DiSalvo P, Cooper G, Tsao J, et al. - This study was intended to present a case series of nine individuals without opioid use disorder who presented to two urban emergency departments (EDs) with opioid toxicity after insufflating a substance they believed to be cocaine. Nine patients from five discrete locations were brought to two affiliated urban academic EDs over a period of under three hours. Prior illicit opioid use was denied by all individuals. It was shown that Illicitly manufactured fentanyl and fentanyl analogue (IMF)-contamination of illicit drugs remains a public health concern that does not appear to be restricted to heroin. This confirmed outbreak indicates that for concomitant unintentional IMF exposure, providers should elevate their level of suspicion even in cases of non-opioid drug intoxication. The outcomes suggested that the responsive public health apparatuses must prepare for future IMF-contamination outbreaks.