Risk Factors Associated with a Major Medical Outcome among Illicit Fentanyl Exposures Reported to Regional Poison Centers (2019-2023)

Ana M. Coggin a ; Kanku Sumbundu a ; Alicia M. Dalton a ; Andrew Monte a,b

a Rocky Mountain Poison & Drug Safety

b University of Colorado School of Medicine, Department of Emergency Medicine

Background

Exposures to illicit fentanyl reported to regional Poison Centers (PCs) have been increasing over time.

Availability and use of illicit fentanyl is of public health concern as exposures to this drug can result in

significant morbidity and mortality. As a result, timely and proper treatment is essential. Though there

are likely many risk factors for severity that exist, this analysis utilizes data obtained from PCs to

understand potential risk factors related to major medical outcomes (MMOs).

Methods

This exploration examined the use of illicit fentanyl and the odds of an exposure resulting in a MMO

utilizing US PC data with data collection initially starting on August 18, 2019 through December 31,

2023. MMO was defined as an outcome of either “death” or “major effect”. Risk factors were selected a

priori to understand their relative impact on an exposure resulting in a MMO. The risk factors included

gender, age, and the number of concomitant substances. A series of univariate logistic regression

models were used to analyze the relationship between these risk factors and the probability of an

exposure resulting in a MMO.

Results

Among the total number of exposures to illicit fentanyl (n=7,322) from August 2019 to December 2023,

31.5% resulted in a MMO. Gender and age were found to be strongly related to the odds of experiencing

a MMO. Among illicit fentanyl users, the odds of having a MMO is 1.23 (95% CI: 1.10, 1.36) times higher

in males vs females) and 1.88 (95% CI: 1.54, 2.30) times higher for 12–17-year-olds vs 18–29-year-olds.

The number of substances that a person took along with the illicit fentanyl was also found to be a strong

predictor of experiencing a MMO (Number of substances ranged from 1 to 16). For every additional

substance taken, a person is 1.05 times (95% CI: 1.00, 1.10) as likely to experience a MMO.

Conclusion

The odds of an exposure resulting in a MMO reported in US Poison Centers is higher in males, 12-17

year olds, and when more than one substance is used with illicit fentanyl. As exposures to illicit fentanyl

continue to rise, ongoing efforts to identify risk factors to allow for appropriate and timely treatment

are important. Additionally, efforts to prevent exposures should be implemented and assessed.

Keywords:

Illicit fentanyl; major medical outcome; public health; opioid

2024