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Related Experiment Videos

Emergency Department Patients with Para-Fluorofentanyl Overdose.

Kim Aldy1, Alex Krotulski2, Jeffrey Brent3

  • 1American College of Medical Toxicology, Phoenix, Arizona; Department of Emergency Medicine, Baylor University Medical Center, Dallas, Texas.

The Journal of Emergency Medicine
|April 27, 2025
PubMed

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Naloxone Administration in Relation to Fentanyl, Xylazine, CNS Depressants, and Stimulants Exposure After Suspected Opioid Overdose: A Pilot Study.

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine·2026
Summary

Para-fluorofentanyl (PFF) overdose patients received less naloxone than fentanyl overdose patients, especially men. This highlights evolving illicit opioid trends and potential sex-based differences in emergency care.

Area of Science:

  • Emergency Medicine
  • Toxicology
  • Pharmacology

Background:

  • Illicit opioid supply increasingly includes fentanyl analogs like para-fluorofentanyl (PFF).
  • Understanding the clinical impact of PFF is crucial for public health and emergency response.

Purpose of the Study:

  • To compare demographics, clinical effects, and naloxone administration in emergency department (ED) patients with confirmed PFF overdose versus fentanyl overdose.
  • To investigate sex-based differences in naloxone administration for PFF overdose.

Main Methods:

  • Prospective observational cohort study (ToxIC Fentalog Study, 2020-2023) at 10 U.S. hospitals.
  • Included adult patients with confirmed fentanyl or PFF overdose based on comprehensive toxicological analysis of serum samples.
  • Analyzed associations between PFF and naloxone administration, with stratified analyses for sex differences.
Keywords:
fentalogsfentanyl analogsopioidsoverdosepara-fluorofentanyltoxico-surveillance

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Main Results:

  • Of 833 patients included, 139 had PFF overdose (PFFP).
  • PFFP patients were less likely to receive >2 mg naloxone (48.2% vs. 60.8%) and out-of-hospital naloxone.
  • PFFP men were less likely to receive ≥2 mg naloxone compared to PFF-negative men, but this was not observed in women.

Conclusions:

  • Para-fluorofentanyl (PFF) is present in nearly 20% of confirmed fentanyl overdose ED cases.
  • Naloxone administration was lower for PFF compared to fentanyl overdose, with more pronounced differences in men.
  • Further research is needed on PFF dose-response and the mechanisms behind observed sex differences in fentanyl analog overdose management.