What is Fentanyl?
Fentanyl, also spelled fentanil, is an opioid used as a pain medication and together with other medications for anesthesia. Fentanyl is also used as a recreational drug, often mixed with heroin or cocaine. It has a rapid onset and its effects generally last less than two hours. Medically, fentanyl is used by injection, nasal spray, skin patch, or absorbed through the cheek (transmucosal) as a lozenge or tablet.
Fentanyl was first made by Paul Janssen in 1960 and approved for medical use in the United States in 1968. In 2015, 1,600 kilograms (3,500 lb) were used in healthcare globally. As of 2017, fentanyl was the most widely used synthetic opioid in medicine. Fentanyl use is the most common cause of overdose deaths in the United States at more than 20,000, about half of all opioid-related deaths. Most of these overdose deaths were due to illegally made fentanyl.
Things you Should Know About Fentanyl.
1. How it works
Fentanyl may be used to treat severe pain that is unresponsive to less potent pain-relief medicines (analgesics). Fentanyl is a full agonist at the mu receptor (full agonists have a larger effect at higher dosages). By binding to these receptors, pain signals are blocked on their way to the brain.
Fentanyl belongs to the group of drugs known as opioids or opioid analgesics. Fentanyl may also be called a narcotic analgesic.
Fentanyl is a very strong pain-relieving medicine used for the relief of moderate-to-severe pain that is unresponsive to less potent pain-relieving medicines. Available as an injection, transdermal patch or device, nasal spray, sublingual (under-the-tongue) tablet or spray, or buccal (beneath the cheek) tablet. Different formulations have different uses. For example, fentanyl injection may be used as part of anesthesia to help prevent pain after an operation or procedure.
Fentanyl patches or transdermal devices may be used for moderate-to-severe pain that requires round-the-clock therapy. Sublingual sprays or tablets may be used for break-through type cancer pain. Fentanyl is a pure opioid agonist analgesic. This means that with increasing dosages, it provides increasing pain relief, unlike some other opioids that have a ceiling effect (plateau off above a certain dosage).
Generic fentanyl is available.
If you are between the ages of 18 and 60, take no other medication, or have no other medical conditions, side effects you are more likely to experience include:
Nausea, vomiting, constipation, sedation, dizziness, lack of energy, shortness of breath, and abdominal distension. May also cause flushing, sweating, itching, red eyes, and a drop in blood pressure on standing. Fentanyl is extensively metabolized through the liver when taken orally and as a consequence of this, fentanyl is not available in an oral formulation, although buccal (beneath the cheek) and sublingual (under the tongue) formulations exist. Buccal and sublingual formulations bypass the liver and enter straight into the bloodstream.
Fentanyl should NOT be used in people who have never been prescribed an opioid analgesic (opioid-naive people). Fentanyl is usually only available from a certified pharmacy under a special program. Fentanyl is a schedule II controlled substance and is up to 100 times more potent than morphine on a weight for weight basis.
Note that different sources cite different equivalent dosages; in reality, there is a wide inter-individual variation between effective opioid dosages. Do not try to convert fentanyl on a weight-for-weight basis (for example from patch to injection using the same mcg dosage) because of an extremely high risk of over-dosage. It is always safer to underestimate fentanyl requirements.
Because of the risk of addiction and dependence, fentanyl patches should only be used for severe, chronic pain that requires round-the-clock, long-term opioid treatment and for which other treatments have been ineffective. Other forms of fentanyl (such as sublingual spray or tablets) may be used for the relief of breakthrough pain. Fentanyl should not be used for acute or postoperative pain, or for headaches or migraines.
Keep out of the reach of children and pets. Death has been reported in children and pets who have accidentally ingested fentanyl products. Fatal breathing problems have occurred in patients given fentanyl products. The risk is higher in those who have not been administered opioids before.
Fentanyl has a high potential for abuse and care must be taken to keep it hidden from drug seekers.
Fentanyl is often used to lace counterfeit drugs – several deaths have been reported, for example, from
Xanax-laced with fentanyl. May interact with other drugs, particularly ones that inhibit the
metabolism of fentanyl through CYP3A4, such as ketoconazole, erythromycin, and ritonavir, and those with similar side effects (such as respiratory depression, sedation). Fentanyl also interacts with other
drugs that increase levels of serotonin (such as SSRIs, TCAs, triptans, tramadol). May affect your ability to drive and operate machinery. Avoid alcohol. May not be suitable for people with pre-existing respiratory disease, head injuries, bradycardia (slow heartbeat), and other conditions.
. Bottom Line
Fentanyl is a very potent pain-relieving medicine. It is not recommended for people who have never been prescribed opioid-type pain relief before and deaths have been reported from improper dosing or abuse.
- Ensure you dispose of all fentanyl products (such as used patches, empty spray canisters) carefully as although they may be empty they may still contain enough fentanyl to kill a child or an animal. Many products supply a charcoal-lined pouch in the carton to help with disposal.
- When used for break-through pain NEVER take more than two doses of short-acting fentanyl products (such as Subsys) at one time (each dose must be at least 30 minutes apart).
- Never share your fentanyl with anybody, as it may kill them due to overdose.
- Do not drive or operate machinery if you are sleepy or your reaction time is impaired after taking fentanyl.
- Do not mix fentanyl with alcohol, sleeping aids, or tranquilizers unless prescribed by a doctor.
- Some fentanyl products are provided with a child-safety kit to help adults store them out of reach of children or pets.
6. Response and Effectiveness
- Time to effect varies depending on formulation from 15-30 minutes (sublingual tablets), 46 minutes (buccal tablets), 1.5 hours (spray) to 3 hours (patch). Respiratory depressant effects can be seen from as early as 15-30 minutes after administration and persist for several hours.
Dangers with Fentanyl
Reports of fentanyl abuse, including mixing fentanyl into heroin, have been reported more across the United States since 2015. Coming into accidental contact with the sticky side of the patch can cause the drug to be released into the bloodstream. For people with little or no tolerance to narcotics, especially children, this can be life-threatening. In fact, per the Food and Drug Administration, using fentanyl patch as prescribed can, within the first 24-72 hours, lead to life-threatening breathing problems, indicating overdose.
Deaths involving illicitly manufactured fentanyl are on the rise.
Rates of overdose deaths involving synthetic opioids other than methadone, which includes fentanyl, increased by 10% from 2017 to 2018. Over 31,000 people died from overdoses involving synthetic opioids (other than methadone) in 2018.
Reports from law enforcement indicate that much of the synthetic opioid overdose increase may be due to illegally or illicitly made fentanyl. According to data from the National Forensic Laboratory
Information System (NFLIS), confiscations, or seizures, of fentanyl, increased by nearly 7 fold from 2012 to 2014. There were 4,585 fentanyl confiscations in 2014. This suggests that the sharp rise in
fentanyl-related deaths may be due to increased availability of illegally made, non-pharmaceutical fentanyl, and not prescribed fentanyl.
The number of states reporting 20 or more fentanyl confiscations every six months is increasing. From July to December 2014, 18 states reported 20 or more fentanyl drug confiscations. By comparison, six states reported 20 or more fentanyl drug confiscations from July to December 2013.
Signs of Fentanyl Overdose
When someone overdoses on fentanyl, they first become sleepy, and it is hard to wake them. Their breathing becomes slow and shallow. They may snore, and they may pass out.
The person’s body may become limp, their face pale or clammy, and their pulse weak or slow. For lighter-skinned people, the lips and fingertips may turn blue or purple. For darker-skinned people, the inside of the lips may become blue or purple.
If someone is overdosing, call 911 right away! While you are waiting for medical help to arrive, you can use your naloxone kit to temporarily reverse the effects of the overdose.
Today most police departments and first responders will carry a naloxone kit, to prevent death. Something stronger than an “Epipen”.
The Good Samaritan Drug Overdose Act protects you from being charged or convicted for drug possession if you call 911 to report an overdose, or if you are at the scene when emergency services arrive. This is true even if you are on probation for possession.
- Because fentanyl is so strong, the difference between a dose that will get you high and a dose that can kill you is very small. You can overdose even if you use someone’s prescription patch and know the dose. Everyone handles fentanyl differently. One person’s dose can kill another person.
- If you are using other drugs at the same time—for example, other opioids, alcohol, or sedatives such as Xanax, Valium, or Ativan—the risk of overdose is even higher.
One of the main culprits behind the growing opioid epidemic is synthetic opioids like fentanyl. The death rate from these drugs has increased by 1,125% between 2011 and 2017, according to mortality data from the Centers for Disease Control and Prevention.
While fentanyl and other synthetic opioids are used in prescription drugs, these substances are increasingly being illegally manufactured and distributed alongside—or mixed with—illegal drugs like heroin. Many opioid-related deaths involve more than one type of drug.
During the first nine months of 2018, 3,286 Canadians lost their lives to apparent opioid-related overdoses. Tragically, this means that between January 2016 and September 2018, more than 10,300 Canadians died as a result of an apparent opioid-related overdose.
In addition, the data show that fentanyl and other fentanyl-related substances continue to be a major driver of this crisis. From January 2018 to September 2018, 73% of accidental apparent opioid-related deaths involved fentanyl or fentanyl-related substances.
A synthetic FDA-approved opioid drug used as an anesthetic and a pain reliever. This drug is 100 times more potent than morphine and 50 times more powerful than heroin. Legal fentanyl is distributed illegally by persons who have stolen it or obtained it via fraudulent prescriptions. It is found in various forms such as lozenges, tablets, injectable liquid, sprays, or patches.
Illegally manufactured fentanyl is much more dangerous and pervasive. It is sold as a powder or tablet and frequently added to other drugs such as heroin, cocaine, or increasingly, K-2/Spice. When users of these other drugs don’t realize how much fentanyl their usual drugs are laced with, they easily and unintentionally overdose.
Counterfeit prescription medication (fake Vicodinm Oxycontin, etc.) is also made that includes fentanyl. A recreational user purchasing oxycodone from a street dealer may actually be purchasing fake dyed tablets of some unknown substance laced with fentanyl and risk death from overdosing.
A fatal dose of fentanyl is about the size of a few grains of salt.
Street names for fentanyl include: Apache, China Girl, China Town, Dance Fever, Friend, Goodfellas, Great Bear, He-Man, Jackpot, King Ivory, Murder 8, and Tango & Cash
Between 2012 and 2018, fentanyl and fentanyl analog deaths increased 1075.3%-from 2,666 to 31,335
If forever reason you need to take fentanyl, it may be necessary to go through a medical drug withdrawal program.
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