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Recreational drug use is associated with poorer reproductive health. (© DedMityay - stock.adobe.com)

PORTLAND, Ore. — Fentanyl is an incredibly dangerous drug that causes tens of thousands of overdose deaths in the United States on a yearly basis. According to the Centers for Disease Control and Prevention, fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. Now, a new study published in BMJ Case Reports reveals how much more terrifying this synthetic opioid can be. Doctors from Oregon Health and Science University (OHSU) have documented the first known instance of toxic leukoencephalopathy, a rare type of brain damage resulting from the inhalation of fentanyl.

The findings shed light on a new and alarming way this dangerous drug can wreak havoc on the brain. The patient, a 47-year-old man with no prior medical issues, was found unresponsive in a hotel room during a work conference. Crushed pills and white residue, later identified as fentanyl, were discovered nearby. When he arrived at the hospital, he was barely conscious and unable to communicate.

Initially, a standard drug screen came back negative. However, doctors had a hunch and ordered a specialized test for fentanyl, which revealed shockingly high levels in his system. Brain scans painted a concerning picture — there was significant damage to the white matter, the brain’s communication highways.

Toxic leukoencephalopathy is a condition where white matter in the brain becomes damaged due to exposure to toxins. Think of it like a city’s roads and bridges crumbling after a massive chemical spill. In this case, inhaling fentanyl vapors is thought to have directly attacked these delicate structures.

“We know very well the classic opiate side effects: respiratory depression, loss of consciousness, disorientation,” says lead study author Dr. Chris Eden, a second-year resident in internal medicine at the OHSU School of Medicine who was part of the patient’s treatment team, in a media release. “But we don’t classically think of it causing possibly irreversible brain damage and affecting the brain, as it did in this case.”

An Oregon Health & Science University patient was the first documented case of illicit fentanyl inhalation causing toxic leukoencephalopathy, where large sections of white matter in his brain became inflamed to the point that he had lost consciousness and risked irreversible loss of brain function, or possibly death
An Oregon Health & Science University patient was the first documented case of illicit fentanyl inhalation causing toxic leukoencephalopathy, where large sections of white matter in his brain became inflamed to the point that he had lost consciousness and risked irreversible loss of brain function, or possibly death. (credit: OHSU)

Fentanyl is an opioid commonly prescribed for severe pain, but in recent years, it has become a major player in the opioid epidemic due to skyrocketing levels of misuse. This case reveals that beyond its known dangers, fentanyl can also silently ravage the brain when inhaled.

The OHSU medical team ruled out other potential causes like infections, stroke, or oxygen deprivation before landing on the diagnosis of fentanyl-induced toxic leukoencephalopathy. Although cases of brain damage from inhaling heroin have been reported before, this is the first time doctors have seen it happen with fentanyl.

Over his month-long hospital stay, the patient slowly regained consciousness and the ability to communicate. He went through intensive rehabilitation to relearn basic skills. Fortunately, he recovered enough to eventually return to work. However, the long-term impacts remain unknown, as toxic leukoencephalopathy can have lasting effects.

“I have regrets often about what I did to myself, my wife and my family,” the patient says. “I’m grateful to all the doctors, nurses and EMTs who saved my life, and the therapists who got me back to a functioning member of society.”

This case is a wake-up call about the hidden neurological dangers of fentanyl abuse, especially for use inhaling the drug. It underscores the importance of screening for this potent opioid, as standard drug tests often miss it. Catching fentanyl poisoning early could prevent devastating brain damage.

As our understanding of toxic leukoencephalopathy grows, doctors hope to find better ways to protect and heal the brain from these damaging effects. For now, the best defense is preventing fentanyl abuse in the first place through education, addiction treatment, and policies to restrict the illegal opioid supply.

StudyFinds’ Matt Higgins contributed to this report.

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