Commentary: What you don’t know can kill you. Maryland should require fentanyl testing in hospitals

By Melanie Yates

The writer is a master’s student at the University of Maryland School of Social Work.

I thought I had a predictable two semesters ahead of myself as I started the final year of graduate school. My partner, Josh, and I were planning our future — graduation, marriage, a house. Still, just as it began to feel like we had it all figured out, life changed in the blink of an eye. Josh overdosed and died.

Like millions of Americans, Josh struggled with opioid addiction. After trying Oxycontin in college, Josh did what so many others who found themselves addicted to prescription opioids do when the legal supply dries up — he turned to illicit street drugs. Yet heroin was surreptitiously displaced by fentanyl, a synthetic opioid 50 times stronger. Fentanyl is much easier to manufacture and distribute than heroin and it and other synthetic narcotics rapidly took over the illicit drug market.

Josh tried to kick his addiction — many times — but, as countless families can attest, addiction is a chronic, relapsing disease. It’s relentless and can sneak back into your life as easily as allowing yourself “just one” glass of wine at the end of a long day. While Josh had been in recovery for long periods — and was doing better than ever — he wasn’t invincible.

In the early morning of October 13th, police found Josh alone, unresponsive on his bathroom floor after his mother and I called for a wellness check. Josh was presenting with the telltale signs of a fentanyl overdose and the drug was found in his apartment. Miraculously, paramedics were able to restart Josh’s heart. His parents and I rushed to the hospital. I saw the love of my life hooked up to a ventilator, his chest a deep shade of maroon. I held his head, softly singing what was meant to be our first dance song into his ear, praying he would wake up. It wasn’t enough. On October 14th, 2022, his 31st birthday, the doctors confirmed our worst fear — Josh was brain dead.

A nurse told us the results of his toxicology screen — positive only for cocaine. Hospitals typically run what’s called the “Federal 5,” a panel that tests for cannabis, cocaine, amphetamines, phencyclidine, and naturally derived opiates like heroin. Synthetic opioids like fentanyl, Oxycontin, and morphine don’t show up in the standard 5 panel drug screen, and a separate test would have to be ordered to confirm its presence. In Josh’s case, even with his history, and the fact he showed all the signs of a fentanyl overdose, no one thought to run a test for the drug.

We knew that, given how long Josh had been unconscious before arriving at the hospital, a fentanyl test would have made little difference in the fight to save his life. Still, we were stunned, and soon became aware of the widespread fentanyl testing gap in hospitals.

According to University of Maryland researchers, only 5% of overdose patients get tested for fentanyl, and the drug carries a 40% positivity rate when tests are performed. Put a different way: with overdoses claiming more than 100,000 lives annually, fentanyl, the leading cause of death for Americans aged 18 to 45, is hardly being tested for in hospitals.

The good news is that we have a chance to change that in Maryland. Following the example of a similar measure that passed unanimously last year in California’s legislature, Delegate Joe Vogel has sponsored House Bill 811, a bill that would have hospitals include fentanyl testing when the provider requests a urine drug screen.

This legislation will help health care professionals collect the data they need to fight the fentanyl epidemic. Fentanyl can now be found in every street drug, from cocaine to marijuana to fake pressed pills that look identical to something you’d get from the doctor. It will also help detect and alert communities to the prevalence of fentanyl, and act as a warning system for patients who unknowingly ingest this lethal drug. While this bill couldn’t have saved Josh’s life, it does have the potential to save countless others who are suffering from the scourge of drug addiction in Maryland.

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