Call for Expanded Fentanyl Testing by Hospitals After Drug Tops Fatal Overdose List

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University of Maryland scientists release the Maryland Emergency Department Drug Surveillance (EDDS) System — require broadened fentanyl screening by health centers.

A brand-new University of Maryland research study discovered fentanyl tops the list of drugs discovered in overdose clients at 2 Baltimore healthcare facility emergency situation departments. The finding recommends that health centers and medical systems throughout the United States think about including fentanyl, a powerful artificial opioid connected to the majority of deadly overdoses in Maryland, to their regular drug screening panels. That is the conclusion of scientists at the University of Maryland School of Medicine (UMSOM) and the Center for Substance Abuse Research (CESAR) at the University of Maryland, College Park. Currently, fentanyl is not regularly consisted of in these panels across the country. The research study is based upon de-identified urinalysis outcomes and other information gathered through the brand-new Maryland Emergency Department Drug Surveillance (EDDS) system, released to support enhanced client results.

Zachary D.W. Dezman

Zachary D.W. Dezman, MD, emergency situation doctor at the University of Maryland Medical Center Midtown Campus and lead author of a research study that discovered fentanyl, connected to the majority of deadly overdoses in Maryland, was the most widespread drug discovered in overdose clients at 2 Baltimore health centers. Credit: University of Maryland Medicine

UMSOM scientists teamed up with detectives at CESAR to examine drugs recognized in urine samples taken at both University of Maryland Medical Center (UMMC) Midtown and Downtown schools from January 2016 through December 2019. Fentanyl screening was integrated for all clients going through urine screens as a regular test at these health centers in January 2019.

“The overdose cases we see in our emergency departments stem from a wide variety of substances that may not be known and present increasingly complex treatment challenges,” stated the research study’s lead author Zachary D.W. Dezman, MD, Assistant Professor of Emergency Medicine, UMSOM. “In the case of fentanyl, without knowing its true role in these overdoses, public health officials and policymakers will find it difficult to implement the correct measures to improve patient care and help prevent substance abuse.”

Fentanyl was the most widespread drug recognized in the research study. It was discovered in 73 to 87 percent of specimens that were evaluated for the compound in each of the 4 calendar quarters in 2019 when fentanyl screening was very first carried out. Sixty-one percent of the fentanyl favorable specimens included other drugs in addition to fentanyl, while 13 percent included fentanyl just. The scientists kept in mind that these outcomes specify to these 2 Baltimore health centers which the rate of fentanyl positives might differ in other health centers and states.

Results from the research study appear in the present concern of the Morbidity and Mortality Weekly Report (MMWR), from the Centers for Disease Control and Prevention. The scientists relied on fentanyl screening after previous EDDS observations at 4 Baltimore health centers revealed that even in the middle of the opioid epidemic, less clients were evaluating favorable for opiates. The opiate screen mainly finds morphine and codeine (most often showing the existence of heroin) however does not identify fentanyl.

“The EDDS system represents an important partnership between University of Maryland researchers and hospitals,” stated Eric D. Wish, PhD, Director of CESAR and Director of the Maryland EDDS. “It can enable faster, more accurate identification of changing trends in substance use and, ultimately, aims to improve patient care.”

Nationwide, healthcare facility lab screening is regular for a variety of compounds consisting of opiates, drug, and methadone, however not fentanyl, according to Dr. Dezman. “Fentanyl was rarely a cause of overdoses, so routine fentanyl testing was not typically performed. However, through our regular fentanyl testing and EDDS collaboration, we have addressed a gap in our patient care, allowing us to better inform our patients of the risks associated with continued use, assist with buprenorphine induction in the emergency department, and help us connect patients to substance use treatment programs,” he stated.

Dr. Dezman, together with CESAR, had actually formerly carried out a little pilot research study at UMMC Midtown Campus to check for fentanyl in a subset of 76 drug overdose specimens. The findings recommended that the opiate screen was, in reality, missing out on a lot of the clients who had actually evaluated favorable for fentanyl. As an outcome, Dr. Dezman motivated both UMMC Downtown and UMMC Midtown health centers to start regular fentanyl screening for all ED clients who go through urine screening, consisting of psychiatric examinations, emergency situation petitions, and labor and shipment clients. The MMWR short article provides the very first findings for fentanyl from the EDDS system for the 4 quarters of 2019.

“This study finding makes an important case for including fentanyl in routine drug overdose testing,” stated UMSOM Dean E. Albert Reece, MD, PhD, MBA, University Executive Vice President for Medical Affairs and the John Z. and Akiko K. Bowers Distinguished Professor. “It highlights the important role and function of the newly created Maryland EDDS system, which helps to better guide patient treatment and more effective overdose prevention programs.”

Reference: “Notes from the Field: High Prevalence of Fentanyl Detected by the Maryland Emergency Department Drug Surveillance System — Baltimore, Maryland, 2019” by Zachary Dezman, MD; Bradford Schwartz, MD; Amy Billing, MSSA; Ebonie Massey, MA; E. Erin Artigiani, MA; Julie Factor and Eric D. Wish, PhD, 12 June 2020, Morbidity and Mortality Weekly Report (MMWR).
DOI: 10.15585/mmwr.mm6923a3

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