LOS ANGELES (AP) — When Tyler Shamash survived a drug overdose at age 19, his mother, Juli, asked her doctor multiple times if she had been tested for fentanyl.
Tyler had been in and out of sober homes in Los Angeles after battling addiction for years, and his family suspected he may have been taking illicit drugs. The doctor said they had run a standard drug test and the fentanyl had not shown up on the toxicology screen.
Juli Shamash believes the doctor was unaware that fentanyl is not included in the standard test used in emergency rooms across the country. A standard drug test panel in most emergency rooms only looks for marijuana, cocaine, amphetamines, PCP, and natural and semi-synthetic opioids (such as heroin and oxycodone), but not synthetic opioids such as fentanyl.
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Tyler Shamash overdosed again the next day and died. His family learned five months later, after the coroner did a toxicology report, that fentanyl had been found in his system.
“I was so incredulous why do you trust doctors; you go to doctors for advice,” Shamash told NBC News. “It is incredible to me that all the institutions are not testing it [fentanyl]. Why not? But then I think the answer to that is: they think they are.»
The death of her son in 2018 prompted Shamash to advocate for legislation that would require a sixth test for fentanyl to be added. Through a bipartisan effort, Tyler’s Law passed unanimously and went into effect in early 2023 in California, the first and so far only state to do so, though the law will expire in just five years.
Overdose deaths associated with fentanyl have surpassed those due to heroin or other opioids. In 2022, the Drug Enforcement Administration seized 50.6 million fentanyl-laced pills posing as regulated prescription pills such as Xanax or oxycodone and more than 10,000 pounds of fentanyl powder. But there is no federal mandate requiring emergency rooms to specifically test for fentanyl.
Shamash is now working with other families who have suffered a similar loss in hopes of enacting federal legislation.
«Every time I hear about the death of another child, it’s like, why don’t we get to them?» she said. “I don’t know if it’s… like I haven’t saved my own son, so I feel like I have to save everyone else.”
He teamed up with Dr. Roneet Lev, an emergency addiction doctor at Scripps Mercy Hospital in San Diego, who developed a Toolbox to help other hospitals test for fentanyl, which he said hospitals are already equipped to do and it’s relatively inexpensive: It costs about 75 cents to add a reagent to test for fentanyl.
“Fentanyl testing has really drastically changed the way I approach patients and how my conversation with them goes when the test is positive,” Lev said.
She sees patients every day who don’t know they’ve taken something laced with fentanyl. Now knowing the seriousness of the drugs they’ve used, Lev said patients “may want to change or do something different. They might throw away those pill bags…or give you a prescription for naloxone, the opioid reversal agent.”
Both the American Hospital Association and the American Academy of Emergency Medicine declined to comment on testing practices and whether national guidance is being considered.
Legislation replicating Tyler’s Law is making its way through the Maryland state House of Representatives, led by the family of Josh Siems, who died of an overdose last year.
Josh’s partner, Melanie Yates, said she had discovered the California law after «going down an investigative rabbit hole» when Josh’s initial toxicology report showed only cocaine, even though his family had found fentanyl in his apartment. .
She was even more puzzled when she found a epic research study done in conjunction with the University of Maryland Center for Substance Abuse Research which indicated that only 5% of toxicology tests were looking at fentanyl. When tested, positivity rates for fentanyl approach 50%, more than three times the positivity rate for opioids.
“How are we going to track fatal and non-fatal overdoses? How are we going to build systems around data we don’t have? How are we going to warn people who don’t know they are taking fentanyl?» Yates said in an interview. “Drug addiction affects all races, all genders, all ages, all socioeconomic groups. There is no one who is exempt from this.”
More than 107,000 Americans died from a drug overdose in 2021, most of them suspected from fentanyl, according to the CDC. The DEA warns on its website: «Drug dealers are increasingly mixing fentanyl with other illicit drugs, in powder and pill form, to create addiction and create repeat customers.»
With fentanyl expanding rapidly in the illicit drug market, Yates says it’s irresponsible for hospitals not to test it.
“We are going to kill people if we don’t test for fentanyl,” he said.
“It’s the right thing to do,” said Lev, the addiction doctor. «We have a covid epidemic; we tested for covid. We have a fentanyl epidemic. Why aren’t we testing for fentanyl?»