The man came in knocked out and very close to dying.
The 47-year-old man came to Oregon Health & Science University's emergency
room by ambulance on February 25, 2023. He had been healthy before and had no
known medical background. It was found that he had passed out in his hotel room
while on a work trip. As doctors started giving treatment that saved lives,
they looked for the cause.
That is, breathing in fentanyl made big parts of the patient's white matter
become swollen to the point where he lost awareness and could have died or lost
the ability to use his brain in the future.
Medical professionals had seen cases where people inhaled heroin before, but
the OHSU patient is thought to be the first case where someone inhaled illegal
fentanyl. The study's lead author says it should be seen as a warning about how
dangerous a drug is that is 50 times stronger than heroin, cheap, and easy to
get.
"Use of opioids, especially fentanyl, has become very shamed," said
lead author Chris Eden, M.D., who was on the patient's care team and is now a
second-year student in internal medicine at the OHSU School of Medicine.
"This is the story of a middle-class man in his late 40s who used fentanyl
for the first time. He has kids." This shows that fentanyl can have an
effect on everyone in our society.
Even though this is the first case that has been reported, Eden said it's
possible that there were other cases that were missed because not much is known
about how the syndrome works in the body. He also said that fentanyl hasn't
usually been found in hospitals' normal urine drug tests.
On the other hand, deaths of fentanyl and other opioids happen all too often
and kill or seriously hurt people.
"We know very well the classic opiate side effects: slow breathing, loss
of consciousness, and feeling lost," Eden said. We usually don't think of
it as damaging the brain in a way that might not be fixable, but in this case
it did.
Brain inflammation was seen on magnetic resonance imaging. But the patient's
continued loss of awareness, memory, and ability to do things could have been
caused by a number of things, such as a metabolic disease, a stroke, or being
exposed to carbon monoxide. Finally, an unusual drug test showed that he had
fentanyl in his blood.
A Slow Comeback:
The patient slowly got better after 26 days in the hospital and then a stay in
a special nursing home to help him speak and do other things again. He is now
back at work and living with his family in the Seattle area. He still can't
remember what happened.
Wraparound care with many doctors and help at Oregon's academic health center
and biggest hospital, both of which take a patient-centered approach, led to
the good result.
Doctors from internal medicine, neurology, neuroradiology, and palliative care
were involved in this case, along with nurses, social workers, release
managers, physical therapists, dietitians, and pharmacists, Eden said.
"I'm proud of how these OHSU multidisciplinary teams work together to care
for patients who are complicated in both medical and social ways."
The article that came out today in BMJ Case Reports also includes a patient's
point of view.
He said, "I often feel bad about what I did to myself, my wife, and my
family." "I'm thankful for all the doctors, nurses, and EMTs who
saved my life and the therapists who helped me become a useful member of
society again."
