Aldy Kim, Krotulski Alex, Brent Jeffrey, Campleman Sharan, Culbreth Rachel, Logan Barry, Wax Paul, Amaducci Alexandra, Judge Bryan, Levine Michael, Schwarz Evan, Calello Diane P, Meaden Christopher W, Shulman Joshua, Hughes Adrienne, Hendrickson Robert, Carpenter Joseph, Buchanan Jennie, Manini Alex F
American College of Medical Toxicology, Phoenix, Arizona; Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas.
Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation, Horsham, Pennsylvania.
J Emerg Med. 2025 May;72:56-69. doi: 10.1016/j.jemermed.2024.11.020. Epub 2024 Nov 20.
Fentanyl analogs, such as para-fluorofentanyl (PFF), are increasing in the illicit opioid supply.
This study characterizes demographics, clinical effects, and sex differences for naloxone administration in emergency department (ED) patients with confirmed PFF overdose compared with fentanyl.
This prospective observational cohort is from the ToxIC Fentalog Study between 2020 and 2023 at 10 participating U.S. hospitals. Adult patients with suspected opioid overdose presenting to EDs were screened and eligible if waste serum samples were available for comprehensive toxicological analysis. Fentanyl-positive patients were included in this analysis examining associations between PFF and naloxone administration, with stratified analyses for sex differences.
Of 4873 screened, 833 were included; 694 PFF negative (PFFN) and 139 PFF positive (PFFP). Mean age was 41 years, and men were predominant (PFFN 73.1% vs. PFFP 69.8%). More than half of PFFP patients presented at 2 of the 10 participating sites, New York (29.8%) and Pennsylvania (21.3%). The most common indication for naloxone was depressed level of consciousness (PFFN 82.1% vs. PFFP 79.8%). PFFP were less likely to receive naloxone doses > 2 mg compared with PFFN (48.2% vs. 60.8%, p = 0.002). After controlling for covariates, PFFP were less likely to receive out-of-hospital naloxone (adjusted odds ratio 0.87; 95% confidence interval 0.81-0.94). PFFP men were less likely to receive naloxone doses ≥ 2 mg (adjusted odds ratio 0.64; 95% confidence interval 0.42-0.97), but this association was not significant for women.
PFF was present in almost 20% of ED patients with confirmed fentanyl overdose. Although naloxone administration was lower for PFF compared with fentanyl, differences were more pronounced in men. Clinicians and public health officials should be aware of the evolving illicit opioid supply. Future study is warranted to explore the PFF dose response and mechanism behind these observed sex differences due to fentanyl analogs.
芬太尼类似物，如对氟芬太尼（PFF），在非法阿片类药物供应中日益增多。
本研究对确诊为PFF过量的急诊科（ED）患者与芬太尼过量患者使用纳洛酮的人口统计学特征、临床效果及性别差异进行了描述。
这项前瞻性观察性队列研究来自2020年至2023年在美国10家参与研究的医院进行的ToxIC Fentalog研究。到急诊科就诊的疑似阿片类药物过量的成年患者接受了筛查，若有废弃血清样本可用于全面毒理学分析则符合入选条件。芬太尼检测呈阳性的患者被纳入本分析，以研究PFF与纳洛酮使用之间的关联，并对性别差异进行分层分析。
在4873名接受筛查的患者中，833名被纳入研究；694名PFF阴性（PFFN）和139名PFF阳性（PFFP）。平均年龄为41岁，男性占主导（PFFN为73.1%，PFFP为69.8%）。超过一半的PFFP患者出现在10家参与研究的机构中的2家，纽约（29.8%）和宾夕法尼亚（21.3%）。纳洛酮使用的最常见指征是意识水平降低（PFFN为82.1%，PFFP为79.8%）。与PFFN相比，PFFP接受>2mg纳洛酮剂量的可能性较小（48.2%对60.8%，p = 0.002）。在控制协变量后，PFFP接受院外纳洛酮的可能性较小（调整后的优势比为0.87；95%置信区间为0.81 - 0.94）。PFFP男性接受≥2mg纳洛酮剂量的可能性较小（调整后的优势比为0.64；95%置信区间为0.42 - 0.97），但这种关联在女性中不显著。
在确诊为芬太尼过量的ED患者中，近20%检测出PFF。尽管与芬太尼相比，PFF患者使用纳洛酮的比例较低，但在男性中差异更为明显。临床医生和公共卫生官员应意识到非法阿片类药物供应的不断变化。有必要进行进一步研究，以探索PFF的剂量反应以及这些观察到的因芬太尼类似物导致的性别差异背后的机制。
