A cross-sectional analysis of fentanyl analog exposures among living patients

Abstract

Background: Synthetic opioids, including fentanyl analogs, contribute to an increasing proportion of opioid-related deaths. Highly potent analogs pose an increased risk for fatal overdose. The prevalence of fentanyl analog exposures in patients with known opioid exposure is unknown. Objective: The purpose of this study was to determine the exposure prevalence for fentanyl analogs in living patients with positive urine screens for opiates or fentanyl. Methods: This was a cross-sectional analysis of urine high performance liquid chromatography/ tandem mass spectroscopy (HPLC-MS/MS) results from patients with a positive urine screen for opiates or fentanyl at a large public healthcare system in Chicago, Illinois. Samples with positive screens were non-continuously tested by HPLC-MS/MS for 5 selected months in 2018 and 2019. Results: A total of 219 urine samples which screened positive for fentanyl or opiates underwent HPLC-MS/MS testing. At least one fentanyl analog was detected in 65.3% (n = 143) of samples with 26.0% (n = 57) testing positive for multiple analogs. The most common analogs, intermediates, or metabolites were: 4-ANPP (n = 131); 2-furanylfentanyl (n = 22); acryl fentanyl (n = 21); butyrylfentanyl (n = 15); cyclopropylfentanyl (n = 15); and carfentanil (n = 13). Of samples which screened positive for fentanyl (n = 188), 70.2% (132) tested positive for at least one fentanyl analog. Of samples which screened negative for fentanyl but positive for opiates (n = 31), 35.5% (n = 11) tested positive for fentanyl analogs Conclusion: Fentanyl analog exposure is common in patients with positive urine screens for fentanyl or opiates. Screening living patient samples for synthetic opioids has future toxicosurveillance implications and these data underscore the increased risks from illicit opioid use.

Characterization of the Discriminative Stimulus Effects of Binary Mixtures of Mu Opioid Receptor Agonists in Rats Discriminating Fentanyl

“…Data on the involvement of fentanyl analogs in overdose deaths are difficult to obtain because they are not detected in standard drug screens (Solbeck et al, 2021). However, one study evaluating urine samples in Chicago from a 5-month period spanning 2018-2019 discovered at least one fentanyl analog in 65.3% of opioid positive urine samples, highlighting the prevalence of exposure to these drugs (Chhabra et al, 2021). A three-year study in New York City discovered that from 2016-2019 fentanyl-positive urine screens more than tripled from $15% to over 50%.…”

Toxicosurveillance of novel opioids: just screening tests may not be enough

“…In the article from Chhabra et al [12] published in this issue of the The American Journal of Drug and Alcohol Abuse, the authors aimed to describe the prevalence of specific fentanyl analogues and other synthetic opioids via urine specimen testing from living patients presenting to a large healthcare system. Following a preliminary screening test for fentanyl and opiates, a confirmatory analysis for the identification of fentanyl analogues, fentanyl metabolites, and other synthetic opioids, was performed by means of HPLC-MS/MS.…”