{"title":"Norfentanyl detection after negative confirmatory testing following heavy illicit fentanyl exposure: A two-patient case series.","authors":"Daisy Valdivieso, Maryam Soltani","doi":"10.1111/ajad.70216","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Prolonged fentanyl detection may complicate urine drug testing (UDT). We describe norfentanyl detection after negative confirmatory testing.</p><p><strong>Methods: </strong>Two patients (N = 2) entering residential treatment after heavy illicitly manufactured fentanyl exposure underwent clinically indicated serial UDT with confirmatory LC-MS/MS.</p><p><strong>Results: </strong>Both had negative confirmatory results followed by subsequent low-level urinary norfentanyl detection. Recurrent exposure could not be excluded.</p><p><strong>Discussion: </strong>These findings demonstrate diagnostic uncertainty rather than a defined pharmacokinetic mechanism.</p><p><strong>Conclusions and scientific significance: </strong>Low-level norfentanyl after negative confirmatory testing should prompt longitudinal assessment rather than automatic attribution to recurrent use or prolonged detection.</p>","PeriodicalId":7762,"journal":{"name":"American Journal on Addictions","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal on Addictions","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ajad.70216","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SUBSTANCE ABUSE","Score":null,"Total":0}
引用次数: 0
Abstract
Background and objectives: Prolonged fentanyl detection may complicate urine drug testing (UDT). We describe norfentanyl detection after negative confirmatory testing.
Methods: Two patients (N = 2) entering residential treatment after heavy illicitly manufactured fentanyl exposure underwent clinically indicated serial UDT with confirmatory LC-MS/MS.
Results: Both had negative confirmatory results followed by subsequent low-level urinary norfentanyl detection. Recurrent exposure could not be excluded.
Discussion: These findings demonstrate diagnostic uncertainty rather than a defined pharmacokinetic mechanism.
Conclusions and scientific significance: Low-level norfentanyl after negative confirmatory testing should prompt longitudinal assessment rather than automatic attribution to recurrent use or prolonged detection.
期刊介绍：
The American Journal on Addictions is the official journal of the American Academy of Addiction Psychiatry. The Academy encourages research on the etiology, prevention, identification, and treatment of substance abuse; thus, the journal provides a forum for the dissemination of information in the extensive field of addiction. Each issue of this publication covers a wide variety of topics ranging from codependence to genetics, epidemiology to dual diagnostics, etiology to neuroscience, and much more. Features of the journal, all written by experts in the field, include special overview articles, clinical or basic research papers, clinical updates, and book reviews within the area of addictions.
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