Evidence map›Paper›PMID 41781809›Full record

ArticleJournal of medical toxicology : official journal of the American College of Medical Toxicology2026

Interpreting Fentanyl and Norfentanyl Concentrations among Patients Seen in the Emergency Department after a Nonfatal Opioid Overdose: A Multicenter Study.

Jessica T Kent, Rachel Culbreth, Jacob A Lebin, Keith Burkhart, Robert G Hendrickson, Zachary D W Dezman, Kim Aldy, Jeffrey Brent, Alyssa Falise, Sharan Campleman and 7 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Jessica T KentDepartment of Emergency Medicine, Unity Health - St. Michael's Hospital, Toronto, ON, Canada. jekent@nosm.ca.ORCID http://orcid.org/0000-0003-4017-7479
Rachel CulbrethAmerican College of Medical Toxicology, Phoenix, AZ, USA.
Jacob A LebinDepartment of Medicine, University of Colorado, Aurora, CO, USA.
Keith BurkhartFood and Drug Administration, Silver Spring, MD, USA.
Robert G HendricksonDepartment of Emergency Medicine, Oregon Health and Science University, Portland, OR, USA.
Zachary D W DezmanFood and Drug Administration, Silver Spring, MD, USA.
Kim AldyAmerican College of Medical Toxicology, Phoenix, AZ, USA.
Jeffrey BrentDepartment of Medicine, Division of Pulmonary and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Alyssa FaliseAmerican College of Medical Toxicology, Phoenix, AZ, USA.
Sharan CamplemanAmerican College of Medical Toxicology, Phoenix, AZ, USA.
Barry K LoganCenter for Forensic Science Research and Education at the Fredric Rieders Family Foundation, Horsham, PA, USA.
Michael LevineDepartment of Emergency Medicine, University of California, Los Angeles, CA, USA.
Michael CharyDepartment of Emergency Medicine, Cornell University, New York, NY, USA.
Alex KrotulskiCenter for Forensic Science Research and Education at the Fredric Rieders Family Foundation, Horsham, PA, USA.
Jeanmarie PerroneDepartment of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Paul WaxAmerican College of Medical Toxicology, Phoenix, AZ, USA.
ToxIC DOTS Study Group

Funding

U.S. Food and Drug Administration #75F40122D00028/75F40123F19002
6 · The paper itself

Abstract

backgroundFentanyl concentrations are typically interpreted in forensic contexts using postmortem and driving under the influence data, both of which have important limitations. This study describes fentanyl and norfentanyl concentrations measured in an acute, clinical setting among patients presenting to the emergency department with a suspected opioid overdose.

methodsA prospective observational study was performed utilizing the Toxicology Investigators Consortium (ToxIC) Drug Overdose Toxico-Surveillance (DOTS) Reporting Program enrolling patients ≥ 13 years old from April 2023 to July 2024 following a life-threatening overdose treated at 17 EDs within the United States. Fentanyl and norfentanyl concentrations were determined by liquid chromatography tandem quadrupole mass spectrometry (lower limit of quantification (LLOQ) 1 ng/mL). Fentanyl and norfentanyl concentrations were summarized using descriptive statistics and stratified by time of ED presentation to blood collection. Fentanyl concentrations were also stratified by norfentanyl concentrations.

resultsThree hundred and thirty-one patients presented with a clinical presentation consistent with an opioid overdose and were included in the study. Of these, 248 (74.9%) had fentanyl concentrations above the LLOQ. The median concentration of fentanyl and norfentanyl was 4.5 ng/mL (IQR: 2.4, 8.8) and 2.7 ng/mL (IQR:1.6, 5.3), respectively. The median time to blood draw was 165 min. The median fentanyl/norfentanyl (F/NF) ratio was 0.5 (IQR: 0.4, 1.0).

conclusionsQuantitative fentanyl and norfentanyl concentrations in the acute emergency department setting among patients with a suspected opioid overdose were lower than those in the postmortem literature with significant toxicity observed at levels below the LLOQ. Use of an arbitrary F/NF ratio of 1 did not delineate acute exposure.

Indexed as

Analytical toxicologyEmergency medicineFentanylForensic toxicologyNorfentanylOverdoseToxicology

Identifiers

PMID41781809
PMCPMC13076824

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.