{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:04:25Z","timestamp":1792843465156,"version":"4.5.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000038","name":"Food and Drug Administration","doi-asserted-by":"publisher","award":["#75F40122D00028\/75F40123F19002"],"award-info":[{"award-number":["#75F40122D00028\/75F40123F19002"]}],"id":[{"id":"10.13039\/100000038","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Drug overdoses presenting to emergency departments (EDs) remain poorly characterized largely due to limitations resulting from constraints of hospital toxicology testing. This presents significant challenges for forensic and public health communities, as this population of primarily nonfatal overdoses is frequently not included with other data streams (e.g. fatalities, recreational drug markets), producing incomplete national and regional knowledge. To combat this issue, we performed a comprehensive toxicological analysis on patients presenting to EDs with suspected opioid or stimulant overdose. The Toxicology Investigators Consortium (ToxIC) implemented the Drug Toxico-Surveillance Reporting System at 17 healthcare institutions across the United States between April 2023 and September 2024, 995 patients (mortality rate\u2009=\u20091.0%, n\u2009=\u200910) were enrolled, and blood specimens were collected and analyzed at the Center for Forensic Science Research and Education. All specimens underwent blood alcohol analysis, comprehensive screening of over 1,200 xenobiotics, and quantitation for drugs of interest. At least one xenobiotic was detected in 992 specimens. Most frequently observed drugs include fentanyl (n\u2009=\u2009713, mean: 8.0\u2009\u00b1\u200911 ng\/mL), methamphetamine (n\u2009=\u2009380, mean: 170\u2009\u00b1\u2009210 ng\/mL), and cocaine (n\u2009=\u2009306, mean: 7.6\u2009\u00b1\u200915 ng\/mL). There were 629 detections of 43 unique novel psychoactive substances (NPS), including potent alpha-2-agonists xylazine (n\u2009=\u2009249, mean: 14\u2009\u00b1\u200929 ng\/mL) and medetomidine (n\u2009=\u200931, mean: 1.5\u2009\u00b1\u20091.8 ng\/mL). Regional trends observed include increased prevalence of methamphetamine in the western and central United States, alpha-2-agonists in the eastern United States, and greater NPS diversity in the eastern United States. Traditional opioids and stimulants were generally detected at higher mean concentrations than their more potent NPS counterparts. Quantitative data varies in comparison to literature on postmortem and driving under the influence of drugs cases. This is the first study to analyze blood specimens and provide quantitative data from a large sample of primarily nonfatal opioid\/stimulant related overdoses.<\/jats:p>","DOI":"10.1093\/jat\/bkag036","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T11:41:04Z","timestamp":1780141264000},"source":"Crossref","is-referenced-by-count":1,"title":["Comprehensive toxicological characterization and quantitation of drugs identified among nonfatal opioid and stimulant overdose presentations to US emergency departments"],"prefix":"10.1093","volume":"50","author":[{"given":"Brianna N","family":"Stang","sequence":"first","affiliation":[{"name":"Center for Forensic Science Research and Education, Fredric Rieders Family Foundation , Horsham, PA 19044,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4017-7479","authenticated-orcid":false,"given":"Jessica T","family":"Kent","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, St. Michael\u2019s Hospital, Unity Health Toronto , Toronto, ON M5B 1C9,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4461-5293","authenticated-orcid":false,"given":"Sara E","family":"Walton","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Research and Education, Fredric Rieders Family Foundation , Horsham, PA 19044,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Aldy","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology , Phoenix, AZ 85028,","place":["United States"]},{"name":"Baylor University Medical Center , Dallas, TX 75246,","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":"Alyssa","family":"Falise","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology , Phoenix, AZ 85028,","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"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2400-4711","authenticated-orcid":false,"given":"Barry K","family":"Logan","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Research and Education, 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":"Jeffrey","family":"Brent","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine , Aurora, CO 80045,","place":["United States"]},{"name":"Toxicology Associates , Littleton, CO 80120,","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"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1775-1882","authenticated-orcid":false,"given":"Alex J","family":"Krotulski","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Research and Education, Fredric Rieders Family Foundation , Horsham, PA 19044,","place":["United States"]},{"name":"College of Life Science, Thomas Jefferson University , Philadelphia, PA 19017,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"2026061512292257200_bkag036-B1","doi-asserted-by":"publisher","first-page":"737","DOI":"10.15585\/mmwr.mm6834a2","article-title":"Changes in opioid-involved overdose deaths by opioid type and presence of benzodiazepines, cocaine, and methamphetamine\u201425 states, July\u2013December 2017 to January\u2013June 2018","volume":"68","author":"Gladden","year":"2019","journal-title":"Morb Mortal Wkly Rep"},{"key":"2026061512292257200_bkag036-B2","doi-asserted-by":"crossref","DOI":"10.15620\/cdc\/170565","volume-title":"Drug Overdose Deaths in the United States, 2003-2023. 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