Leah LaRue, PharmD, PMPAssociate Director, Clinical AffairsMillennium Health

Fentanyl Increasingly Found in Cocaine and Meth Drug Tests

MedicalResearch.com Interview with:

Leah LaRue, PharmD, PMPAssociate Director, Clinical AffairsMillennium Health

Dr. LaRue

Leah LaRue, PharmD, PMP
Associate Director, Clinical Affairs
Millennium Health

MedicalResearch.com: What is the background for this study?

Response: Drug overdose deaths continue to increase, despite the leveling off of prescription opioid use and policy changes limiting opioid prescribing. While fentanyl has garnered most of the attention, overdose deaths involving cocaine and methamphetamine also have increased markedly over the past few years. It is possible that those increases are due not just to those drugs, but to concomitant use with fentanyl.

To better understand what is causing this rapid increase in overdose deaths, it is important to characterize the emerging combination of other illicit drugs with fentanyl, which increases the risk of overdose. The purpose of this study was to determine whether rates of the combination of nonprescribed fentanyl with cocaine or methamphetamine have changed in urine drug test (UDT) results through time.

MedicalResearch.com: What are the main findings?

Response: In this cross-sectional study of 1 million urine drug tests (UDT) results from January 2013 through September 2018, positivity rates for nonprescribed fentanyl in the cocaine-positive group increased significantly from 0.9% to 17.6%, a 1850% increase. Positivity rates for nonprescribed fentanyl in the methamphetamine-positive group also increased significantly, from 0.9% to 7.9%, a 798% increase. 

MedicalResearch.com: What should readers take away from your report? 

Response: The concomitant use of fentanyl with a stimulant poses a significant risk to public health because of heightened risk of overdose. Clinicians and patients should be aware of the risk of intentional or inadvertent fentanyl exposure with stimulant use, and take precautions to maximize patient safety.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Future research may include analysis of regional differences, as previous work by the authors have indicated that the rate of fentanyl positivity in combination with other drugs (i.e. heroin), have varied substantially by region. The results of this study may also prompt investigation into other fentanyl drug combinations. It also may be interesting to investigate whether these findings represent signs of a shift from heroin to fentanyl use in combination with the stimulants.

Any disclosures?

This study was supported by Millennium Health. Drs. LaRue, Dawson, Frasco, Huskey, and Guevara and Mr. Whitley are employees of Millennium Health. Dr. Twillman is a consultant of Millennium Health. 


LaRue L, Twillman RK, Dawson E, et al. Rate of Fentanyl Positivity Among Urine Drug Test Results Positive for Cocaine or Methamphetamine. JAMA Netw Open. 2019;2(4):e192851. doi:10.1001/jamanetworkopen.2019.2851

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Last Updated on April 28, 2019 by Marie Benz MD FAAD