{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T02:02:21Z","timestamp":1780020141201,"version":"3.53.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"National Institute on Drug Abuse of the National Institutes of Health","award":["R01DA048009"],"award-info":[{"award-number":["R01DA048009"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Clandestine fentanyl manufacturing oftentimes introduces adulterants and contaminants. This article aims to evaluate trends in adulterants from a cohort of patients presenting to the emergency department (ED) with illicit opioid overdose across the United States. The Fentalog Study group is a multicenter toxicology study group which evaluated ED patients with suspected opioid overdose at 10 medical centers across the United States between 21 September 2020 through 5 February 2024. Comprehensive qualitative toxicology testing was performed on residual serum specimens. Study sites were divided into three geographic regions: West (California, Oregon, Colorado), Midwest (Missouri, Michigan), and East (New York, New Jersey, Pennsylvania, Georgia). Illicit opioids were defined as fentanyl and fentanyl analogs, heroin or its metabolites, and\/or novel potent opioids such as nitazenes. 1295 patients with confirmed illicit opioid overdose were included. Males accounted for the majority (73.7%) of patients. The median age was 39 (IQR: 31\u201354) years. Adulterants were detected in 745 (57.5%) patients. Quinine was the most abundantly encountered adulterant (433; 33.4%). Antihistamines were the most frequently detected class of adulterants (19.6%). There were significant differences in adulterants detected across the three time periods, with notable decreases in adulterants from time-period 1 (79.5%) to time-period 3 (41.7%; P\u2009&amp;lt;\u2009.001). Adulterants were found in 84 (27.0%) of patients that presented to a hospital in the Western United States, compared with 181 (24.3%) in the Midwest, and 480 (64.4%) of patients in the East (P\u2009&amp;lt;\u2009.001). Patients with concurrent cocaine were more likely having an adulterant present than those without cocaine present (OR 1.23; 95% CI 1.15\u20131.31). In contrast, patients with illicit opioids and concurrent methamphetamine were less likely to have adulterants present (OR 0.89; 95% CI 0.84\u20130.95). Adulteration of illicit opioids was more likely in the Eastern United States and for those with concurrent cocaine and opioid exposures.<\/jats:p>","DOI":"10.1093\/jat\/bkag006","type":"journal-article","created":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T12:45:49Z","timestamp":1771418749000},"source":"Crossref","is-referenced-by-count":0,"title":["Illicit opioid adulterant trends in patients presenting with acute opioid overdose"],"prefix":"10.1093","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1868-5322","authenticated-orcid":false,"given":"Michael","family":"Levine","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Division of Medical Toxicology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Culbreth","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology , Phoenix, AZ 85028,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeannie","family":"Buchanan","sequence":"additional","affiliation":[{"name":"Denver Health and Hospital Authority Department of Emergency Medicine. , Denver, CO 80045,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Schwarz","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Division of Medical Toxicology, University of California, Los Angeles , Los Angeles, CA 90024,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Love","sequence":"additional","affiliation":[{"name":"NYC Health + Hospitals\/Elmhurst; Center for Research on Emerging Substances, Poisoning, Overdose, and New Discoveries (RESPOND), Icahn School of Medicine at Mount Sinai , New York, NY 11373,","place":["United 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Fredric Rieders Family Foundation , Horsham, PA 19044,","place":["United States"]},{"name":"NMS Labs , Horsham, PA 19044,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Shulman","sequence":"additional","affiliation":[{"name":"University of Pittsburgh School of Medicine , Pittsburgh, PA 15213,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Emory University School of Medicine , Atlanta, GA 19044,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Wax","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology , Phoenix, AZ 85028,","place":["United States"]},{"name":"University of Texas Southwestern Medical Center , Dallas, TX 75390,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra M","family":"Maducci","sequence":"additional","affiliation":[{"name":"Lehigh Valley Health Network , Allentown, PA 18017,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane P","family":"Calello","sequence":"additional","affiliation":[{"name":"Rutgers New Jersey Medical School , Newark, NJ 07103,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharan","family":"Campleman","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology , Phoenix, AZ 85028,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex F","family":"Manini","sequence":"additional","affiliation":[{"name":"NYC Health + Hospitals\/Elmhurst; Center for Research on Emerging Substances, Poisoning, Overdose, and New Discoveries (RESPOND), Icahn School of Medicine at Mount Sinai , New York, 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