• J Emerg Med · Oct 2023

    URINE TOXICOLOGY PROFILES OF EMERGENCY DEPARTMENT PATIENTS WITH UNTREATED OPIOID USE DISORDER: A MULTI-SITE VIEW.

    • Ethan Cowan, Jeanmarie Perrone, James Dziura, E Jennifer Edelman, Kathryn Hawk, Andrew Herring, Ryan McCormack, Alexandra Murphy, Manali Phadke, David A Fiellin, and Gail D'Onofrio.
    • Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: ethan.cowan@mountsinai.org.
    • J Emerg Med. 2023 Oct 1; 65 (4): e357e365e357-e365.

    BackgroundOpioid overdose deaths in 2021 were the highest ever, driven by fentanyl and polysubstance use.ObjectiveThe aim of the study was to characterize drug use, assessed by urine drug screens (UDSs), in patients with untreated opioid use disorder (OUD) presenting to 28 emergency departments (EDs) nationally and by region.MethodsWe analyzed UDSs from patients enrolled in the CTN-0099 ED-INNOVATION (Emergency Department-Initiated Buprenorphine Validation) trial between July 12, 2020 and March 9, 2022. Participants were adult ED patients with OUD not engaged in addiction treatment with a UDS positive for an opioid, but negative for methadone. Sites were divided into "East" and "West" regions.ResultsA UDS was available for all 925 enrolled participants, 543 from East and 382 from West. Fentanyl was in 702 specimens (76%) (n = 485 [89%] East vs. n = 217 [57%] West; p < 0.01) and was the only opioid in 269 (29%). After fentanyl, the most common opioids were morphine (presumably heroin; n = 411 [44%]; n = 192 [35%] East vs. n = 219 [57%] West; p < 0.01) and buprenorphine (n = 329 [36%]; n = 186 [35%] East vs. n = 143 [37%] West; p = 0.32). The most common drugs found with opioids were stimulants (n = 545 [59%]), tetrahydrocannabinol (n = 417 [45%]), and benzodiazepines (n = 151 [16%]). Amphetamine-type stimulants were more common in West (n = 209 [55%] vs. East (n = 125 [23%]). Cocaine was more common in East (n = 223 [41%]) vs. West (n = 82 [21%]). The presence of multiple drugs was common (n = 759 [82%]).ConclusionsMost participants had UDS specimens containing multiple substances; a high proportion had fentanyl, stimulants, and buprenorphine. Regional differences were noted. Given the increased risk of death with fentanyl and polysubstance use, ED providers should be providing risk reduction counseling, treatment, and referral.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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