149 - Clinical Characteristics and Harm Reduction Interventions in Adolescent Illicitly Manufactured Fentanyl Overdoses at a Quaternary Children’s Hospital

Publication Number: 1139.149

Crystal Dickson, Children's Hospital Colorado, Aurora, CO, United States; Eli Forst, Children's Hospital Colorado, Aurora, CO, United States; Danae Massengill, Children's Hospital Colorado, Denver, CO, United States; Lynne Rosenberg, Rocky Mountain Drug and Poison Safety, Denver, CO, United States; Mairead Dillon, University of Colorado School of Medicine, Denver, CO, United States; George Sam. Wang, University of Colorado School of Medicine, Aurora, CO, United States

Background: Adolescent opioid overdoses and deaths have increased since the introduction of Illicitly Manufactured Fentanyl (IMF).

Objective: Describe the clinical characteristics of adolescent IMF toxicity, analyze the timeline of symptomatology to guide observation requirements for naloxone after different routes of exposure, and evaluate hospital interventions and harm reduction measures.

Design/Methods: This was a retrospective case series study of patients 10-18 years old with fentanyl exposures presenting at a single, quaternary care children's hospital from 1/1/2015 to 12/31/2024. Chart review was performed on patients with confirmed fentanyl exposure defined by positive urine liquid chromatography-tandem mass spectrometry (LC-MS/MS) or rapid fentanyl immunoassay (IA). Exposures were presumed to be IMF based on lack of access to medical fentanyl. Data was summarized using medians (IQRs) and counts (percentages). Chi-squared tests analyzed association between fentanyl IA and discharge naloxone.

Results: Thirty-three subjects met including criteria, comprising 37 encounters (Figure 1). The median age was 15.8 years. The primary routes of exposure were ingestion (38%) and inhalation (22%). There were 14 (38%) critical care admissions, 10 (27%) intubations, and three deaths (8%). All deaths were found on scene in cardiac arrest without bystander naloxone (Table 1). Fentanyl ingestions had longer times to last naloxone dose compared with other routes of exposure, with the longest time being 577 minutes (Figure 2). Naloxone was given to 26 (70%) patients: 21 (57%) in the pre-hospital setting, including two who received it at home before emergency services (EMS) arrived. There were few adverse events with naloxone: three (12%) required intervention for agitation and two (8%) had pulmonary edema (both also received cardiopulmonary resuscitation). Among survivors, 19 (56%) received discharge naloxone. Subjects with a fentanyl IA were more likely to be discharged with naloxone compared to subjects without a fentanyl IA (p < 0.001). Buprenorphine became available in January 2024 and started on two (33%) eligible patients.

Conclusion(s): The most common route of IMF exposure was ingestion, where the time for requiring the last naloxone dose was longer, suggesting a longer observation time is needed compared with inhalations. No deaths received naloxone prior to EMS arrival. Two patients were revived after parental naloxone administration, highlighting the profound impact of bystander naloxone. Improvements can be made in discharge naloxone, which can be aided by the use of fentanyl IA to rapidly identify fentanyl exposure.

Figure 1


Table 1


Figure 2