While standard toxicology screenings test for opiates, chemicals extracted from natural sources such as morphine (an indicator of heroin use), most of these screenings do not detect fentanyl, a synthetic opioid. Patients who are treated in the emergency department for overdoses are tested for fentanyl in only 5% of cases, and fentanyl is detected in almost 50% of these tests. As overdose deaths from synthetic opioids were 18 times more likely in 2020 than in 2013, updating screening protocols to include fentanyl testing would be prudent.