A middle-aged American man with no previous medical history was found unconscious in his hotel room with “unidentified crushed pills and a white residue” on a nearby table. White powder was visible around the man’s mouth. This case marked the first reported instance of toxic leukoencephalopathy (TLE) from smoking fentanyl. TLE, or damage to the brain’s white matter from a toxic substance, has previously been seen in people smoking heroin, taking immunosuppressant drugs, or undergoing chemotherapy.

The 47-year-old man had significant damage to his cerebellum and globus pallidus, both crucial for movement and coordination. Symptoms of TLE can range from mild confusion to coma and death. The patient required extensive hospital treatment and rehabilitation but made a full recovery within a year. However, many others with substance-abuse-related TLE have not been as fortunate, with a high mortality rate observed in such cases.

Given the potency of fentanyl and its increased use in the US and UK, it is anticipated that more cases of fentanyl-induced TLE will emerge. Smoking or inhaling the drug may pose greater risks due to faster and higher concentrations reaching the brain. Additionally, even more potent synthetic opioids like nitazenes and brorphines are emerging, which could complicate toxicity screening and treatment further.

For more information, visit Smoking fentanyl can cause irreversible brain damage.