Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU Grossman School of Medicine, 455 1(st) Ave, Rm 124, New York, NY 10016, USA; Department of Health and Mental Hygiene, New York City Poison Control Center, 455 1(st) Ave, Rm 124, New York, NY, 10016, USA.
Department of Forensic Toxicology, Office of Chief Medical Examiner, 520 First Avenue, New York 10016, USA.
Am J Emerg Med. 2021 Feb;40:103-105. doi: 10.1016/j.ajem.2020.12.002. Epub 2020 Dec 7.
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.
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.
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.
越来越多的过量死亡事件被怀疑与非法制造的芬太尼和芬太尼类似物（IMFs）有关。然而，迄今为止，报告仅使用非阿片类物质的意图后，实验室确认 IMF 毒性的患者的先前爆发很少。在此，我们报告了九名没有阿片类药物使用障碍的患者的病例系列，他们在吸入一种他们认为是可卡因的物质后，出现阿片类药物中毒症状，并前往两家城市急诊部就诊。
在不到三个小时的时间内，来自五个不同地点的九名患者被送往两家附属的城市学术急诊部。所有患者均否认有先前的非法阿片类药物使用史。所有患者均表示在急诊就诊前不久曾吸食可卡因。接触后不久，所有患者均出现头晕和/或呼吸抑制。七名患者在送往医院的途中接受了纳洛酮；所有患者到达急诊部时呼吸功能均有所改善。在急诊部，没有患者需要额外的纳洛酮治疗。所有九名患者在观察后均出院回家。从八名患者中获得了血液/尿液样本。所有提供标本的患者均检测出可卡因代谢物阳性，并且有可量化的 IMF 浓度，以及几种可检测到的芬太尼衍生物、类似物和合成阿片类药物制造中间体。
非法药物中的 IMF 污染仍然是一个公共卫生问题，似乎不仅限于海洛因。这次确诊的爆发表明，即使在非阿片类药物中毒的情况下，提供者也应提高对同时发生的非故意 IMF 暴露的怀疑程度。响应性的公共卫生机构必须为未来的 IMF 污染爆发做好准备。
