Tramadol as a fentanyl adulterant: Prevalence and management in a ToxIC Fentalog study prospective cohort.

Background: Tramadol is an adulterant of illicit opioids. As it is a serotonin-norepinephrine reuptake inhibitor as well as a μ-opioid agonist, tramadol adulteration may worsen overdose signs and symptoms or affect the amount of naloxone patients receive.

Methods: This is a multicenter, prospective cohort of adult patients with suspected opioid overdoses who presented to one of eight United States emergency departments and were included in the Toxicology Investigators Consortium's Fentalog Study.

Pediatric exposure to illicit fentanyl is associated with drug availability in the community.

Introduction: Fentanyl has replaced diacetylmorphine (heroin) as the primary illicit opioid in the United States. Over the last several years, exposures to illicit fentanyl in small children have increased nationally. We hypothesized that the increase in illicit fentanyl in the community, as measured by regional drug seizures, would be associated with the number of pediatric exposures to illicit fentanyl.

Characteristics of Fentanyl Toxicity in Very Young Children.

Children exposed to illicit fentanyl often experience severe toxicity and receive repeated naloxone doses and prolonged airway support. This retrospective study presents the clinical course and management of 4 cases, emphasizing the urgent need for prompt recognition and intervention to address the severe, extended effects of illicit fentanyl exposure in very young children.