Summary

Fentanyl and derivatives in patients attended in Emergency Departments: detection with an enzyme immunoassay technique

Rosa María Zumbado Víctor¹, Maira Almeida González¹, Clara Gironés Bredy², M.ª de los Ángeles López-Hernández², Fernando Fernández-Pérez³, Mercedes García-Rodríguez⁴, Nayra Cabrera González⁴, José Pavón Monzó⁵, Luis Alberto Henriquez-Hernández¹, L. D. Boada¹, Guillermo Burillo-Putze^2,6

Affiliation of the authors

¹Unidad de Toxicología, Departamento de Ciencias Clínicas, Facultad de Ciencias de la Salud, Universidad de Las Palmas de Gran Canaria, Spain. ²Departamento de Medicina Física y Farmacología, Universidad de La Laguna, Tenerife, Spain. ³Servicio de Urgencias, Hospital Universitario Ntra. Sra. de Candelaria, Tenerife, Spain. ⁴Hospital del Sur de Tenerife, Arona, Tenerife, Spain. ⁵Servicio de Urgencias, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain. ⁶Red de Investigación de Atención Primaria en Adicciones (RIAPAD), Spain.

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Zumbado Víctor RM, Almeida González M, Gironés Brady C, López-Hernández MA, Fernández-Pérez F, García-Rodríguez M, Cabrera González N, Pavón Monzó J, Henriquez-Hernández LA, Boada LD, Burillo-Putze G. Fentanyl and derivatives in patients attended in Emergency Departments: detection with an enzyme immunoassay technique. Rev Esp Urg Emerg. 2023;2:158–3

Summary

BACKGROUND AND OBJECTIVES. Opioids in general and fentanyl in particular are used as recreational drugs. They and their synthetic analogs are considered new psychoactive substances, yet they cannot be detected with the enzyme immunoassays used in Spanish hospitals. This study aimed to detect the use of fentanyl and related synthetics in hospital emergency department patients using a new enzyme immunoassay, and to analyze the test’s sensitivity and specificity.
MATERIAL AND METHODS. Prospective observational study to detect and identify fentanyl and its synthetic derivatives in 150 urine samples from patients older than 14 years suspected of drug poisoning or use on admission to 4 hospital emergency departments in the Canary Islands. Patients were screened for fentanyl, acetylfentanyl, and carfentanil with a Randox biochip immunoassay, and the results were confirmed by liquid chromatography with tandem mass spectrometry (LC-MS/MS).
RESULTS. The Randox assay gave positive results for some fentanyl derivative in 27.3% of the samples and specifically for fentanyl in 21 samples (14%). LC-MS/MS confirmed the positive results for fentanyl in 24 samples (16%), but none of the samples positive for acetylfentanyl or carfentanil according to the Randox assay were confirmed by LC-MS/MS. Both the Randox assay and LC-MS/MS found higher percentages of positive results in women (P < .05). The sensitivity of the Randox assay was 87.5% for detecting the analyzed derivatives; specificity was 84.1%. Sensitivity for detecting fentanyl itself was 87.5% and specificity was 100%.
CONCLUSIONS. There undetected use of fentanyl by patients attended in emergency departments. The Randox immunoassay facilitates the detection of fentanyl, although more cases should be studied for confirmation, and there is a need for detection of more fentanyl-related opioids in these patients.