An analysis of fentanyl analog exposures in Cook County, Illinois recently published in this journal by Chhabra et al. found that more than half of urine drug screens detected at least one fentanyl analog or synthetic opioid (1). The relative ease of manufacturing and cost-cutting measures in the illicit drug industry has caused a flooding of the market with synthetic opioids, which is reflected in reported overdose deaths, as synthetic opioid-involved deaths increased 1040 from 2013 to 2019 (2). Use and overdose of carfentanil specifically has increased rapidly around the United States since it was first identified in patient samples in 2016 (3). Given the high potency of the drug (approximately 10,000 times as potent as morphine), most cases of carfentanil use have been identified postmortem, which poses a serious threat to patients with opioid use disorder.
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