UMass study finds half of overdose patients unaware of their fentanyl exposure
By
Susan Spencer
Telegram & Gazette Staff
Posted Jul 19, 2017 at 8:28 PM
Updated at 7:34 AM
WORCESTER - Fentanyl, a synthetic opioid that’s 50 times more potent
than heroin, has been, since early last year, the leading factor in
opioid-related deaths in Massachusetts, the state Department of Public
Health has reported. In 2016, fentanyl was found in more than three out
of four of 2,069 confirmed and suspected opioid overdose deaths
statewide.
But less is known about how people are exposed to illicit fentanyl.
A recent study out of the University of Massachusetts Medical School and UMass Memorial Medical Center, with the Center for Forensic Science Research and Education in Willow Grove, Pennsylvania, found that among adult patients who came to the emergency room after being revived from a heroin overdose, nearly all had fentanyl in their urine. When asked, roughly half of the patients did not know they had taken fentanyl.
The study was published this month in Clinical Toxicology journal.
Researchers have been aware for some time of “clandestine opioids” used to adulterate heroin, Dr. Kavita M. Babu, chief of the Division of Toxicology in the Department of Emergency Medicine at UMass, said in an interview. Profits from illicit fentanyl mixed into other drugs can be enormous, bringing in tens of millions of dollars in revenue from a few thousand dollars spent on fentanyl powder.
Most of the data on the drugs comes from post-mortem studies on people who died or from evidence seized by law enforcement.
Hospital laboratories tend to look for drugs such as heroin or oxycodone, but generally aren’t specific enough to identify fentanyl, which has a different structure and lower concentration than heroin.
In this study, UMass physicians sent urine samples from 30 patients who had been revived from overdoses with naloxone, or Narcan, to the Center for Forensic Science Research and Education, a specialized lab.
Twenty-nine of the 30 patients had fentanyl in their urine samples, and nearly all, 93.3 percent, tested positive for heroin.
Ten of the 30 participants, or 33 percent, had never previously
required naloxone for an overdose. Two out of three - 20 participants -
reported a relapse from recent abstinence. And 12 participants, 40
percent, reported using cocaine at the same time.
Dr. Babu said this study presented a new context for fentanyl overdoses. “We could actually talk to users and ask them where they could have been exposed,” she said.
None of the patients had received a prescription for fentanyl, which is used legitimately to manage chronic or severe pain, and none had obtained it from someone else who had a prescription, according to Dr. Babu. “Everyone in our study intended to buy heroin.”
Sixteen participants, or 55 percent, were able to say there was fentanyl in their heroin, although Dr. Babu said that some likely based that statement on the fact that they had overdosed and concluded they must have had fentanyl.
Some said their fentanyl-laced heroin appeared “a little different,” she continued, but the most notable clue was, “It took up so fast.”
Unfortunately, that strong sensation occurs as the overdose has already started, making it past the point where a user can cut the dose.
Even a little fentanyl can be deadly. Dr. Babu said, “The amount of fentanyl that’s required to kill an adult is equal to three grains of salt.
“People are actually eager to talk to us,” said Brittany Chapman, a
research coordinator and co-author at UMass. “They’ll do whatever they
can to prevent this from happening to somebody else.”
Researchers also found types of related opioids in participants’ urine that hadn’t been reported in this area. Nine had acetylfentanyl, which was linked to a spate of deaths in Rhode Island in 2013. Two samples had U-47700, another drug that had not been reported locally previously.
“That’s why these studies are important,” Dr. Babu said. “On a research basis we can do that surveillance.”
UMass toxicology and emergency medicine researchers are launching a follow-up study next week using participants’ blood samples, rather than urine, which will help identify more specifically what the culprit was in causing the overdose.
The study will also be done at hospitals in other New England cities, including Hartford, Boston, Providence and Portland, to map fentanyl and related opioid use.
Other studies involve following patients who have been given naloxone to take home after their overdose, to track its use and effectiveness.
On Aug. 19, on Overdose Awareness Day, UMass launched an Overdose Prevention Fund to support research, community outreach, clinical work and education to eradicate overdoses. For information or to donate, visit www.umasstox.com.
“This cause needs champions,” Dr. Babu said. “It needs responses at all levels.”
She continued: “We do this every day. People are so saturated with the opioid crisis. There can be a little fatigue on how to respond to it.”
Dr. Babu said that the situation is not hopeless. She pointed to people in recovery who have built rewarding, robust lives, and said that’s something we need to talk more about.
“The challenge is maintaining momentum,” she said.
Other authors on the study included Dr. Matthew K. Griswold and Dr. Peter R. Chai from UMass; Dr. Edward W. Boyer, now at Brigham and Women’s Hospital in Boston; and Alex J. Krotulski, Barry K. Logan and Melissa Friscia, from the Center for Forensic Science Research and Education.
Analyses for the study were funded by the Frederic Rieders Family Foundation. Additional costs were supported by the Overdose Prevention Fund and National Institutes of Health.
But less is known about how people are exposed to illicit fentanyl.
A recent study out of the University of Massachusetts Medical School and UMass Memorial Medical Center, with the Center for Forensic Science Research and Education in Willow Grove, Pennsylvania, found that among adult patients who came to the emergency room after being revived from a heroin overdose, nearly all had fentanyl in their urine. When asked, roughly half of the patients did not know they had taken fentanyl.
The study was published this month in Clinical Toxicology journal.
Researchers have been aware for some time of “clandestine opioids” used to adulterate heroin, Dr. Kavita M. Babu, chief of the Division of Toxicology in the Department of Emergency Medicine at UMass, said in an interview. Profits from illicit fentanyl mixed into other drugs can be enormous, bringing in tens of millions of dollars in revenue from a few thousand dollars spent on fentanyl powder.
Most of the data on the drugs comes from post-mortem studies on people who died or from evidence seized by law enforcement.
Hospital laboratories tend to look for drugs such as heroin or oxycodone, but generally aren’t specific enough to identify fentanyl, which has a different structure and lower concentration than heroin.
In this study, UMass physicians sent urine samples from 30 patients who had been revived from overdoses with naloxone, or Narcan, to the Center for Forensic Science Research and Education, a specialized lab.
Twenty-nine of the 30 patients had fentanyl in their urine samples, and nearly all, 93.3 percent, tested positive for heroin.
Dr. Babu said this study presented a new context for fentanyl overdoses. “We could actually talk to users and ask them where they could have been exposed,” she said.
None of the patients had received a prescription for fentanyl, which is used legitimately to manage chronic or severe pain, and none had obtained it from someone else who had a prescription, according to Dr. Babu. “Everyone in our study intended to buy heroin.”
Sixteen participants, or 55 percent, were able to say there was fentanyl in their heroin, although Dr. Babu said that some likely based that statement on the fact that they had overdosed and concluded they must have had fentanyl.
Some said their fentanyl-laced heroin appeared “a little different,” she continued, but the most notable clue was, “It took up so fast.”
Unfortunately, that strong sensation occurs as the overdose has already started, making it past the point where a user can cut the dose.
Even a little fentanyl can be deadly. Dr. Babu said, “The amount of fentanyl that’s required to kill an adult is equal to three grains of salt.
Researchers also found types of related opioids in participants’ urine that hadn’t been reported in this area. Nine had acetylfentanyl, which was linked to a spate of deaths in Rhode Island in 2013. Two samples had U-47700, another drug that had not been reported locally previously.
“That’s why these studies are important,” Dr. Babu said. “On a research basis we can do that surveillance.”
UMass toxicology and emergency medicine researchers are launching a follow-up study next week using participants’ blood samples, rather than urine, which will help identify more specifically what the culprit was in causing the overdose.
The study will also be done at hospitals in other New England cities, including Hartford, Boston, Providence and Portland, to map fentanyl and related opioid use.
Other studies involve following patients who have been given naloxone to take home after their overdose, to track its use and effectiveness.
On Aug. 19, on Overdose Awareness Day, UMass launched an Overdose Prevention Fund to support research, community outreach, clinical work and education to eradicate overdoses. For information or to donate, visit www.umasstox.com.
She continued: “We do this every day. People are so saturated with the opioid crisis. There can be a little fatigue on how to respond to it.”
Dr. Babu said that the situation is not hopeless. She pointed to people in recovery who have built rewarding, robust lives, and said that’s something we need to talk more about.
“The challenge is maintaining momentum,” she said.
Other authors on the study included Dr. Matthew K. Griswold and Dr. Peter R. Chai from UMass; Dr. Edward W. Boyer, now at Brigham and Women’s Hospital in Boston; and Alex J. Krotulski, Barry K. Logan and Melissa Friscia, from the Center for Forensic Science Research and Education.
Analyses for the study were funded by the Frederic Rieders Family Foundation. Additional costs were supported by the Overdose Prevention Fund and National Institutes of Health.
No comments:
Post a Comment