Emerg Med Inves, an open access journal ISSN: 2475-5605 1 Volume 9; Issue 01 Brief Report Updated Developments in Fentanyl Use among Psychiatric Emergency Room Patients Jessica Burris * , Brian Fuehrlein Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA * Corresponding author: Jessica Burris, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA Citation: Burris J, Fuehrlein B (2024) Updated Developments in Fentanyl Use among Psychiatric Emergency Room Patients. Emerg Med Inves 9: 10133. DOI: 10.29011/2475-5605.110133 Received Date: 30 March, 2024; Accepted Date: 06 April, 2024; Published Date: 23 April, 2024 Emergency Medicine Investigations Burris J, et al. Emerg Med Inves 9: 10133. www.doi.org/10.29011/2475-5605.010133 www.gavinpublishers.com Abstract Background and objectives: Opioid overdose-related deaths in the US continue to increase. The primary aim of this study is to determine the rates of fentanyl in the urine drug screens of all patients who presented to the psychiatric emergency room at VA Connecticut over a 7-month period in 2022 and how this compares to 2018. Methods: Data were collected for all patients during a 7-month period in 2022. There were 581 total patient presentations, 400 of which were unique. Collected data included demographic information, psychiatric diagnosis, and urine drug screen for illicit substances, including fentanyl. Results: Over 18% of patients screened positive for fentanyl, 26% for cocaine and only 7% for non-fentanyl opioids. From 2018 to 2022 the use of non-fentanyl opioids decreased, and the use of fentanyl-only and cocaine-related fentanyl increased. This suggests an overall shift from non-fentanyl opioids to fentanyl, and an increase in the combination of fentanyl and cocaine. Discussion and conclusions: Fentanyl continues to be frequently used among psychiatric emergency room patients. Additionally, trends in use suggest a dangerous shift towards fentanyl-only use and fentanyl use in combination with cocaine. Given the relative potency of fentanyl compared to traditional opioids, special attention should be paid to harm reduction strategies, naloxone administration and buprenorphine inductions. Scientific significance: This is a follow-up study to track trends of fentanyl use in psychiatric emergency room patients. These findings extend the current state of knowledge by replication in a psychiatric emergency room and build upon previously published results to track trends. Introduction Despite numerous public health and policy efforts, opioid overdose deaths continue to increase. From 2019 to 2020, the age-adjusted rate of drug overdose deaths in the US increased by 31%, from 21.6 per 100,000 to 28.3 per 100,000. In 2020, 75% of overdose deaths involved an opioid. The specific opioid involved in these deaths has also changed; in 2020, 82.3% of opioid-related overdose deaths involved fentanyl [1]. CDC’s National Center for Health Statistics reported an increase in fentanyl overdose deaths from 57,834 in 2020 to 71,238 in 2021 [2]. Additionally, annual drug overdose deaths involving heroin continue to be in steady decline [3]. While heroin and other opioid-related emergency department visits declined in 2021, fentanyl-related emergency department visits steadily rose throughout 2021 [4]. In addition to the exceptionally high risk of death involved in its use, fentanyl presents several challenges in management in the emergency room setting. Very high potency fentanyl overdoses can be resistant to naloxone treatment [5-8]. Additionally, fentanyl presents novel management challenges for buprenorphine induction. Standard induction protocols and withdrawal assessments were created to treat withdrawal from opioids such as heroin [9]. However, fentanyl has much greater potency, much greater receptor affinity, and longer half-life than previously available opioids, making precipitated withdrawal more likely [10].