- Fentanyl and fentanyl analogues are the most common current heroin adulterants
- Reversal of fentanyl and fentanyl analogues may take large doses of naloxone
- DC patients with naloxone rescue prescriptions
- CMC substance of abuse urine drug screen (UDS) is associated with false negative testing:
- Immunoassay is not sensitive for synthetic opioids (fentanyl, fentanyl analogues, methadone, tramadol, U-47700)
- Immunoassay is insensitive for semi-synthetic opioids (requires high urine concentration of hydrocodone, meperidine, oxycodone)
- UDS is expensive: ~$900 cost to the patient. Order wisely!
- Be vigilant for unusual toxic manifestations from adulterants
- Be vigilant of personal safety and use appropriate PPE