Fentanyl is found in most U.S. overdose victims; doctors seem to think ERs test for it, but they aren't required to

Tyler Samash (Family photo)

Why are hospital emergency departments not testing for fentanyl? "They already think they are," Juli Shamash of Los Angeles told NBC News. The overdose and death of her 19-year-old son provides an example. "When Tyler Shamash survived a drug overdose at 19, his mother, Juli, asked his doctor several times if he'd been tested for fentanyl. The doctor said they had run a standard drug test, and fentanyl hadn't come up in the toxicology screen," NBC reports. "Tyler overdosed again the next day and died. His family found out five months later after the coroner ran a toxicology report that fentanyl was found in his system."

"I was so in disbelief because you trust doctors; you go to doctors for advice," Shamash told NBC. "It's unbelievable to me that every institution isn't testing for it. Why wouldn't you? But then I think the answer to that is: They think they are."

Fentanyl is found in the blood of most U.S. overdose victims, "but there isn't a federal mandate that emergency rooms test specifically for fentanyl," Maura Barrett and Bianca Seward of NBC report. "A standard drug test panel in most emergency rooms checks only for marijuana, cocaine, amphetamines, PCP and natural and semi-synthetic opioids (like heroin and oxycodone) — but not synthetic opioids like fentanyl."

Samash worked with Dr. Roneet Lev, an emergency addiction physician, to create a toolkit for hospitals to use for fentanyl testing. It costs about 75 cents. "Her son's death in 2018 pushed Shamash to advocate for legislation requiring a sixth test be added for fentanyl," NBC reports. "Through a bipartisan effort, Tyler's Law passed unanimously and took effect at the beginning of 2023 in California — the first, and so far only, state to do so, though the law is set to expire in just five years."

"Fentanyl testing has really dramatically changed how I approach patients and how my conversation with them goes when the test is positive," Lev told NBC, which reports, "She sees patients every day who don't know that they've taken something laced with fentanyl. Now armed with knowing the severity of the drugs they've used, Lev said patients 'may want to change or do something differently. They may throw away those bags of pills … or it leads to a prescription for Naloxone, the opioid reversal agent.'"

NBC adds, "Shamash is now working with other families who have suffered a similar loss in hopes of enacting federal legislation. . . . Legislation replicating Tyler's Law is making its way through the Maryland state House . . . . More than 107,000 Americans died from a drug overdose in 2021 — a majority of them suspected to be from fentanyl," according to the Centers for Disease Control and Prevention. Lev told NBC: "We had a Covid epidemic; we did Covid testing. We have a fentanyl epidemic. Why aren't we doing fentanyl testing?"