Podcast 760: Why Fentanyl is the Worst - The Emergency Medical Minute

Podcast 760: Why Fentanyl is the Worst

Contributor: Don Stader, MD

Educational Pearls:

  • Fentanyl’s common administration route through pills has lowered the psychological barrier of using opioid compared to injecting and smoking heroin
  • Fentanyl is showing up in all illicit drugs with documented cases even in marijuana
  • 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
  • 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¬†
  • Send any patient using an illicit drug home with Narcan to protect them from potential opioid overdoses
  • Start patients on buprenorphine for opioid withdrawal in the ED
  • Fentanyl is very lipophilic, thus patients require longer washout times (sometimes over 24 hours) before buprenorphine induction to avoid precipitated withdrawal


Adams, K.K., Machnicz, M. & Sobieraj, D.M. Initiating buprenorphine to treat opioid use disorder without prerequisite withdrawal: a systematic review. Addict Sci Clin Pract 16, 36 (2021). https://doi.org/10.1186/s13722-021-00244-8

Moustaqim-Barrette, A., Dhillon, D., Ng, J. et al. Take-home naloxone programs for suspected opioid overdose in community settings: a scoping umbrella review. BMC Public Health 21, 597 (2021). https://doi.org/10.1186/s12889-021-10497-2

*Image from NIDA


Summarized by Mason Tuttle

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