Fentanyl is responsible for the majority of fatal overdoses. However, ERs don’t test for it.

After her son's death, Juli Shamash began advocating for legislation to require hospitals to test for fentanyl. Tyler’s Law took effect in California this year.

LOS ANGELES — Tyler Shamash, 19, survived a drug overdose and his mother Juli asked several times if he had been tested for fentanyl.

Tyler Shamash. Family Photo

After years of struggling with addiction, Tyler was in and out sober living homes in Los Angeles. His family suspects that Tyler may have been using illicit drugs. According to the doctor, they had done a standard drug screen and found no fentanyl in the toxicology screens.

Juli Shamash believes that the doctor did not know that fentanyl was not included in the standard drug test in all emergency rooms in the country. The majority of emergency rooms have a standard drug panel that checks for drugs such as marijuana, cocaine and amphetamines. However, it does not check for synthetic opioids like Fentanyl.

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Tyler Shamash died the following day from another overdose. Five months later, his family discovered that fentanyl had been found in his system after a toxicology report was run by the coroner.

Shamash said to NBC News that he was in disbelief because doctors are trustworthy and doctors can give advice. It’s amazing to me that no institution tests for it [fentanyl]. Why would you? Then again, I believe the answer is “They think they are.”

Shamash was inspired to advocate for legislation that would add a sixth test for fentanyl after her son’s passing in 2018. Tyler’s Law was passed unanimously in a bipartisan effort. It took effect in California at the beginning 2023, making it the first and only state to do this. However, the law will expire in five years.

img alt=”Charles Shamash and Juli Shamash.” height=”1080″ src=”https://media-cldnry.s-nbcnews.com/image/upload/t_fit-760w,f_auto,q_auto:best/rockcms/2023-03/230313-Charles-Juli-Shamash-se-1103a-99c09c.jpg” width=”1638″/>
Charles, and Juli Shamash. NBC News

Fentanyl overdose deaths have outnumbered heroin and other opioid-related deaths. The Drug Enforcement Administration seized 50.6 millions fentanyl-laced pills that were disguised as prescription pills such as Xanax and oxycodone, along with more than 10,000 pounds fentanyl powder. However, there is no federal requirement that emergency rooms be tested for fentanyl.

Shamash now works with families that have experienced a similar loss to try and pass federal legislation.

She said, “Everytime I hear of another child dying, it is like, Why didn’t they get to them?” “I don’t know if it’s… like my son died, so I feel like everyone needs to be saved.”

Dr. Ronet Lev, an emergency physician at Scripps Mercy Hospital San Diego, developed a Toolkit that allows hospitals to conduct fentanyl testing. It costs only 75 cents to add a reagent.

Lev stated that “Fentanyl testing really has changed the way I approach patients” and “how my conversations with them go when it is positive.”

Dr. Roneet Lev.
Dr. Roneet Lev.NBC News

Every day, she sees patients who don’t realize they have taken fentanyl. Lev stated that patients now have the information they need to know the consequences of their drug use. They might throw out those pills or get a prescription for Naloxone (an opioid reversal drug).

The American Hospital Association and American Academy of Emergency Medicine did not comment on the testing practices or whether national guidance was being considered.

The Maryland state House is currently considering legislation to replicate Tyler’s Law. It will be led by Josh Siems’ family, who overdosed last year.

Melanie Yates, Josh’s partner, stated that she had discovered the California law after “going down a rabbit hole” when Josh’s initial toxicology report showed only cocaine. His family had also found fentanyl inside his apartment.

Josh Siems.
Josh Siems.Courtesy Melanie Yates

Even more puzzled was her discovery of an Epic Research study that was done in conjunction the University of Maryland’s Center for Substance Abuse Research. It indicated that only 5% of toxicology screens had been tested for fentanyl. Positive rates for fentanyl have been reported at close to 50% when testing is performed. This is three times higher than the rate for opiates.

“How will we track fatal and non-fatal overdoses?” How can we build systems that are based on data we don’t already have? Yates stated in an interview that how are we going to alert people who don’t know they’re using fentanyl? Drug addiction affects every race, gender, age, and socioeconomic class. This is a problem that affects everyone.

In 2021, more than 107,000 Americans were killed by drug overdoses. The majority of these deaths were due to fentanyl. The DEA warns that drug traffickers are mixing fentanyl and other illegal drugs to create addiction and repeat customers.

Yates believes it is irresponsible to not test for fentanyl because of the rapid growth of illicit drugs like fentanyl.

She said, “We’re going kill people if they don’t test foentanyl.”

Lev, an addiction doctor, stated that “it’s the right thing” We have a Covid epidemic. We did Covid testing. There is a fentanyl crisis. We have a fentanyl epidemic. Why don’t we do fentanyl testing?

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