. During our study period, 451 patients reported active substance use. Of these, 208 reported active opioid use and 165 consented for the study. The median age was 49 years [interquartile range: 38, 57] and 77.0% ( = 127) were male; 42 participants (25.5%) presented to ED after an acute overdose event. Heroin was the preferred opioid of use in 90.8% of the participants, primarily via intranasal route (64.6%). Polysubstance use was reported in 98.8%, most commonly with cocaine (57.6%; = 95). Fentanyl was detected in 104 out of 129 urine samples tested (80.6%). 84.2% ( = 139) identified fentanyl as highly potent and 85.5% ( = 141) recognized highest risk of death in fentanyl overdose. A larger proportion of non-overdose participants intentionally purchased fentanyl (34.1%; = 42) compared to the overdose group (16.7%, = 7; = .04). The majority of ED patient with active opiate use were exposed to fentanyl while one in three participants intentionally purchased fentanyl despite their awareness of its potency and the high-risk of death from overdose.
自 2013 年以来，芬太尼及其类似物的过量死亡人数显著增加。关于在有阿片类药物使用的急诊（ED）患者中芬太尼暴露的流行情况，数据有限。我们在 2018 年 5 月 20 日至 7 月 30 日在一家城市医院进行了一项横断面研究。我们招募了在 ED 就诊前七天内有阿片类药物使用的成年 ED 患者的便利样本。使用快速反应单药物检测条（BTNX Inc.，加拿大万锦市）检测尿液样本中的芬太尼。使用简短的调查工具获取有关人口统计学、物质使用史和芬太尼知识的信息。我们的主要结局是芬太尼暴露的流行率；次要结局包括患者对芬太尼的效力、过量死亡风险和故意购买芬太尼的认识。在我们的研究期间，451 名患者报告了阿片类物质的使用。其中，208 名报告了阿片类药物的使用，165 名同意参加研究。中位年龄为 49 岁[四分位数范围：38，57]，77.0%（ = 127）为男性；42 名参与者（25.5%）因急性过量事件就诊 ED。在参与者中，90.8%（ = 90）首选海洛因作为阿片类药物，主要通过鼻内途径（64.6%）使用。98.8%（ = 165）报告了多物质使用，最常见的是可卡因（57.6%； = 95）。在 129 个测试的尿液样本中，有 104 个（80.6%）检测到芬太尼。84.2%（ = 139）认为芬太尼具有高度效力，85.5%（ = 141）认为芬太尼过量致死风险最高。与过量组（16.7%， = 7； = .04）相比，非过量组的参与者中更有更大比例（34.1%， = 42）故意购买芬太尼。大多数有阿片类药物使用的 ED 患者接触过芬太尼，尽管他们意识到芬太尼的效力及其过量致死的高风险，但仍有三分之一的参与者故意购买芬太尼。
