Emergency Medical Minute1 Maalis 2022

Podcast 760: Why Fentanyl is the Worst

Contributor: Don Stader, MD

Educational Pearls:

Fentanyl's common administration route through pills has lowered the psychological barrier of using opioid compared to injecting and smoking heroin
Fentanyl is showing up in all illicit drugs with documented cases even in marijuana
Testing for fentanyl is difficult and requires a send out test because UA does not show up not common in ED but can better inform our care
Fentanyl doesn't show up on UA drug screen and requires a send out test, thus we should ask patients if they're using fentanyl specifically
Send any patient using an illicit drug home with Narcan to protect them from potential opioid overdoses
Start patients on buprenorphine for opioid withdrawal in the ED
Fentanyl is very lipophilic, thus patients require longer washout times (sometimes over 24 hours) before buprenorphine induction to avoid precipitated withdrawal

References:

Adams, K.K., Machnicz, M. & Sobieraj, D.M. Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review. Addict Sci Clin Pract 16, 36 (2021). https://doi.org/10.1186/s13722-021-00244-8

Moustaqim-Barrette, A., Dhillon, D., Ng, J. et al. Take-home naloxone programs for suspected opioid overdose in community settings: a scoping umbrella review. BMC Public Health 21, 597 (2021). https://doi.org/10.1186/s12889-021-10497-2

*Image from NIDA

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