Podcast 760: Why Fentanyl is the Worst

<strong>Contributor: Don Stader, MD</strong> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Fentanyl’s common administration route through pills has lowered the psychological barrier of using opioid compared to injecting and smoking heroin</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Fentanyl is showing up in all illicit drugs with documented cases even in marijuana</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Testing for fentanyl is difficult and requires a send out test because UA does not show up not common in ED but can better inform our care</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Fentanyl doesn’t show up on UA drug screen and requires a send out test, thus we should ask patients if they’re using fentanyl specifically </span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Send any patient using an illicit drug home with Narcan to protect them from potential opioid overdoses</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Start patients on buprenorphine for opioid withdrawal in the ED</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Fentanyl is very lipophilic, thus patients require longer washout times (sometimes over 24 hours) before buprenorphine induction to avoid precipitated withdrawal</span></li> </ul> <p><strong>References:</strong></p> <p><span style="font-weight: 400;">Adams, K.K., Machnicz, M. & Sobieraj, D.M. Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review.</span> <em><span style="font-weight: 400;">Addict Sci Clin Pract</span></em> <span style="font-weight: 400;">16, 36 (2021).</span> <a href= "https://doi.org/10.1186/s13722-021-00244-8"><span style= "font-weight: 400;">https://doi.org/10.1186/s13722-021-0