Frequency of Fentanyl Exposure in Emergency Department Patients With Illicit Drug Use

Addition of illicitly manufactured fentanyl to the opioid and nonopioid illicit drug supply has exacerbated the drug overdose crisis in the United States. People who use drugs are often unaware that their drugs contain fentanyl. Awareness about fentanyl adulteration may be protective against fatal overdose.

We performed a cross-sectional study of a convenience sample of emergency department (ED) patients who presented with illicit drug-related complaints from April 2022 to January 2024 in New York City, NY. Patients were surveyed about their drug use and provided urine samples for fentanyl testing. Results were analyzed according to the patient's intention of using opioids versus only nonopioid substances.

Of 338 eligible patients, we enrolled 229 (68% acceptance, men: 78%, mean age: 43 years [SD=12.2], Hispanic/Latino: 57%), with 53% (121/229) and 47% (108/229) intending to use opioids and only nonopioid substances, respectively. Among patients who used opioids and provided urine, 89% (86/97) samples were positive for fentanyl, including 90% (27/30) fentanyl positivity among those who did not believe that they were using fentanyl. Among those intending to use only nonopioids, 24% (23/94) urine samples were positive for fentanyl.

Many drug-related ED visits involved fentanyl exposure, even when individuals did not believe they were using fentanyl. Knowledge of fentanyl adulteration can inform people who intend to use opioid and/or nonopioid drugs about harm reduction approaches, such as distribution of fentanyl test strips and educational interventions.