More people may have overdosed from fentanyl than know it because emergency rooms rarely screen for the drug: study

• Overdose patients are rarely being tested for fentanyl exposure in emergency rooms.
• A new study shows that most overdose patients receive an outdated toxicology screening.

When patients show up to emergency rooms experiencing a drug overdose, they are often given toxicology screening to determine what narcotic was responsible.

But the tests used rarely screen for fentanyl — a synthetic opiate making its way into many street drugs. The drug is responsible for a rise in overdose deaths around the country, a recent study by Epic Research and the Center for Substance Abuse Research revealed.

"Between 45 and 50% of the patients who come in with a generic diagnosis of an overdose end up getting tested with a standard toxicology screen, but most of these were created back in the 1980s when drug testing became commonplace," Epic researcher David Little told Insider. "It includes traditional opioids — natural opioids, like morphine — but it does not include the synthetic opioids like fentanyl."

In order to learn if fentanyl was in the system of the patient, the physician would have to order a second screening specifically for that drug.

In an emergency department setting, the physician's primary goal is to keep their patient alive — usually by giving them an overdose reversal drug, Naloxone — and determining exactly what drug caused the overdose is secondary, Little said.

"As a physician in the emergency department, you may be taking care of six or eight or 10 patients all at once," Little said. "And when a patient comes in with an overdose, you give them Naloxone, and they get better. There's not a compelling, immediate need to say, okay, was this hydrocodone? Was this oxycodone? Was this fentanyl?"

But determining if fentanyl is present in a patient's system is important for their safety because fentanyl is especially dangerous, Little said.

Fentanyl is is 50 to 100 times more potent than morphine, and is often mixed with other narcotic drugs, such as heroin, to make them more potent, according to the US Drug Enforcement Administration.

The synthetic drug is much cheaper to produce and lighter to transport, so it is economically beneficial for those producing the drugs, several drug experts told Insider.

While the presence of fentanyl in other opioids, like heroin or illicit pain pills, has been a well-known threat in certain parts of the country for the last five years, it's now starting to show up in street drugs like cocaine and cannabis.

In 2020, more than 56,000 US deaths involved a synthetic opioid — like fentanyl, according to the Centers for Disease Control and Prevention.

Letting a patient know that fentanyl was in their system during their overdose could protect them from future harm because they will know to either avoid that dealer, Little said.

"It's important for law enforcement to know if we're seeing clusters of unexpected fentanyl exposures in a given hospital or a given neighborhood at a given point in time," he said.

Little said that the study by Epic and the University of Maryland's Center for Substance Abuse Research included data from 170 organizations and 315,000 emergency department visits.

He hopes awareness of the findings will prompt more physicians will consider offering the additional fentanyl tests to overdose patients in emergency rooms, and potentially the development of a more efficient drug test that will include fentanyl.