This is a news article about fentanyl overdoses. In the event of an actual overdose, stop reading, call 911, and seek immediate medical assistance.
Part II of a 4-part series.
Fentanyl Toxicology Screen
When a patient arrives at a hospital emergency room where drug use are a factor in the treatment of the patient a doctor may order a toxicology screen, an Immunoassay biochemical test that will test for amphetamines, cocaine, THC, opiates, and PCP and may include tests for heroin, hydrocodone, hydromorphone, oxycodone, barbiturates, benzodiazepines, and MDMA.
If a hospital emergency room is presented with a patient who is thought to have overdosed on fentanyl-laced marijuana and was treated with Narcan (naloxone) before coming to the hospital, a Mass Spectrometry test would likely be ordered, at a cost of $800 to $1200, to confirm fentanyl in the urine. The urine specimen would typically be sent out to a lab where getting results could typically take 1 – 4 days, although that could be expedited, depending on the location of the lab (onsite or at a remote location) and the condition of the patient, and take less than an hour.
How to Test for Fentanyl
There are several methods for testing for the presence of fentanyl:
Urine drug test: This is a common method for detecting fentanyl. It involves collecting a urine sample from the individual and analyzing it for the presence of fentanyl.
Blood test: A blood test can also be used to detect fentanyl in the body. It is usually more accurate than a urine test and can detect lower levels of the drug.
Saliva test: A saliva test is a non-invasive method to detect the presence of fentanyl. It is considered to be less accurate than urine and blood test.
Hair test: It is less common, but it can detect the presence of fentanyl for a longer period of time. It is considered to be the most accurate test for fentanyl.
Field test: There are some field tests that can detect the presence of fentanyl. These tests are similar to a pregnancy test and can give a quick result, but they are not always accurate and should be confirmed by a lab test.
These methods are only used to detect the presence of fentanyl and not the quantity of the drug present. Such tests are carried out in a laboratory, with results interpreted by a trained professional.
NRFD/Empress Incident Response to a 2017 Opioids Overdose in New Rochelle
On January 9, 2017, at 3 Pinebrook Road near Fifth Avenue, across from WVOX radio, three young men overdosed on opioids. We were on scene that night as paramedics moved the victims on gurneys to ambulances. One victim was already deceased and placed in an ambulance.
Another victim was non-responsive, not moving, not breathing on their own. He was intubated by way of what an NRFD officer on scene said was for them a new piece of ventilation equipment, a Chest Compression System.
A third victim was alert but confused as to what happened. He asked about his friends. Told one was dead, he began wailing and sobbing.
The Lucas CPR equipment — the Chest Compression System — used by Empress Ambulance that night — works to automate CPR. The equipment was on loan from the Larchmont Volunteer Ambulance Corps. The life-saving device is used on sudden cardiac arrest patients to avoid neurological damage by keeping a steady supply of blood flowing to the heart and brain.
How a Human Body Reacts to Fentanyl
Fentanyl — unlike say morphine or hydromorphone (dilaudid) — is lipophilic, which means it dissolves very easily in fatty tissue. It is why transdermal ingestion of fentanyl is such an issue — simply touching a few milligrams of fentanyl powder can be fatal because it can enter the bloodstream by even incidental contact with the skin — or the eyes, or breathing in fentanyl powder. It is why hazmat teams respond to locations where the presence of fentanyl is found or suspected.
A plume of fentanyl vapor can get into the body via the lungs and directly to the brain across exposed neural tissue in the form of the eyes.
The brain is made of fatty tissue (neurons are surrounded by myelin which is made of fat), the eyes are neural tissue.
However it enters a human body, a sudden dose of fentanyl can cause acute chest wall tightness; a patient suddenly cannot breathe and requires immediate intubation.
In a surgical setting where a patient is already on a ventilator breathing anesthesia vapor, naloxone is not necessary to reverse the fentanyl; it has nothing to do with mu/opioid receptor in the brain and the reaction resolves quickly.
In a “street” setting, a sudden dose of fentanyl can cause a person to stop breathing. The reaction does not resolve quickly, and the person will become non-responsive. The person may suffer brain damage due to a lack of oxygen to the brain or death. This is why it is important to revive the person with Narcan (naloxone) quickly and seek immediate medical attention.
Symptoms of a Fentanyl Overdose
An opioid overdose, including fentanyl, presents with obtundation, collapse, slow and ineffective respiration. A patient who has overdosed on fentanyl will be impacted immediately and quickly incapacitated or non-responsive.
Symptoms of a fentanyl overdose can include:
- Slow or shallow breathing
- Blue or purple lips and nails
- Drowsiness or loss of consciousness
- Slow or irregular heartbeat
- Cold and clammy skin
- Nausea and vomiting
- Pinpoint pupils
An overdose from fentanyl can happen quickly and requires immediate medical attention.
Narcan (naloxone), an opioid overdose reversal medication, can be used to treat an overdose from fentanyl but should be administered by a medical professional.
Smoking Fentanyl-Laced Marijuana
Smoking fentanyl-laced marijuana can have serious and potentially life-threatening effects. Fentanyl is a powerful synthetic opioid that is up to 100 times more potent than morphine. When it is mixed with marijuana and smoked, the risk of overdose and death increases significantly.
Some effects of smoking fentanyl-laced marijuana may include:
- Respiratory depression: Fentanyl can slow down breathing, which can lead to brain damage or death if left untreated
- Sedation: Fentanyl can cause drowsiness and confusion, making it difficult for the individual to stay alert or react quickly to potential dangers
- Nausea and vomiting: Fentanyl can cause stomach upset, which can lead to dehydration and other complications.
- Heart problems: Fentanyl can affect the heart’s rhythm and blood pressure
- Overdose: Fentanyl can cause an overdose even in small doses, and the risk of overdose increases when it is mixed with other drugs such as marijuana
Fentanyl can be disguised as other drugs and added to marijuana or other substances without the user’s knowledge. Therefore, it’s important to avoid using any illegal drugs and to only take prescription medications as directed by a healthcare professional.
