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Substance Abuse

How Fentanyl Is Used Aside From Its Prescribed Purpose

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Fentanyl, one of the strongest opiods and narcotic analgesics in the market today, is indicated for the management of chronic pain mostly prescribed for cancer patients or in treating patients after a major surgery. It is commonly known under the brand names Durogesic, Duragesic, Sublimaze, Abstral, Haldid and Lazanda, among others.

This substance is said to be 50 times more potent than heroin and 100 times more potent than morphine. It is usually used in combination with Demerol or morphine. Any misuse or abuse of this drug can lead to addiction that may eventually lead to death.

It was in the 1970’s when Fentanyl has begun circulating for non-therapeutic purposes.  Its biological effect was said to be similar as that of heroin, which is why sometimes street heroin is mixed with fentanyl or sold as fentanyl itself because of its euphoric effect.

There are several known fentanyl analogue, such as the following:

  • 3-Methylthiofentanyl
  • β-Hydroxyfentanyl
  • α-Methylthiofentanyl
  • Thiofentanyl
  • Butyrfentanyl

The prescription or administration of fentanyl should only be done by a health care professional who has full knowledge in using such potent opiod to manage chronic pain.

Different Forms of Fentanyl

Fentanyl Transdermal Patches

Known through the brand name Duragesic, this form of fentanyl is absorbed through the skin into the bloodstream. Its effect can last up to 72 hours, which is very favorable in managing chronic pain. This is only prescribed to patients who are opiod-tolerant or those patients who are have been taking at least 60 mg of morphine in a day.

Intravenous fentanyl

Under the brand name Sublimaze, this is most commonly used as anesthesia accompanied with another substance like propolol for epidural or spinal administration. In combination with sedatives like benzodiazepine, it is used for medical procedures like surgery and endoscopy.

Used patches should be discarded properly because the gel of these patches can be swallowed or injected, which may cause some serious side effects on the person.

Fentanyl lozenge

This form, popular as Actiq, may pose danger when children accidentally ingest them. This should not be prescribed along with other narcotic medicines because it may lead to difficulty in breathing, which could be fatal. Although fentanyl is an analgesic, it is not recommended for short- term pain such as migraine or dental pain. Fentanyl lozenges should be taken with a 4-hour interval.

Intranasal Fentanyl

This form should be used with utmost care. It is not advised to convert or substitute it with other products that may contain fentanyl. The prescribed dosage may be different on each patient.

Adverse Effects

Like most prescribed drugs, there are certain side effects that the patient may feel after administration or ingestion of fentanyl. These are:

  • Nausea
  • Dizziness
  • Drowsiness
  • Insomnia
  • Vertigo
  • Constipation
  • Fatigue
  • Headache
  • Palpitations
  • Diarrhea
  • Dry mouth
  • Abdominal pain
  • Itching
  • Weakness
  • Muscle spasms
  • Depression
  • Hallucinations
  • Slow heart rate
  • Cold, clammy skin
  • Dyspnea
  • Hypoventilation

Dangers of fentanyl abuse

Drinking alcohol is prohibited while taking Fentanyl because it increases the risk of feeling sleepy or dizzy. The drug is not advisable over a long period of time because of it being highly addictive. However, there are individuals who have illicitly used this medicine.

Its efficacy in treating pain has been proven to be very high. However, there had been reports of abuse in the usage of the said drug. Fentanyl is highly addictive. Meanwhile, the slight difference between the prescribed medical dosage and dead dose can be very slim.

Fentanyl is sometimes sold combined with low-quality heroin to increase the heroin value. The combination of these substances can be more than a hundred times more potent than street heroin. Drug users take Fentanyl orally, injected, snorted or smoked. This causes severe respiratory depression, wherein there is inadequate ventilation to perform gas exchange. This is a very common side effect among those who use recreational drugs.

Since Fentanyl can only be purchased through prescription, the black market has found its way to sell and distribute fentanyl transdermal patches from which the gel inside the patches can be injected or ingested. This poses danger to children when these patches are not properly disposed.  According to some reports, children who have been exposed to these transdermal patches have died due to ingestion.

Actiq Fentanyl lollipop, sold as Oral Transmucosal Fentanyl Citrate (OTFC) and listed as a Schedule II Controlled Substance under the Federal Controlled Substances Act, is a sugar-coated fentanyl on a stick. This is absorbed through the buccal mucosa (inner cheek), where it is slowly dissolved in the mouth. Actiq lollipop contains 2 grams of sugar in raspberry flavor and is available in 6 different strengths. The strongest is 1600 mcg, which could be the equivalent of absorbing 160 mg of morphine.

Other than the common psychological effects of taking fentanyl is the increase of dental caries on long-time users of this drug. This may be due to the sugar that goes with the fentanyl lozenges since it does not dissolve quickly and sugar sticks into their teeth for a long time.

Individuals using Fentanyl can also quickly create tolerance to this substance. The usage of an individual may increase week after week until it comes to a point of endangering his own life.

There is an increase in the number of overdose cases with fentanyl-laced heroin. According to the Drug Enforcement Administration (DEA), “drug incidents and overdoses related to fentanyl are occurring at an alarming rate throughout the United States and represent a significant threat to public health and safety”.  Chicago, Philadelphia and Detroit have been reported to have multiple cases of deaths due to fentanyl overdose. They have traced the source of the lab to be in Mexico.

Conclusion

Fentanyl users have common reasons why they resort to substance abuse when they are asked. They want to either get away from their problems, or have the sense of belongingness and have fun. What comes with this addiction is losing integrity and credibility. With that, drug addiction in general has been linked to so many crimes that even family members are not spared.

Unless we take a step in helping these individuals, more people will succumb to drug abuse, which can lead to the total destruction of the community.

Substance Abuse

A Comprehensive List of Fentanyl Abuse Risks and Dangers

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The U.S. Drug Enforcement Agency (DEA) has previously issued public warnings regarding the use of the opioid drug fentanyl and its analogs. According to the agency, the incidents of drug overdoses and deaths relating to fentanyl have significantly increased in the last two years.

The Centers for Disease Control and Prevention (CDC) likewise reported that in 2013, about 92 fentanyl-related unintentional deaths were recorded in the state of Ohio alone. The following year, CDC data showed that the number of such incidents had increased by almost 500%. There were more than 500 fentanyl overdose deaths in 2014.

What is Fentanyl?

fentanyl abuse

Fentanyl, also known as its brand names Sublimaze, Actiq, Durogesic, Duragesic, and Fentora is a potent opioid analgesic. It is estimated to be 50 times more potent than pure heroin and up to 100 times stronger than morphine. It is classified as a Schedule II prescription drug and is used in the treatment of chronic pain among patients who are non-responsive to other opioids. It is also prescribed for the management of pain associated with cancer treatments or post-surgical procedures.

At present, fentanyl is the strongest narcotic that is used in medical treatment. It has been described as potentially lethal even when administered at low doses. According to the DEA, ingestion of as low as 0.25 mg of the substance can be dangerous.

Prescription fentanyl comes in various forms. It may be administered intravenously, via injection, intranasal sprays, transdermal patches, and oral lozenges.

Non-pharmaceutical fentanyl, however, is sold on the streets where it is sold in common names such as Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, Tango, and Cash. Street fentanyl is produced illegally and it is often laced with other drugs including heroin and cocaine. It comes in several forms such as powder, spiked on blotter paper, and tablets that mimic other pharmaceutical products. It is abused by snorting, swallowing, or injecting. The use of recreational fentanyl has been associated with cases of drug overdose and deaths.

What are Fentanyl Analogs?

Clandestine laboratories produce variations of the drug sold in the black market. The effects can be more potent pure fentanyl itself. Some people may not even be aware that they are purchasing drugs that have been chemically adulterated. Ingesting these substances places them at a high risk of adverse effects such as respiratory depression, overdose, coma, and death.

Some of the fentanyl analogs include alfentanil (Alfenta), Brifentanil, Butyrfentanyl, 3-Allylfentanyl, 3-Methylfentanyl, 3-Methyl-thiofentanyl, 4-Phenylfentayl, Acetyl-α-methylfentanyl, Acetylfentanyl, α-Methylfentanyl, β-Hydroxy-3-methylfentanyl, β-Hydroxyfentanyl, ρ-Fluororofentanyl, Carfentanil (Wildnil), Diampromide, Lofentanil, Orcefentanil, Ohmefentanyl, Mirfentanil, Para-fluorofentanyl, Phenaridine, Remifentanil (Ultiva), Sufentanil (Sufenta, Sufentil), Thiofentanyl, and Trefentanil.

While most of these identified analogs have been banned or are currently listed among DEA’s controlled substances, some laboratories have found ways to tweak the chemical structures of the drug to come up with new versions. This makes it easy to import, market, and sell other adulterated versions of fentanyl without being detected.

In April, it was reported that a new analog called furanyl fentanyl was circulating in the U.S. In fact, it accounted for the fatal overdose of a 30-year-old man in Chicago, Illinois.

Fentanyl and the Brain

Fentanyl affects opioid receptors in the same way that heroin, morphine, and other opioids do. Such receptors are found in the brain and are responsible for controlling the response to painful stimuli. Fentanyl binds opioid receptors and causes an upsurge in dopamine levels. This results in the alteration of the user’s perception of pain and pleasure.

brain functioning addiction

Taking the drug numbs the perception of pain but because of the increase in dopamine levels, it also induces feelings of euphoria and extended pleasure. Repeated exposure to the drug alters the brain’s circuits, making it dependent on the substance for the production of pleasure signals. Ingesting it over time may lead to addiction.

Fentanyl has been classified as a substance with a high potential for abuse. The addictive process is similar to that of other painkillers such as Tramadol, OxyContin, Vicodin, and morphine. Compared to the mentioned opioids, however, the addiction to fentanyl can occur very quickly given its potent properties.

Fentanyl and Respiration

Multiple opioid receptors are present in the regions of the brain that control respiration or breathing rate. When fentanyl is taken in high doses, the opioid can cause respiratory depression which can lead to death.

Some studies have shown that the administration of pharmaceutical fentanyl for the treatment of post-operative pain and cancer affects respiration. To date, while fentanyl and other opioid painkillers remain as mainstays in the management of chronic pain, the fear of the incidence of respiratory depression is still a major clinical concern. As such, the prescription of fentanyl is reserved for patients who have developed a tolerance to other opioids and whose pain conditions can no longer be managed with the use of other analgesics.

On the other hand, recreational users of fentanyl are at a high risk of experiencing this adverse side effect. Some statistics have shown that respiratory distress is a major cause of death in most fentanyl-related overdose cases.

Overdose

The potency of fentanyl increases the risk of overdose, especially among recreational users and those who may not be aware that the drugs they have purchased on the streets are laced with the substance. It is possible that low-grade heroin or cocaine have been mixed with versions of fentanyl to amplify the effects of the drugs.

Users who have been prescribed fentanyl should strictly follow the physician’s instructions to avoid fatal overdose. They should watch out for potential overdose symptoms that include difficulty in swallowing, extreme fatigue, fainting, dizziness, difficulty of breathing, altered consciousness, and severe confusion.

Fentanyl overdose may be reversed with the timely administration of the drug naloxone (Narcan). The drug acts as an opioid receptor antagonist and reverses the effects of the overdose. It also restores normal breathing rates.

It is imperative, however, that fentanyl overdose is treated immediately in order to effectively counter the effects and avoid fatality.

Naloxone is available in several states and is distributed to injection drug users and the general public for use in case of overdose. Some agencies and health facilities also provide information dissemination and training for the proper administration of naloxone.

Other Adverse Effects

Generally, fentanyl produces the same effects as heroin and morphine but because it is more potent, the adverse effects can occur within a shorter time and at more intense levels. Some of the adverse effects include the following:

  • Euphoria
  • Hallucinations
  • Drowsiness
  • Dizziness
  • Nausea
  • Vomiting
  • Diarrhea
  • Confusion
  • Fatigue
  • Constipation
  • Abdominal pain
  • Indigestion
  • Urinary retention
  • Shortness of breath
  • Sweating
  • Headaches
  • Swelling of extremities
  • Dry mouth
  • Anxiety
  • Depression
  • Tolerance
  • Addiction

Withdrawal Effects

Sudden cessation of fentanyl use can cause unpleasant withdrawal symptoms. These include the following:

  • Extreme restlessness
  • Yawning
  • Sweating
  • Watery eyes
  • Runny nose
  • Fever
  • Chills
  • Tremors
  • Muscle and bone pain
  • Nausea
  • Vomiting
  • Anxiety
  • Panic attacks
  • Agitation
  • Irritability
  • Weakness
  • Loss of appetite
  • Stomach cramps
  • Diarrhea
  • Insomnia
  • High blood pressure
  • Intense drug cravings

Several treatment and rehabilitation centers offer structured detoxification programs that are intended to mitigate and manage the symptoms of opiate withdrawal. In most cases, in-house rehabilitation is strongly recommended because these facilities have addiction specialists, therapists, and medical professionals on duty who are trained to handle patients undergoing withdrawal symptoms.

Dangers of the Fentanyl Transdermal Patch

The use of the fentanyl patch has also shown to be habit-forming. The transdermal patch contains potent analgesic properties, which are highly addictive. As with other forms of fentanyl, it is reserved for patients who are regular users of opiates. Those with no prior exposure to other opioid drugs are at a great risk of respiratory depression and death.

Misuse and improper application of the skin patch can also result in fatal overdose. In July 2005, the U.S. Food and Drug Administration reported that there had been hundreds of fentanyl-related deaths arising from the use of skin patches. In Florida alone, the drug was accountable for 379 deaths in the years of 2003 to 2004.

In Aiken County, South Carolina, it was reported that between January 2006 and May 2008, about 11 residents died as a direct result of the misuse of fentanyl patches.

Those who intentionally misuse or abuse the fentanyl patch for the purpose of ingesting higher doses of the drug employ methods such as:  placing it in the mouth, chewing, swallowing, sucking, injecting, snorting, or applying multiple patches to the body. These methods increase the risk of overdose and death.

Accidental exposure to a used patch can likewise cause fatal side effects. This is because the drug is not completely eradicated from the patch even after a three-day period of use. As such, discarded patches are often sought by some abusers.

Children are also at a risk of experiencing adverse side effects due to accidental exposure to either new or unused patches. To avoid these risks, transdermal patches should be stored or disposed of properly.

Using the patch for a longer or shorter period than prescribed is potentially fatal for a patient. Since the patch provides sustained release of the drug, wearing it longer than 72 hours or withdrawing from it before the prescribed period may result to the user’s death.

The risk of fentanyl side effects is also increased when the drug is used in conjunction with other medications such as amiodarone, amprenavir, aprepitant, carbamazepine, clarithromycin, diltiazem, erythromycin, fluconazole, fosamprenavir, itraconazole, ketoconazole, nefazodone, nelfinavir, phenytoin, rifampin, ritonavir, troleandomycin, and verapamil.

Certain pharmaceutical preparations also interact with the fentanyl patch and can cause side effects, aggravate the symptoms of existing health conditions, or affect the effectivity of the drug in some way. Some of the medicines that have been found to interact with fentanyl include phenothiazines, sodium oxybate, anticholinergics, benzodiazepines, crizotinib, fosaprepitant, other narcotic pain medicines, macrolide antibiotics, mixed agonist/antagonist pain medicines, and rifamycins.

Patients who have been prescribed fentanyl should inform their physicians of any other medication that they may be currently taking to avoid possible contraindications. Also, the patch must be used strictly as directed by the medical professionals, and in accordance with the manufacturer’s instructions or medicine guide.

Conclusion

The potency of fentanyl makes it one of the most dangerous drugs to be ingested. While its use as a prescription drug has become increasingly common especially among regular opioid users, care should be taken to avoid the dangers that can be brought about by incorrect administration, misuse, or abuse.

The public should likewise be warned of the grave consequences of using fentanyl non-medically or of consuming drugs that have purchased from the streets which may be laced with the substance.

As the DEA intensifies its efforts to curb the proliferation and sale of clandestine drugs in the black market, everyone should be on guard against the harmful effects of illicit drug use and prescription drug abuse.

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