UMEM Educational Pearls

Category: Toxicology

Title: Prevalence of fentanyl exposure in Baltimore

Keywords: opioid use disorder, fentanyl exposure, baltimore, (PubMed Search)

Posted: 6/13/2019 by Hong Kim, MD, MPH
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Since 2013, the availability of fentanyl has been increasing in the illicit drug supply, especially in heroin supply. Fentanyl and its analogs have been responsible for the dramatic increase in opioid overdose death over the past 5 years. 

Two recent cross-sectional studies screened ED patients with opioid use disorder for fentanyl exposure.

Study 1:

  • Of 165 patients, urine samples were obtained from 129 participants.
  • 80.6% tested positive for fentanyl from urine sample when over 95% reported preference for heroin in the fentanyl positive group.
  • 85.7% of the overdose group (n=42) was positive for fentanyl.
  • Over 84% recognized fentanyl’s high potency and high risk of death in overdose.
  • 29.7% (n=49 of 165) intentionally purchased fentanyl for use.  
  • Intentional fentanyl purchase was more common in non-overdose group(34.1% vs. 16.7%).

Study 2: 

  • 76 ED patients were screened.
  • 83% showed presence of fentanyl in urine.
  • 5% reported knowledge of using fentanyl (i.e. intentional use).

Bottom line:

  • Fentanyl exposure is common among opioid users in Baltimore
  • Up to 30% of ED patients with opioid use disorder intentionally purchase fentanyl although majority recognize the higher risk of overdose death from fentanyl compared to other opioids.


Bach H et al. Prevalence of fentanly exposure among emergency department patients with history of opioid abuse. Clin Toxicol 2019 May (Abstract presented at the EAPCCT 2019, Naples, Italy)

Dezman ZDW et al. Evidence of fentanyl use is common and frequently missed in a cross-sectional study of emergency deparmtne patients in Baltimore, Maryland. Clin Toxicol 2019 April 17.