Oregon Man Suffers First Known Case of Brain Inflammation from Fentanyl Inhalation

A 47-year-old man from Oregon nearly died after experiencing the first documented case of brain inflammation caused by inhaling fentanyl, according to doctors at Oregon Health & Science University (OHSU). The man lost consciousness and risked irreversible brain damage after snorting the powerful opioid during a business trip in February 2023.

The previously healthy man almost succumbed after being found unresponsive in his Portland hotel room, surrounded by crushed pills and white residue. He was rushed to the emergency department at OHSU, where clinicians diagnosed him with toxic leukoencephalopathy, a rare condition characterized by inflammation and damage to the brain's white matter. MRI scans revealed severe white matter inflammation, swelling, and cerebellar injury.

Upon arrival at the hospital, the man was obtunded, withdrawing only to pain stimuli. Initial drug screens were negative, but a subsequent fentanyl test confirmed the presence of the drug in his system. This case marks the first time toxic leukoencephalopathy has been linked to fentanyl inhalation, as previous instances were associated with heroin use.

Why this matters: The incident highlights the severe and potentially irreversible brain damage that can result from inhaling fentanyl, in addition to the well-known risks of respiratory depression and loss of consciousness. As fentanyl becomes increasingly prevalent due to its low cost and potency, public health officials warn of the growing dangers posed by this lethal substance.

The patient remained bedridden for 18 days, requiring tube feeding and various treatments to manage complications. He gradually regained consciousness and responsiveness but had no memory of how he inhaled the fentanyl. After 26 days in the hospital and a stay in a skilled nursing facility, the man made a full recovery and returned to work within a year.

Dr. Chris Eden, lead author of the case study, emphasized the importance of including fentanyl in routine drug screens for early identification and appropriate management. "This case serves as a reminder of the ever-changing illicit drug supply and the importance of considering atypical presentations of opioid toxicity," Eden stated. The successful outcome involved a multidisciplinary team of OHSU clinicians working together to provide extensive treatment for the patient.

Key Takeaways

• First documented case of brain inflammation from fentanyl inhalation.
• Man lost consciousness, risked brain damage after snorting fentanyl.
• Diagnosed with rare condition of white matter inflammation and damage.
• Successful recovery after 26 days in hospital and skilled nursing care.
• Highlights dangers of fentanyl inhalation and importance of drug screening.