What question did this study set out to answer?

To examine longitudinal patterns and compare the 30-day risks of opioid-related harmful outcomes associated with illicit-source versus medical-source fentanyl exposure.

August 16, 2026EClinicalMedicineOpen Access

Longitudinal patterns of fentanyl utilisation (medical versus illicit sources) in the United States 2015–2023: a retrospective cohort study

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Authors

SLSeungyeon LeeCleveland Clinic WSWenyu SongBrigham and Women's Hospital DBDavid W. BatesBrigham and Women's Hospital

Discussion

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Implication

Retrospective cohort study finds substantially higher 30-day risks of overdose and dependence with illicit versus medical fentanyl exposure, highlighting its role in the opioid crisis.

Key Points

To examine longitudinal patterns and compare the 30-day risks of opioid-related harmful outcomes associated with illicit-source versus medical-source fentanyl exposure.
Conducted a retrospective cohort study of N=295,728 patients (85,535 medical-source and 210,193 illicit-source) using the US Epic Cosmos electronic health record database between 2015 and 2023.
Categorized fentanyl exposure by linking urine drug testing (UDT) results with electronic medication records using a sequential time-window screening approach.
Adjusted for baseline confounders and social vulnerability using stabilized inverse probability weighting and evaluated 30-day outcomes using Cox proportional hazards regression.
Nonfatal opioid overdose prevalence increased substantially over time to 18.6% in the illicit-source cohort compared with a modest increase to 4.3% in the medical-source cohort.
Illicit fentanyl initiation was associated with significantly elevated 30-day risk of overdose (aHR 2.99; 95% CI, 2.71–3.29; P < 0.001), dependence (aHR 3.05; 95% CI, 2.89–3.22; P < 0.001), and abuse (aHR 1.96; 95% CI, 1.84–2.10; P < 0.001) compared with medical-source initiation.
Higher prevalence and risk of opioid-related harms in the illicit-source cohort remained consistent across clinical subgroups and geographical regions.

Cite This Study

Lee et al. (2026) studied this question.

synapsesocial.com/papers/6a8179cbf2fb91fc834ad1e1 https://doi.org/10.1016/j.eclinm.2026.104141

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Implication

Retrospective cohort study finds substantially higher 30-day risks of overdose and dependence with illicit versus medical fentanyl exposure, highlighting its role in the opioid crisis.

Longitudinal patterns of fentanyl utilisation (medical versus illicit sources) in the United States 2015–2023: a retrospective cohort study

Discussion

Member takes

Implication

Key Points

Cite This Study

Longitudinal patterns of fentanyl utilisation (medical versus illicit sources) in the United States 2015–2023: a retrospective cohort study

Discussion

Member takes

Implication

Key Points

Cite This Study

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