Epic Research: Only 5% of Overdose Patients Tested for Fentanyl, #1 Killer of Americans 18-45

Fentanyl continues to be the primary contributor to opioid overdose deaths, yet only 5% of overdose-related emergency visits have fentanyl toxicology screening done limiting data to inform public health prevention and treatment interventions that can save lives

VERONA, Wis., Aug. 23, 2022 /PRNewswire/ -- Overdoses—often from substances laced with fentanyl— and other unintentional injuries are now the top cause of death for Americans aged 1 to 44, and fentanyl overdoses are the top cause of death in those 18 to 45. In 2020, there were more than 56,000 overdose deaths from fentanyl and fentanyl analogs, which accounted for over 82% of opioid-involved deaths that year. Unfortunately, patients experiencing an overdose are rarely screened for fentanyl or other synthetic opioids when they visit emergency departments (ED). Providers are focused on treating the patient's symptoms and often administer naloxone as a prophylactic in any suspected overdose to give the patient the best chance of survival rather than waiting for toxicology results. Most EDs complete limited toxicology testing on patients that present for an overdose, but those toxicology panels often don't include synthetic opioids, like fentanyl.

Researchers from Epic and the University of Maryland's Center for Substance Abuse Research (CESAR) used deidentified Cosmos data to study patterns in toxicology screenings from more than 315,000 emergency department (ED) overdose visits across the U.S. that occurred between 2017 and August 2022. Their findings, which Epic Research published this morning, include the following:

• Patients are tested for fentanyl during just 5% of overdose-related ED visits. The opiate testing rate is nearly 50% (data not shown).
• When patients are tested for fentanyl, the positivity rate exceeds 40%—more than three times that of opiates like morphine, heroin, and codeine.

In contrast, the positivity rate for opiates has decreased since 2017 to below 14%. This suggests that heroin users may now instead be exposed to fentanyl.

"Comprehensive toxicology screenings are critical to both lifesaving treatments in the ED and effective public health efforts in the community," said Dave Little, MD, director of clinical informatics at Epic and co-author of the study. "We need to know precisely how people are struggling so that we can help them before their lives are on the line."

Before this nationwide collaboration, CESAR and collaborating ED physicians published multiple studies on fentanyl toxicology in the greater Baltimore area, the latest of which was featured as a CDC Morbidity and Mortality Weekly Report, and received funding to expand their work with the Emergency Department Drug Surveillance (EDDS) system to 20 additional hospitals. EDDS currently includes 39 hospitals across the U.S.

"Our earlier, limited, region-specific research on this topic suggested a lack of fentanyl screening across the country," said Eric Wish, PhD, director at CESAR and co-author on the study. "In this study, we had the unique opportunity to confirm this finding in many more hospitals. Because Cosmos data is both vast and representative of the U.S. population, it makes it possible to quickly observe this kind of nationwide challenge and inspire data-driven interventions."

"Our findings highlight the need for a centralized overdose surveillance system and a nationwide standard for toxicology screenings in overdose treatment in order to track drug epidemics. This will give medical personnel the information they need to accurately diagnose and treat overdoses and other related problems and improve patient outcomes," Wish commented.

SOURCE Epic Research