OHSU sees world’s first documented case of brain disease from fentanyl inhalation

PORTLAND, Ore. ( KOIN ) – A patient who arrived at an Oregon emergency room “unconscious and near death” in 2023 is the world’s first documented case of brain disease from inhaling fentanyl, according to Oregon Health & Science University.

The patient, a previously healthy 47-year-old man, was taken to OHSU by ambulance in February 2023 after he was found collapsed in his hotel room where he was staying for a business trip, OHSU said.

According to the case study — published in the journal BMJ Case Reports — as doctors searched for a cause, an initial drug test was negative for opioids.

Doctors conducted a specialized test which found fentanyl in the patient’s system — leading to a “surprising and unprecedented diagnosis” of toxic leukoencephalopathy by fentanyl inhalation, OHSU said.

According to the hospital, inhaling fentanyl led to large sections of white matter in the patient’s brain to become inflamed to the point he lost consciousness and was at risk of irreversible loss of brain function or death.

Medical officials have previously documented cases of similar diagnoses with patients inhaling heroin; however, this is believed to be the first case involving inhaling illicit fentanyl, OHSU said.

“Opioid use, especially fentanyl, has become very stigmatized,” said case study lead author Dr. Chris Eden, a second-year resident in internal medicine in the OHSU School of Medicine who was part of the patient’s treatment team. “This is a case of a middle-class man, in his late 40s, with kids, who used fentanyl for the first time. It demonstrates that fentanyl can affect everyone in our society.”

Even though this is the first documented case, Eden notes other cases were likely not recognized because little is known about the syndrome, and hospitals haven’t traditionally included fentanyl in their standard drug screens.

“We know very well the classic opiate side effects: respiratory depression, loss of consciousness, disorientation,” Eden said. “But we don’t classically think of it causing possibly irreversible brain damage and affecting the brain, as it did in this case.”

‘Miraculous’ recovery

OHSU said the patient recovered after 26 days in the hospital and a stay in a skilled nursing facility to regain speech and function.

Researchers said the case study should serve as a warning about the dangers of fentanyl — which is cheap, readily available, and 50 times more potent than heroin — and said fentanyl should be included in hospital drug screenings.

Now, the patient is home with family in the Seattle area and back to work.

“From what I can remember early on is that my recovery was miraculous. Early on it was looking like I would need 24-hour care after being discharged but I focused and worked hard in my therapy session and was determined not to leave the hospital only to be checked into a group facility for ongoing care. It’s been 6 months now and I am back at home, working and feeling strong and healthy. I have regrets often about what I did to myself, my wife, and my family. I’m grateful to all the doctors, nurses, and EMTs that saved my life and the therapists that got me back to a functioning member of society,” the patient recalled in the study.

The case study comes as Oregon recorded the largest year-to-year increase of fentanyl overdose deaths in 2023 in the nation , with Washington state close behind.

According to the Centers for Disease Control and Prevention , Oregon had a 41% increase in fentanyl overdose deaths between September 2022 and September 2023, as first reported by The Oregonian .

In 2019, Oregon saw 78 fentanyl overdose deaths, followed by 705 in 2022, and 1,268 in 2023, the CDC reported.

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