Inhaling Fentanyl may cause irreversible brain damage, finds study

Leukoencephalopathy refers to inflammation and damage to the brain’s white matter—the network of nerve fibres that enable the exchange of information and communication between different areas of the brain’s grey matter. Toxic leukoencephalopathy is a sudden or longstanding neurological syndrome, which has been reported after heroin inhalation. The condition manifests in various signs and symptoms, the most obvious of which are neurological and behavioural changes, ranging from mild confusion to stupor, coma, and death.

In this case, a previously healthy man was discovered unconscious in his hotel room with unidentified crushed pills nearby. Upon admission to the hospital, he exhibited neurological deficits, including an inability to respond to questions or commands, and only responding to pain stimuli in his legs.

Brain imaging revealed inflammation and swelling in the white matter and cerebellar injury, affecting his gait and balance. Despite testing negative for epilepsy, a urine test indicated exceptionally high levels of fentanyl, leading to a diagnosis of toxic leukoencephalopathy induced by fentanyl inhalation.

Over the following weeks, he remained bedbound and required various medical interventions for urinary incontinence, kidney injury, cognitive impairment, suspected opioid withdrawal, pain, agitation, and pneumonia. After 26 days, he was discharged to a rehabilitation facility and later returned home with outpatient physiotherapy and occupational therapy support. Remarkably, within a year of his hospitalization, he fully recovered and resumed full-time work.

“This is the first reported case associated with fentanyl. This case illustrates the need for the inclusion of fentanyl in routine urine drug screens for earlier identification and appropriate management,” said the report authors.

Reference: Eden CO, Alkhalaileh DS, Pettersson DR, et alClinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathyBMJ Case Reports CP 2024;17:e258395.