Abstract
Introduction
Opioid overdoses and violent injury are leading causes of death in the United States,
yet testing for novel opioids like fentanyl remains uncommon. The purpose of this
investigation is to characterize a population of victims of violence who test positive
for illicit fentanyl.
Methods
Retrospective cohort study of patients treated at a level-one trauma center between
January 31, 2019 and February 21, 2020. Data were extracted from the electronic medical
record. Subjects were included if they had an encounter diagnosis for a violent or
intentional injury, using the International Classification of Diseases, v10 (X92-Y09).
We excluded patients who received licit fentanyl as a part of their care before testing.
Those who tested positive for fentanyl exposure on our standard hospital urine drug
screen were considered to have been exposed to illicit fentanyl. Those testing negative
for fentanyl were considered controls.
Results
Of the 1132 patients treated for intentional injuries during the study period, 366
were included in the study (32.3%). Of these, 133 (36.3%) subjects were exposed to
illicit fentanyl prehospital. There were no demographic differences between cases
and controls. Cases had a lower GCS voice score on arrival (median = 4, interquartile
range [IQR] = 4-5 versus median = 5, IQR = 4-5, P = 0.02), higher rates of ventilator usage (32.3% versus 21.5%, P = 0.02), and more intensive care unit admissions (27.1% versus 12.0%, P = 0.005). More than half of cases tested negative for opiates (78/133, 58.6%). Cases
had more trauma center encounters (26.3% had ≥2 visits versus 15.5%).
Conclusions
Exposure to illicit fentanyl was common among victims of violence in this single-center
study. These patients are at increased risk of being admitted to intensive care units
and repeated trauma center visits, suggesting fentanyl testing may help identify those
who could benefit from violence prevention and substance abuse treatment.
Keywords
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Article info
Publication history
Published online: December 08, 2022
Accepted:
October 16,
2022
Received in revised form:
September 13,
2022
Received:
May 10,
2022
Identification
Copyright
Published by Elsevier Inc.
