Antecedents of Fentanyl Coinvolvement in Deaths Attributed to Stimulant Poisoning in San Francisco, CA

Antecedents of Fentanyl Coinvolvement in Deaths Attributed to Stimulant Poisoning in San Francisco, CA

Published: November/December 2026
Journal Article

Overview

This one-hour, journal article-based activity examines factors associated with fentanyl co-involvement in deaths attributed to stimulant poisoning. Learners will explore differences between fentanyl-stimulant and stimulant-no-opioid deaths, including demographic, clinical, and substance-use-related factors associated with fentanyl co-involvement. The article also examines the implications of these findings for identifying opportunities to tailor overdose prevention and other risk-reduction strategies for people who use stimulants and opioids. 

The target audience for this intermediate continuing education activity includes physicians, nurse practitioners, physician assistants, and other clinicians, researchers, students, and policymakers. 

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, and Systems-Based Practice. 

Abstract

Aims 

Deaths attributed to stimulants in the United States are largely driven by fentanyl coinvolvement. We sought to compare antecedents of acute stimulant deaths involving fentanyl to those that do not involve opioids.

Methods

We analyzed data from 31 fentanyl-stimulant and 70 stimulant-no-opioid decedents in a psychological autopsy study in San Francisco, CA. We used Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify variables potentially associated with coinvolvement of fentanyl in death. We included 36 variables (sociodemographic characteristics, substance use, medical history, and circumstances surrounding death) from medical examiner reports, informant interviews, and medical records. We conducted multivariable logistic regression using variables selected by the LASSO model to assess associations with coinvolvement of fentanyl in death.

Results

Past-year fentanyl use and opioid-related emergency department visits in the 3 years before death were associated with higher odds of fentanyl involvement in death (adjusted odds ratio (aOR) = 3.10, 95% CI: 1.16—8.29, P = 0.02 and aOR = 4.62, 95% CI: 1.03—20.66, P = 0.045, respectively). Having a cardiac condition (from medical history, autopsy, or informant report) was associated with lower odds of fentanyl involvement in death (aOR = 0.13, 95% CI: 0.03—0.46, P < 0.002).

Conclusion

Our findings add to existing evidence that fentanyl-stimulant deaths are markedly different than stimulant-no-opioid deaths. The association of opioid-related emergency department history with fentanyl involvement in death reinforces a potential touch point for overdose prevention efforts (e.g., naloxone, medications for opioid use disorder). Our finding of cardiac conditions being associated with lower odds of fentanyl involvement in death supports the hypothesis that stimulant-no-opioid deaths may be driven by cardiovascular conditions.

Learning Objectives

Upon completion of this activity, learners will be able to:

1. Compare characteristics and antecedents associated with fentanyl-stimulant and stimulant-no-opioid deaths.  
2. Interpret associations between prior fentanyl use, opioid-related emergency department (ED) visits, cardiac conditions, and fentanyl co-involvement in deaths attributed to stimulant poisoning. 
3. Apply study findings to identify opportunities for tailored prevention strategies among people who use stimulants and opioids. 

Registration Rates

*Residents, Fellows-in-training, Interns, and Students must join ASAM to receive a discounted registration rate. Click here to become an ASAM member. National and Chapter membership dues apply. There is no charge for Students to become a Member, but verification of student status is required.

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Refunds & Cancellations

All ASAM eLearning Center refund requests must be made in writing to [email protected] within 90 days of purchase. Those requesting refunds for courses that are in progress will receive partial refunds or eLearning Center credit. Automatic full refunds will be made for any course with a live-course component that has been canceled.

Open Registration: 11/03/2026 - 02/10/2029

Close Access Date: 02/10/2029

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click Download Journal Article in the box titled Journal Article and read the journal article in its entirety. 
3. Click Complete Post-Test to answer multiple-choice questions. You will have 10 attempts to pass and must answer 2 out of 3 questions correctly.
4. Click Complete Evaluation to provide valuable activity feedback. Scroll down on all questions, as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

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Accreditation & Credits

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credits Available

• Physicians: 1.00 Credit
• Nurses & NPs: 1.00 Nursing Contact Hour
• PAs: 1.00 Credit
• Interprofessional Continuing Education: 1.00 Credit
• Certified Counselors: NBCC Contact Hours Not Offered
   American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. American Society of Addiction Medicine is solely responsible for all aspects of the programs.

Maintenance of Certification (MOC)/Continuing Certification Program (CCP)

This activity is designed to meet the requirements for MOC/CCP for several primary physician boards and for state licensing CME requirements. MOC Credit is only reported and designated for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• ABIM MOC Points: 1.00 Medical Knowledge
• ABP MOC: 1.00 Lifelong Learning & Self-Assessment
• ABS Continuing Certification: 1.00 Accredited CME
• ABA MOCA 2.0®*: 1.00 Lifelong Learning MOCA 2.0® is a trademark of the American Board of Anesthesiology®. This activity contributes to the CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology's (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, https://www.theaba.org/, for a list of all MOCA 2.0 requirements.

Additionally, this activity has been designed to satisfy the requirements of the following primary physician board certification requirements. Please confirm with your individual Board.

• American Board of Preventive Medicine (ABPM)
• American Board of Psychiatry and Neurology (ABPN)
• Royal College of Physicians and Surgeons of Canada (RCPSC)

Certificates for other professions

All participants may request a certificate of participation upon completion of the activity and an online evaluation confirming their participation. Learners are strongly advised to contact their professional licensing board or professional association to confirm this certificate will be accepted as evidence supporting continuing education requirements.

Disclosure Information

In accordance with the disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all accredited continuing education activities. These policies include identifying and mitigating all relevant financial relationships with ineligible companies for those involved in the creation and dissemination of accredited continuing education. 

See the attached article and pdf for a list of disclosures