An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use

Letters6 November 2018An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine UseUzoma B. Duru, MD, Gauri Pawar, MD, Jed A. Barash, MD, Liv E. Miller, PsyD, Indrani K. Thiruselvam, PhD, and Marc W. Haut, PhDUzoma B. Duru, MDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.), Gauri Pawar, MDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.), Jed A. Barash, MDSoldiers' Home, Chelsea, Massachusetts (J.A.B.), Liv E. Miller, PsyDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.), Indrani K. Thiruselvam, PhDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.), and Marc W. Haut, PhDWest Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L18-0411 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Davies suggests that gabapentin be considered a potential causal factor in fentanyl-related amnesia. We certainly cannot completely refute that any drug for which testing is not done could be involved. Moreover, the abuse of gabapentin and other medications may go unreported. However, neither our patient nor 10 of the 14 patients from Massachusetts who developed this syndrome (1) were known to be using gabapentin at the time of presentation. That fentanyl played a primary role in this syndrome is strengthened by a subsequent report of 4 additional patients in Massachusetts who tested positive for this agent, including ...References1. Barash JA, Somerville N, DeMaria A. Cluster of an unusual amnestic syndrome—Massachusetts, 2012-2016. MMWR Morb Mortal Wkly Rep. 2017;66:76-9. [PMID: 28125568] doi:10.15585/mmwr.mm6603a2 CrossrefMedlineGoogle Scholar2. Barash JA, Ganetsky M, Boyle KL, Raman V, Toce MS, Kaplan S, et al. Acute amnestic syndrome associated with fentanyl overdose [Letter]. N Engl J Med. 2018;378:1157-8. [PMID: 29562161] doi:10.1056/NEJMc1716355 CrossrefMedlineGoogle Scholar3. Barash JA, Kofke WA. Connecting the dots: an association between opioids and acute hippocampal injury. Neurocase. 2018;24:124-31. [PMID: 29774783] doi:10.1080/13554794.2018.1475572 CrossrefMedlineGoogle Scholar4. GOV.UK. Gabapentin (Neurontin): risk of severe respiratory depression. 26 October 2017. Accessed at www.gov.uk/drug-safety-update/gabapentin-neurontin-risk-of-severe-respiratory-depression on 30 June 2018. Google Scholar5. Barash JA, Ganetsky M, DeMaria A. More on acute amnestic syndrome associated with fentanyl overdose [Letter]. N Engl J Med. 2018;378:2247-8. [PMID: 29874536] doi:10.1056/NEJMc1805681 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: West Virginia University School of Medicine, Morgantown, West Virginia (U.B.D., G.P., L.E.M., I.K.T., M.W.H.)Soldiers' Home, Chelsea, Massachusetts (J.A.B.)Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0575. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAn Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use Uzoma B. Duru , Gauri Pawar , Jed A. Barash , Liv E. Miller , Indrani K. Thiruselvam , and Marc W. Haut An Unusual Amnestic Syndrome Associated With Combined Fentanyl and Cocaine Use Todd Davies Metrics Cited byFentanyl Overdose Causing Hippocampal Ischaemia Followed by Delayed LeukoencephalopathyThe rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies 6 November 2018Volume 169, Issue 9Page: 662-663KeywordsAmnesiaAnticonvulsantsCocaineDisclosureDrug abuseDrug interactionsDrugsHypoxiaOpioidsOxygen ePublished: 6 November 2018 Issue Published: 6 November 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...