Trending in the Emergency Department: Fentanyl Analogs and Pre-hospital agitation PATRICK AARONSON PHARM.D., DABAT CLINICAL PHARMACIST - EMERGENCY MEDICINE UNIVERSITY OF FLORIDA AND SHANDS – JACKSONVILLE
[email protected] Goals and Objectives Pharmacist: – Recognize the most recent drug abuse crisis - Fentanyl Analogs – Recognize the challenges of naloxone dosing for Fentanyl analogs – Evaluate the risks and benefits of pre-hospital Ketamine for undifferentiated agitation Goals and Objectives Technician: – Discuss the Fentanyl analog crisis trajectories – Recognize the pharmacological effects of Ketamine for undifferentiated agitation Disclosure I do not have a vested interest in or affiliation with any corporate organization offering financial support or grant monies for this continuing education activity, or any affiliation with an organization whose philosophy could potentially bias my presentation. DEA: 2013: 700 Fentanyl deaths nationally CDC.gov/drugoverdose/pdf/pbss/PBSS-Report-072017.pdf Mortality Weekly Report (MMWR), 64(50–51), 378–1382 statnews.com/2016/09/29/fentanyl-heroin-photo-fatal-doses/ dea.gov/divisions/hq/2016/hq092216_attach.pdf Poison Center / Emergency Department Data • Lag time between experimentation and academic outlet • Poison center data less useful (disguised substances, familiar toxidrome) • Nonfatal fentanyl cases attributed to heroin • ELISA reports Fentanyl unless GC/MS was utilized to detect analogs Year Cases Deaths Year Cases National Florida 2015 1402 47 2017 69 2014 1418 5 2016 83 Clinical Toxicology