In the emergency department, the line between life and death can blur in a matter of minutes. When a patient is rushed in for acute intoxication – barely conscious, breathing shallowly, lips turning blue – clinicians are thrust into a high-stakes puzzle. The culprit could be fentanyl, xylazine, nitazenes or a dangerous mix of them all. In this chaotic environment, compounded by increasing use of deadlier drugs, early diagnostics and continuous monitoring aren’t just helpful – they’re essential.
Recently, the state of Rhode Island passed legislation requiring all college campuses in the state to stock naloxone, commonly known as Narcan, in dormitories and provide training on its use. Other U.S. states, such as Connecticut, Washington and Maryland, have passed similar laws aimed at reducing overdose deaths among young adults. Narcan is an opioid antagonist that can quickly help restore normal breathing for a person experiencing an opioid overdose. It is a critical tool and can have potentially lifesaving effects for someone, but in an increasingly complex and rapidly evolving opioid crisis, it isn’t always enough.
While Narcan can provide almost immediate support for some, these effects may not last as long as the drugs causing the overdose, especially with potent synthetics or drugs absorbed through the gut like fentanyl or nitazenes. Even after the initial symptoms appear to be resolved, the drugs may continue to affect a patient, leading to a return of symptoms as the body continues to process the drugs. Multiple doses of Narcan may be needed to treat someone experiencing acute intoxication effectively.
Narcan is also only effective for patients experiencing an overdose from opioids. In cases involving non-opioid drugs, such as benzodiazepines or barbiturates, Narcan may not be effective at all. For patients experiencing acute intoxication from multiple drugs at once, Narcan may have limited effects. This is why accurate and repeat testing and continuous monitoring are so critical – patients can experience recurring symptoms long after the first crisis seems to have passed.
The opioid crisis has evolved rapidly, with synthetic opioids like fentanyl and more potent analogs now dominating overdose statistics. These substances are not only more powerful but are also frequently used in combination with other drugs, such as xylazine, a veterinary tranquilizer, or stimulants like cocaine and methamphetamine. This polydrug use makes each case more unpredictable and more challenging to treat, as the symptoms can be masked or altered by the combination of substances involved. The risk of fatality from an overdose can also increase with polydrug use, and they may require more aggressive forms of treatment, making it critical that healthcare providers have rapid and accurate toxicology results when treating acute intoxication.
The challenge is compounded by the fact that many patients do not even realize what substances they have taken. Counterfeit pills, like Adderall or Xanax, and street drugs are often laced with fentanyl or other potent analogs, making it nearly impossible for users, and sometimes even clinicians, to know what they’re dealing with. This uncertainty underscores the need for emergency departments to expand their screening protocols, update toxicology panels and invest in staff training to keep pace with the ever-changing drug landscape.
Emergency clinicians must make split-second decisions, but the complexity of today’s drug landscape means that standard diagnostic panels often fall short of providing accurate results. Many of these emerging substances evade routine drug screens, requiring advanced methods like mass spectrometry for detection. Without early and accurate identification, patients are at greater risk for fatal complications or delayed effects that can spiral out of control even after initial treatment.
Early diagnostics for acute intoxication in the emergency department are about more than just identifying the cause of an overdose. They can enable timely intervention, reduce the risk of fatal outcomes, and open the door to substance use disorder treatment and recovery. As the crisis continues to evolve, so too must our strategies for detection and response. In this relentless race against time, early diagnostics remain the sharpest tool we have to save lives and offer hope when it matters mos
Photo: Visual Generation, Getty Images
Jared Jaeger, PhD, Clinical Science Liaison, QuidelOrtho, is a seasoned healthcare professional with a proven track record of driving clinical and commercial success in high-performance environments. Leveraging a strong technical foundation, he brings deep scientific expertise to strategically support both internal teams and external stakeholders. As a trusted liaison between research, commercial and clinical communities, Jaeger excels at translating complex scientific data into actionable insights that advance patient care and support evidence-based decision-making. Recognized for a results-oriented mindset and collaborative approach, he is committed to delivering value, building strong relationships and contributing to the success of innovative healthcare solutions.
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