A middle-aged Seattle man collapsed in his Portland, Ore.-area hotel room, where he was staying during a business trip.

He’d just tried fentanyl for the first time, and it very nearly killed him by literally destroying his brain.

Inhaling fentanyl caused terrible inflammation throughout large sections of white matter in the patient’s brain, his doctors at Oregon Health & Science University (OHSU) deduced.

White matter serves as the network of neural highways that connect various parts of the brain to each other and to the spinal cord.

As a result, he lost consciousness and came perilously close to irreversible loss of brain function — either killing him or leaving him a vegetable.

The patient is the first documented case of this phenomenon involving fentanyl, although previous cases have been noted involving heroin, researchers noted.

“This is a case of a middle-class man, in his late 40s, with kids, who used fentanyl for the first time,” said lead researcher Dr. Chris Eden, a second-year internal medicine resident at the OHSU School of Medicine. “It demonstrates that fentanyl can affect everyone in our society.”

Fentanyl is cheap, readily available and 50 times more potent than heroin, Eden noted. Illicit drug manufacturers frequently cut fentanyl into other substances like heroin, often without the knowledge of the user.

“We know very well the classic opiate side effects: respiratory depression, loss of consciousness, disorientation,” Eden said in an OHSU news release. “But we don’t classically think of it causing possibly irreversible brain damage and affecting the brain, as it did in this case.”

MRI scans revealed inflammation in the man’s brain, and a drug test revealed fentanyl in his system, according to a report published April 29 in BMJ Case Reports.

Even after he regained consciousness, the man couldn’t talk properly and continued to suffer from problems with memory and brain function.

Doctors ruled out other potential causes of the man’s brain damage — stroke, carbon monoxide exposure, diabetes — and ultimately pointed the finger at fentanyl.

The man recovered after 26 days in the hospital, followed by a stay in a skilled nursing facility to help him regain his speech and brain function.

He’s now home with his family in the Seattle area, and back to work.

To this day, he has no memory of the episode, doctors said.

“I have regrets often about what I did to myself, my wife and my family,” the man, who was not identified, said in the report. “I’m grateful to all the doctors, nurses and EMTs who saved my life, and the therapists who got me back to a functioning member of society.”

More information

The U.S. Centers for Disease Control and Prevention has more about fentanyl.

SOURCE: Oregon Health & Science University, news release, April 29, 2024