Notification from the Los Angeles County Department of Public Health
Notification from the Los Angeles County Department of Public Health
LAC DPH Health Alert:
Contaminated Ecstasy and Accidental Drug Overdoses
May 27, 2022
This message is intended for healthcare professionals including emergency departments, primary care physicians, and first responders. Please distribute as appropriate.
Key Messages
  • Three cases of accidental drug overdoses among adolescents in Los Angeles County were identified over the past several days that resulted in unexpected cardiac and neurologic toxicities. All cases involved the presumed use of ecstasy that was contaminated with fentanyl and other yet-to-be-identified psychoactive substance(s). All three cases were responsive to naloxone.
  • The likelihood that contaminated ecstasy and other pills are available in the community is very high, as is the risk of overdose when exposed to these substances.
  • Emergency clinicians should evaluate their patients with suspected drug-induced altered mental status for cardiac and neurological toxicity.
  • Widespread access to harm reduction interventions such as naloxone (an opioid overdose reversal medication, commonly known as the brand name Narcan) and drug checking with fentanyl test strips, which can test a drug supply for fentanyl and other common contaminants, is essential to prevent accidental overdoses and death in adolescents.
Situation
On May 25, 2022, three female adolescents were found down in a Los Angeles County residence. They required emergency medical intervention including intranasal naloxone and intubation. The adolescents had purchased blue circular tablets that were reportedly ecstasy from an online dealer, who they reported arrived with a large bag of these pills, raising significant concern for the possibility of ongoing overdoses in Los Angeles County. The adolescents crushed and snorted the tablets and subsequently lost consciousness.
Clinically, they were found to have significant cardiac and neurologic toxicity from the substances: there were elevated troponins with shortened ejection fractions with echocardiograms but no EKG evidence of a heart attack, and watershed infarcts in the basal ganglia on MRI with persistent rigidity and posturing on clinical examination.
This incident highlights the growing national and local trend of illicit drugs and counterfeit pills being contaminated with illegally manufactured fentanyl and other stimulant contaminants with toxicity impacting multiple organ systems, including the heart and brain, that can lead to life threatening complications. Fentanyl and methamphetamine-related overdose deaths have increased in Los Angeles County since the pandemic and continue to rise at an alarming rate.
Nationwide, there has been a growing trend of illicit drugs (particularly methamphetamine and cocaine) and counterfeit pills contaminated with fentanyl and other life-threatening substances. This has impacted both adults and youth. In 2021, fentanyl was identified in about 77% of adolescent overdose deaths nationally, and over 80% of drug overdose deaths among adolescents aged 15 – 19 in 2015 were unintentional.
Fentanyl is a high potency synthetic opioid that is colorless and odorless and can cause rapid respiratory depression resulting in accidental death. Methamphetamine is a synthetic stimulant that can cause dangerous increases in heart rate and blood pressure resulting in heart attacks, strokes, and death. The combination of these synthetic substances increases the likelihood of overdose deaths. Awareness of these substances is necessary for both the general public, including youth and adults, as well as healthcare providers.
Actions Requested of Providers
Treating Overdose Cases
  • Suspect fentanyl toxicity and be aware of multi-substance contamination in overdose cases. Note that contamination of drugs and/or pills may result in patients being unaware of exposures.
  • Be aware that, when fentanyl is involved, multiple and higher doses of naloxone are often needed due to the higher potency of fentanyl compared to other opioids.
  • In patients with suspected drug-induced altered mental status, consider assessing cardiac function with an EKG and echocardiogram, in addition to cardiac enzymes, given the risk of cardiac toxicity from overdoses involving various unknown substances. Also, consider conducting a neurological examination to inform an appropriate workup, which may include MRI imaging to identify intoxication-related neurologic damage.
  • Report cases to Poison Control. Call 1-800-222-1222
Identify Patients at Risk and Provide Anticipatory Harm Reduction Guidance
  • Screen all patients, including adolescents, for recreational drug use.
  • Educate patients who use drugs to avoid using drugs from unknown sources and to never use alone.
Prescribe Naloxone to Patients at Risk for Overdose
  • Naloxone reverses opioid poisoning.
  • Prescribe naloxone for any patients at risk for drug overdoses. It can be administered through the nose or as an intramuscular injection to save their life. Both methods are equally effective.
  • Educate patients on how to use naloxone: http://www.narcan.com
Recommend Fentanyl Test Strips
  • Fentanyl test strips identify drugs contaminated with fentanyl, and although they are not 100% reliable, they can help individuals make informed decisions about the drugs they use. Fentanyl test strips require dissolving a small amount of the drug supply in water, dipping the test strip into the liquid, and waiting 15 seconds for a result.
  • Fentanyl testing strips can be purchased online at:
  • Fentanyl testing strips can be obtained through AIDS Project Los Angeles (APLA):
Additional Resources
Obtaining Substance Use Disorder Treatment
In Los Angeles County, the general public, health care providers, and patients can find substance use treatment services and bed availability using an online, filterable service locator known as the Services and Bed Availability Tool (SBAT), going on www.RecoverLA.org on their mobile devices, or by calling the Substance Abuse Service Helpline (SASH). Services include outpatient and intensive outpatient treatment, residential treatment, withdrawal management, and Opioid Treatment Programs.
This communication was sent by Siddarth Puri, M.D., Associate Medical Director of Prevention, Division of the Substance Abuse Prevention and Control, Los Angeles County Department of Public Health.
To view a printable PDF of this communication and other LAHAN communications, please visit publichealth.lacounty.gov/lahan.
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