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SYMPOSIUM 7: Creative Solutions for Global Challenges in Fentanyl Monitoring and Toxicology

Tracks
Track 3
Monday, September 22, 2025
2:00 PM - 3:30 PM
Grand Copthorne Waterfront Hotel - Waterfront Ballroom II

Details

With the rise in fentanyl-related toxicity and overdose cases worldwide, healthcare systems are grappling with unique issues surrounding accurate monitoring, effective treatment, and prevention. The symposium will focus on emerging technologies, collaborative international approaches, and novel intervention strategies for better management and reduction of fentanyl-related harm. Session 1: Advanced Monitoring Technologies for Fentanyl Detection and Management • Discuss the latest advancements in TDM technologies for real-time fentanyl monitoring, including point-of-care devices, biosensors, and wearable tech. • Speakers will address the benefits and challenges of these technologies, especially for high-risk patients. Session 2: Addressing Illicit Fentanyl in Forensic Toxicology and Public Health Surveillance • Examine the growing impact of illicit fentanyl in toxicology and its burden on public health, including laboratory strategies to detect new analogs. • Emphasis will be on global data-sharing and best practices to monitor and address synthetic opioid crises. Session 3: Innovative Solutions for Emergency Response and Overdose Prevention • Discuss novel interventions in fentanyl overdose response, such as next-generation naloxone, community-level interventions, and law enforcement collaborations. • International experts will highlight successful public health initiatives and legislative models.


Speaker

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A/Prof Bridin Murnion
St. Vincent's Hospital. St. Vincent's Clinical School

Setting the scene-A clinical perspective on the opioid epidemic

Abstract

There are multiple factors underlying the development and maintenance of the opioid crisis in North America. Policy decisions, healthcare standards and their impact on clinical practice and unscrupulous marketing have all contributed. The response to the crisis has occurred in multiple domains. This presentation will discuss the policy and clinical evolution and response to this crisis and the challenges relating to providing care in this population.
This session will
1. Provide an overview of the opioid crisis, with a focus on the evolving patterns of opioid use, including the rise of synthetic opioids like fentanyl, across different global regions.
2. Describe the clinical realities faced by healthcare professionals, including challenges in diagnosis and management of opioid use disorder (OUD), overdose, and associated comorbidities.
3. Identify gaps in current healthcare responses, such as limitations in screening tools, access to treatment, and health system preparedness and the burden for health systems.
4. Set the foundation for interdisciplinary dialogue, by framing the clinical challenges that necessitate innovative solutions in toxicology, monitoring, public health, and policy— some topics which will be explored in subsequent sessions of the symposium.

Biography

Associate Professor Murnion is a Clinical Pharmacologist/Toxicologist working in an inner city hospital in Sydney, Australia. She also has fellowships in Pain and Addiction Medicine. Her clinical and research interests are in use and harms of medicines used in pain management.
Dr Guillaume Drevin
Pathologie, Centre Hospitalier Universitaire d’Angers

Leveraging pharmacogenetics for tailored fentanyl overdose prevention and response

Abstract

The fentanyl crisis continues to drive opioid-related morbidity and mortality globally, necessitating innovative, precision-based strategies. Pharmacogenetics represents a critical tool to personalise both prevention and therapeutic approaches across the spectrum of opioid use and misuse. Genetic susceptibility to opioid dependence is increasingly recognized, particularly in patients prescribed opioids for chronic non-cancer pain. Variants in genes such as OPRM1, CNIH3, and ion channel genes (KCNC1, KCNG2) have been associated with increased vulnerability to opioid use disorder (OUD). Integrating genetic risk screening into pain management could enable anticipatory identification of high-risk individuals, allowing for closer monitoring, non-opioid alternatives, or early addiction intervention. In the context of overdose prevention, pharmacogenetic profiling may identify individuals with altered opioid receptor function or impaired fentanyl metabolism—such as carriers of OPRM1 A118G or CYP2B6*6 alleles—who are at elevated risk for fentanyl toxicity. In such individuals, pharmacogenetic data could inform both clinical and community-based interventions: priority access to take-home naloxone kits, education of lay responders, and the potential for genotype-guided adjustments in naloxone dosing strategies to improve reversal outcomes in high-potency exposures. Moreover, rapid genotyping during overdose emergencies may further enhance individualized naloxone administration, particularly in refractory or atypical presentations. Finally, pharmacogenetic-guided personalization of maintenance therapies (e.g. methadone or buprenorphine) has shown promise in improving adherence, reducing withdrawal symptoms, and enhancing long-term treatment outcomes. To conclude, embedding pharmacogenetics into clinical and harm reduction frameworks represents a paradigm shift toward more precise, equitable, and effective responses to the fentanyl crisis. Further translational research and infrastructure development are imperative for clinical implementation.

Biography

Guillaume Drevin, MD, is a medical biologist and clinical pharmacologist at Angers University Hospital, France. His work focuses on clinical and forensic toxicology, with a particular interest in toxicogenetics and its integration into routine practice to refine the interpretation of toxicological findings and personalize overdose risk assessment. He also serves as a court-appointed expert.
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Dr Lei Fu
Sunnybrook Health Sciences Centre, University of Toronto

Detection and monitoring fentanyl use and misuse in patients presented in emergency room and out-patient substance use clinic

Abstract

Opioid toxicity crisis is a major public health and safety concern. Fentanyl is one of the most commonly used or misused synthetic opioids. Clinical diagnostic laboratories play important role in managing poisoned patients, reducing the risks and harms associated with drug use. In this session, we will discuss the laboratory technologies and strategies in drug screen and confirmatory testing for emergency room and out-patient substance use clinics.
Learning objectives:
- Describe the assays used for routine screening and confirmatory detection of fentanyl, the advantages and limitations of each method.
- Describe the patterns of drugs detected in patients presented in emergency room and out-patient substance use clinic, and the prevalence of fentanyl use/misuse in these patient population
- Discuss the laboratory roles in better management and reduction of fentanyl related harm

Biography

Dr. Lei Fu is a clinical biochemist, in the Precision Diagnostics and Therapeutics Program (Laboratory Medicine), at the Sunnybrook Health Sciences Centre, and assistant professor at the Department of Laboratory Medicine and Pathobiology, University of Toronto. She is certified by the Canadian Academy of Clinical Biochemistry, and American Board of Clinical Chemistry in all three disciplines, Clinical Chemistry, Toxicological Chemistry, and Molecular Diagnostics. She is actively engaged in clinical service, teaching, and research. Her research interests are in two areas, biomarkers in maternal and fetal health, and clinical applications of pharmacogenomics.
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Dr Manuela Neuman
In Vitro Drug Safety and Biotechnology lab and University of Toronto

Fentanyl use and misuse – forensic cases, laboratory biomarkers

Abstract

Four waves of opioid overdose deaths have gripped the United States, beginning in the 1990s with a rise in the incidence of prescription opioid overdose deaths. A rise in heroin overdose deaths began in 2010, followed in 2013 by an escalation in synthetic opioid overdose deaths (illegally made fentanyl (IMF) and its congeners). The fourth wave is defined by the increased prevalence of IMF mixed with potent illicit stimulants like methamphetamine and cocaine. This most recent development has led to a surge in polysubstance overdose deaths, a consequence of the potency of fentanyl and the unpredictable effects of mixing such substances. We present five cases of fentanyl-related overdose, one of an adult whose death is a consequence of polysubstance fentanyl and stimulant abuse. The other four cases are of neonates and infants, the most vulnerable casualties of this epidemic. Young children whose parent(s) engage in drug-seeking behavior are at great risk for inadvertent drug overdose through the consumption of drug-tainted breast milk and the oral consumption of illicit drug(s) left within the proximity of the child. Physiological effects of combined IMF and illicit stimulant use during pregnancy also portend significant gestational complications, including placental abruption. Each of these cases considers routes of administration, maternal influences, physiologic effects, and considerations for both cause and manner of death. Laboratory tests play a major role in monitoring fentanyl to identify co-use with other drugs of misuse and guide informed patient care decisions. Moreover, the possible hypersensitivity reaction to fentanyl must be taken into consideration.

Biography

Dr. Manuela Neuman is the founder and CEO of In Vitro Drug Safety and Biotechnology lab in Toronto, which has been a leader in pharmacovigilence and state of the art clinical pharmacology for over twenty years. She is also affiliated Professor at the University of Toronto, Department of Pharmacology and Toxicology, where she has lectured and supervised graduate students from around the world. Beforehand, Dr. Neuman directed the Laboratory of Clinical Pharmacology at Sunnybrook Health Sciences Centre, as well as the Laboratory of Gastroenterology and Nutrition at The Hospital for Sick Children, all in Toronto. Internationally, she was a Visiting Professor at the Institute of Genetic Engineering in Trieste, Italy, a Visiting Professor in the Department of Hepatology and Gastroenterology at L’Université de Paris and Director of Laboratory of drug safety at INSERM XII, in Paris, France. Prior to these positions, Dr. Neuman taught at her alma matter: the Department of Physiology and Pharmacology at Tel Aviv University’s Faculty of Medicine. She also directed The Gastroenterology and Liver Disease Laboratory at a major hospital for many years, all while working as a clinical chemist for one of Israel’s main health insurance company clinics. Dr. Neuman has published extensively and on diverse topics, and is a member of several scientific societies. Most recently, she received The Lifetime Achievement Award from the Ontario Society of Clinical Chemists.
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Dr Fredric Hellman, M.D., M.B.A.
Dekalb County Medical Examiner's Office

Co-presenter

Biography

Dr. Fredric Hellman, M.D., M.B.A. currently serves as the Deputy Chief Medical Examiner for Dekalb County, Georgia, where he has been employed since May, 2022. He also serves as a locums forensic pathologist for the Allegheny County (Pittsburgh, PA) Medical Examiner’s Office and the Rhode Island State Medical Examiner’s Office. Prior to these engagements, Dr. Hellman was the Chief Medical Examiner for Delaware County, Pennsylvania, a large suburb of Philadelphia, where he served for well over 21 years. During that time, Dr. Hellman assumed a variety of leadership roles both in public health and in organized medicine for both Delaware County and Pennsylvania. He also designed and directed/co-directed for fifteen years the Master’s Degree Program in Forensic Medicine at Drexel University College of Medicine, at the time the first forensic science graduate program within an allopathic medical school. He is a military veteran, having been assigned to the Armed Forces Institute of Pathology in Washington, D.C. and having served as a Deputy Medical Examiner for the Armed Forces Medical Examiner’s Office and as a U.S. Army Flight Surgeon. Dr. Hellman investigated twenty aircraft accidents, many as mission chief as well as served as a forensic pathology consultant for many high-profile U.S. federal government medicolegal death investigations. Dr. Hellman was also the forensic pathologist in charge for the 9/11 investigation of United Airlines Flight 93 in Shanksville, Pennsylvania. Dr. Hellman is the author and/or co-author of 21 scientific publications, numerous resolutions in public health for organized medicine, both at the state and national levels, and has served as a speaker at numerous regional, national and international medical conferences. He is a Fellow of the National Association of Medical Examiners, a Member of the American Academy of Forensic Sciences and a Fellow of the College of American Pathologists. Dr. Hellman is Board Certified by the American Board of Pathology in Anatomic, Clinical and Forensic Pathology.

Session chair

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Danijela Kocic
St. Vincent's Hospital

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Ofelia Noceti
National Center for Liver Transplantation and Liver Diseases, Uruguay

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