In treating overdose patients, emergency rooms face challenge in detecting mix of drugs

Patients who wind up in emergency rooms because of drug use have far more types of drugs in their systems than the standard screening test used by hospitals is catching, a new study has found.

While the drug epidemic has focused on opioid use, two-thirds of patients who ended up at two University of Maryland Medical System emergency rooms in 2016 had multiple drugs in their systems — up to six were found in some urine samples.


Emergency rooms tend to use a basic urine test that, like a pregnancy test, turns colors when it detects certain chemicals in drugs. The test is quick and inexpensive, but detects fewer than a dozen drugs, including opioids. The tests don’t detect drugs such as fentanyl and oxycodone, both of which have contributed to record overdoses across the country.

A Johns Hopkins panel of doctors, patients, nurses and other providers has created guidelines for the amount of opioids doctors should prescribe for specific surgeries.

When urine samples from the Midtown Campus in Baltimore and the Prince George’s Hospital Center in Cheverly were sent to an outside lab for a more detailed urine test, more drugs were detected in patients than initially found at the hospital.

Knowing what drugs a patients has taken can help doctors better decide a course of immediate treatment, as well as follow-up treatment such as rehabilitation, said doctors from the two emergency rooms and researchers from the Center for Substance Abuse Research at the University of Maryland, College Park.

“We need to know the drug trends to know how to help people,” said Dr. Zachary D.W. Dezman, an attending physician in the emergency room at Midtown.

Urine samples were tested from 106 patients at Prince George’s and 69 from the Midtown campus. Patients in Baltimore tested positive mostly for marijuana and fentanyl, a highly potent synthetic often added to heroin without users knowing.

The hallucinogenic drug PCP was most detected in Prince George’s County.

House approves opiod measures, but not the one Baltimore health commissioner says 'we desperately need'

The results highlight the complexities that exist in the current epidemic, said principal investigator Eric Wish, director of the Center for Substance Abuse Research. In some cases, dealers are mixing drugs without the knowledge of users. Many of the patients whose urine was tested misinformed doctors about what they had taken.

“It used to be [drug users] didn’t want to admit what they were taking,” Wish said. “In this age they don’t know what they are taking.”


At the time of the study there was a spike in accidental drug overdoses from dangerous synthetic cannabinoids that go by the street names Spice or K2. But the urine samples did not detect much of the drug.

Makers of synthetics constantly tweak the formulas to get around drug laws, making it hard for law enforcement and doctors to keep up. Even the more detailed urine tests need to be constantly updated.

Wish, who has used urine testing in the prison system to uncover drug trends, said hospitals need to do more detailed drug testing.

The number of drug and alcohol-related deaths increased 9 percent in 2017, according to data released by the Maryland Department of Health. Most of them were opioid related.

“People are like walking drug stores now, there are so many drugs in their system,” Wish said. “A lot of the treatment now is focused on opioids. The important thing for the medical and treatment community to know is they are using far more than opioids.”

Dezman, also an assistant professor of emergency medicine at the University of Maryland School of Medicine, would like to see more fentanyl testing done in Baltimore since it is contributing to the problem. Using the detailed urine test might be too expensive and inefficient, he said.

Lawmakers and public health officials need to know the extent of fentanyl use to help reduce it, he said.


“The emergency room is a place from which you can launch those public health efforts,” he said.