Blood analysis on non-fatal opioid-involved overdoses

OHSU and the Oregon Poison Center are one of the sites of this national study run through the American College of Medical Toxicology (ACMT) Toxicologic Investigators’ Consortium (ToxIC). The study analyzes blood from patients who have overdosed on opioids to detect what opioid is present and any adulterants or co-ingestions. View the data on the CDC's interactive website. 

ToxIC Fentalog Clinical Reports

Urine drug screens at OHSU

This study tracks the drugs that are detected on urine drug screens at OHSU in Portland, OR in Tableau format from 2011 until the present. It is a rough estimate of the quantity of drugs that are being used in Oregon. It is easy to isolate individual drug types to see the trend. Of note, the opioid screen has decreased over time because of the increasing use of fentanyl (which does not show up on the opioid screen). Fentanyl was recently added and will start to be reflected in the next quarter. View the urine drug screen data on the interactive CESAR Drug Positive Trends webpage. View more information about the EDDS study and the OHSU site on the interactive CESAR webpage. 

Opioid and stimulant overdoses that present at OHSU ED

OHSU and the Oregon Poison Center are a site in this national multi-center study looking at the opioid and stimulant overdoses that present to the OHSU Emergency Department. The DOTS study includes collecting information on the circumstances of the overdose, what factors contributed to the overdose, and identification of the opioid or stimulant in blood. More information about the study is available on the DOTS study website.  In the first year of the study, we have identified 25 opioid and stimulant overdoses:

Opioid overdoses: The primary opioid that we detected is fentanyl. We did not detect ANY heroin, other opioids, or xylazine.

• All opioid overdoses had fentanyl detected
  • All who overdosed on fentanyl also had methamphetamine detected in smaller quantities in blood. This indicates that most people who use fentanyl also use methamphetamine, though not necessarily at the same time.
  • No cases had any other opioid detected, including heroin metabolites. This indicates that fentanyl has entirely replaced heroin as the main recreational opioid in the area.
• We found no fentanyl analogs or novel psychoactive substances
• In the community:
  • We found no fentanyl cases had measurable amounts of xylazine
  • We detected small quantities of cocaine in 8% of samples, confirming that cocaine use is present, but rare in the area

Stimulant overdoses:  The primary stimulant seen in Oregon is methamphetamine. Methamphetamine users often also use fentanyl. Cocaine was found rarely and was not the cause of any stimulant overdoses.

• Methamphetamine was the cause in almost all of the stimulant overdoses.
  • Half of those patients also had small amounts of fentanyl detected, indicating that many methamphetamine users also use fentanyl, though not necessarily at the same time.
• Only tetrahydrocannabinol metabolites (cannabis) were detected in one patient with stimulant symptoms. Cannabis in large quantities can cause toxicity that is similar to stimulant overdose.
• In the community:
  • Cocaine was detected in very small quantities in one patient who had high concentrations of methamphetamine. This indicates that methamphetamine remains the primary stimulant in the area.
  • We detected no other stimulants – cathinones (bath salts), prescription stimulants (e.g. methylphenidate, amphetamines, MDMA)