Reports Due to Heroin Inhalation, but Not Fentanyl
On Feb. 25, 2023, the man was found unresponsive in his hotel room. While he had no known previous medical issues, the man had been unconscious for an unknown period before he was found. He was discovered close to unidentified crushed pills and white residue on a nearby table.When he arrived at the Oregon Health & Science University (OHSU) emergency department, he could not follow commands or answer questions. He could respond to pain stimuli in his legs but not his arms.
A hospital brain scan revealed that the white matter in his brain was inflamed and swollen, and his cerebellum—responsible for gait and balance—was injured.
While an initial drug screening produced negative results, a subsequent urinalysis showed a very high level of fentanyl, prompting a diagnosis of toxic leukoencephalopathy due to fentanyl inhalation.
Alleged 1st-Time Use
Fentanyl is a synthetic opioid known to be 50 to 100 times more potent than morphine, according to the U.S. Centers for Disease Control and Prevention (CDC). While it can be prescribed for pain, it is often sold through illegal drug markets for its heroin-like effect. As a result, rates of overdose deaths involving synthetic opioids, including fentanyl and fentanyl analogs, increased by more than 22 percent between 2021 and 2022. The overdose death rate was nearly 22 times higher in 2021 than it was in 2013, the CDC reports.“Opioid use, especially fentanyl, has become very stigmatized,” Dr. Chris Eden, lead author of the case study, said in a news release. “This is a case of a middle-class man, in his late 40s, with kids, who used fentanyl for the first time. It demonstrates that fentanyl can affect everyone in our society.”
Eighteen days after he was brought to the hospital, the man was still bedridden and required a feeding tube. He received multiple medications to treat urinary incontinence, kidney injury, cognitive impairment, suspected opioid withdrawal, pain and agitation, and pneumonia.
‘Miraculous’ Recovery
After 26 days, the man was discharged from the hospital to a rehabilitation facility, where he spent another month. He returned home with the support of an outpatient physiotherapist and occupational therapist. He fully recovered and returned to work after less than a year.“This case involved internal medicine, neurology, neuroradiology and palliative care physicians, in addition to nurses, social workers, discharge planners, physical therapists, dieticians and pharmacists,” Dr. Eden said in the press release. “I’m proud of these multidisciplinary teams at OHSU working together to take care of complex patients, both from a medical and social perspective.”
Today, the man has no recollection of the episode but expressed gratitude for his “miraculous” recovery.
“Early on it was looking like I would need 24 hour care after being discharged, but I focused and worked hard in my therapy session and was determined not to leave the hospital only to be checked into a group facility for ongoing care,” he said in a news release. “I have regrets often about what I did to myself, my wife, and my family.”
