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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
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.
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.
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