• Patrick Y Joynt and George Sam Wang.
• Section of Emergency Medicine and Medical Toxicology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: patrick.joynt@childrenscolorado.org.
• Am J Emerg Med. 2021 Dec 1; 50: 811.e3-811.e4.

BackgroundFentanyl is a high potency opioid that has become an increasingly large proportion of the illicit drug supply. Fentanyl overdoses and deaths, including in pediatric patients, has concomitantly increased.PurposeTo describe two cases of pediatric fentanyl overdoses via "M30" pills illicitly sold as oxycodone.Basic ProceduresTwo cases of pediatric opioid toxicity reportedly from oxycodone are presented in which mass spectrometry was used to confirm fentanyl and not oxycodone exposure.Main FindingsBoth pediatric patients required naloxone and admission to the intensive care unit following exposure. Both had urine drug screens that did not show the presence of opioids but mass spectrometry testing confirmed fentanyl exposure.ConclusionsProviders should be aware of these illicit tablets, know not to assume they are pharmaceutical, and consider the risk they pose to pediatric patients through exploratory ingestion or misuse. Further inquiry, including social investigation, should be considered for pediatric patients presenting with reported oxycodone ingestion, especially blue "M30" pills.Copyright © 2021 Elsevier Inc. All rights reserved.

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