• Dana L Sacco, Marc A Probst, Zachary L Mannes, Sandra D Comer, Silvia S Martins, and Bernard P Chang.
• Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY. Electronic address: dls2160@cumc.columbia.edu.
• Ann Emerg Med. 2024 Nov 26.

Study ObjectiveAddition of illicitly manufactured fentanyl to the opioid and nonopioid illicit drug supply has exacerbated the drug overdose crisis in the United States. People who use drugs are often unaware that their drugs contain fentanyl. Awareness about fentanyl adulteration may be protective against fatal overdose.MethodsWe performed a cross-sectional study of a convenience sample of emergency department (ED) patients who presented with illicit drug-related complaints from April 2022 to January 2024 in New York City, NY. Patients were surveyed about their drug use and provided urine samples for fentanyl testing. Results were analyzed according to the patient's intention of using opioids versus only nonopioid substances.ResultsOf 338 eligible patients, we enrolled 229 (68% acceptance, men: 78%, mean age: 43 years [SD=12.2], Hispanic/Latino: 57%), with 53% (121/229) and 47% (108/229) intending to use opioids and only nonopioid substances, respectively. Among patients who used opioids and provided urine, 89% (86/97) samples were positive for fentanyl, including 90% (27/30) fentanyl positivity among those who did not believe that they were using fentanyl. Among those intending to use only nonopioids, 24% (23/94) urine samples were positive for fentanyl.ConclusionsMany drug-related ED visits involved fentanyl exposure, even when individuals did not believe they were using fentanyl. Knowledge of fentanyl adulteration can inform people who intend to use opioid and/or nonopioid drugs about harm reduction approaches, such as distribution of fentanyl test strips and educational interventions.Copyright © 2024 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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