Governor Gavin Newsom signed SB-864 on August 22, making California the first state to require a urine drug screening for fentanyl in the emergency room if the hospital conducts a urine drug screening to assist in diagnosing the condition of the patient.
"Essentially, it says in an emergency department, if you order up a drug screen for whatever reason, that drug screen must include a test for fentanyl," explained Dr. Brian Roberts, MedStop Urgent Care Madonna Plaza Medical Director.
However, the new legislation likely won't change anything about acute care for someone who visits the ER experiencing an opioid overdose,
"It depends on what you're trying to learn. In any one patient, it would rarely make a difference. If you believe there's any chance of a drug overdose you're going to use Narcan," Dr. Roberts said.
He says this new law may provide more information about public health.
"From an epidemiologic point of view, finding out what's really going on there, because maybe we're just seeing the tip of the iceberg and it might help for finding out where the problem is and what sub-group of patients," Dr. Roberts said.
Dr. Brad Knox, Sierra Vista Regional Medical Center Emergency Room Physician and Chief of Staff, says urine drug screenings in the ER do not cover fentanyl but whether or not it is present in the patient's system will not change the acute care they receive if they are showing symptoms of an opioid overdose.
"No. The drug tests don't cover fentanyl, but that doesn't change anything clinically," he said.
Dr. Knox says if a patient enters the ER and is dying from an opioid overdose they treat them aggressively with the only existing reversal agents Narcan and Naltrexone. The patient will be treated the same way regardless of whether it is fentanyl or another opioid in their system because treatment options are limited.
"If you as the ER doctor are waiting for drug screen while you're treating that patient you're already way down. You're way behind the eight-ball," Dr. Knox said.
He says it will not make a difference in the emergency room and whether or not fentanyl is present it will not stop the patient from receiving acute care.
"If I have a crashing opiate overdose in front of me, that patient needs treatment here and now. You don't have time to wait to see a urine test," Dr. Knox added.
If you live around someone who might be susceptible to an opioid overdose it is recommended to keep Narcan on hand. Though it isn't cheap, it can save someone's life.
