For those of you that have severe chronic pain and are considering the use of Fentanyl patches there are some things you may, or may not be aware.

Fentanyl was first synthesized and labeled by Janssen Parmaceutica in 1959.  The first intravenous anesthetic trade name of Fentanyl was Sublimaze.  Then following a series of mid-1990’s clinical trials a product was produced and marketed as a Duragesic alcohol gel infused patches.  These patches then were made available to patients with varing prescription dosages of fentanyl; time released to relieve chronic pain.  The patch is designed to release a specified dosage of the drug continuously for 48-72hours for chronic pain patients.

Thereafter, other pain relief products followed that included flavored lollipops with citrate mixed inert fillers under the name of Actiq (fentanyl oral transmucosal devices) and Onsolis (fentanyl buccal soluble film).  Also dosing is different if switching back and forth from Fentora to Onsolis.  For example, Fentora and Onsolis are given at lower levels than Actiq.

How does the patch work?  When the patch is adhered to the surface of the skin, the pain killer is absorbed where the opiate enters the blood stream.  Who gets the prescription?  Those that have painful cancerous condition, postoperative pain, or chronic pain conditions, such as constant low back pain.

How should you use fentanyl?  Never use more than what is prescribed in dose and frequency.  To use outside of the prescription can be extremely harmful to your health.  This pain medication when used correctly is very effective in controlling pain, but when used incorrectly can produce fatal results.

A huge problem now exists with abuse and addiction regarding fentanyl products.  These patches are entering the marketplace where illicit use of the patch is having deadly consequences due to the highly euphoric and addictive drug properties.  When the time released gel is removed from its blister pack and the gel material is consumed, or users double up on patches adhered to the skins surface, the health effects can be very serious.    For example, in 2005 Florida’s Dept. of Law Enforcement statistics show the patch resulted in 115 deaths.  And throughout the nation in recent years these numbers are up.

Since this pain killer can be 100 times more potent than morphine, drug dealers seek this stuff to provide their customers a quick high.  Inappropriate use of these patches combined with other drugs has also created a patient addiction, or street demand to turn a slow-release form of powerful pain killer into a dangerous high that can produce deadly results.

Tablets, sprays and popsicles were produced to treat and quickly alleviate sudden (breakthrough) cancer pain in patients that already had a high tolerance to strong narcotic pain medications, such as morphine.  If those on the street obtain fentanyl for a euphoric high and don’t understand the use, they can experience respiratory failure and death.

To date there are 12 different analogous (similar structure and in function to fentanyl) with various strengths under different labels ranging from 10 – 10,000 times more powerful than morphine.  For example, Carfentanil (Wildnil) has an analgesic potency 10,000 times that of morphine and is used to sedate very large animals.  Where Sufentanil (Sufenta) has an analgesic effect that is 5 to 10 times more potent than fentanyl and is used for specific surgeries on patients that are opioid tolerant.

These drugs because of potency have become ever more attractive to drug dealers because of the small volume it takes to produce a drug high.  This is a huge problem on the street because it is very hard to approximate the dosages to a point that will not cause the user to overdose.  For example, the fentanyl mixes sold on the streets are very difficult to dilute, especially the gel packs, tablets, films and popsicles because of the unknown potency multiplier within various fentanyl products.  And even if one known’s the various product strengths, proper dilution, or cutting of the product is another issue.

And to complicate illicit use is the mixing of fentanyl with other illegal drugs with one of many analogous clandestine products, e.g., heroin, methamphetamine, cocaine, or morphine, etc.  These hybrid drugs cut with fentanyl on the street is known as “China White.”  For the unsuspecting, your heroin purchase may not be what you think it is.  Now drug dealers acquire fentanyl to upgrade their product if they’ve purchased a low-grade heroin for example.  That’s right, now your drug dealer has a new specialty on his/her resume, “pharmaceutical chemist.”  A drug dealing chemist with no ideal about the medical implications of opiate intolerant users, potency of product, let alone understand the combined drug mix incompatibilities and risk to health and life.

Although fentanyl is commonly ingested; like heroin, it can also be smoked, snorted, or injected.  If a drug dealer sells fentanyl as heroin to an unknowing user, overdosing symptoms can cause a quick depressing effect on the respiratory system because of its fast acting anesthetic effects.  How does the fentanyl end up on the streets?  Although it is not always clear on how someone got their hand on the drug, it has also been reported by patients that their medicine has been stolen, or law enforcement has tracked the drug source as manufactured and distributed from Mexico.

It is clear the patch, tables and other ingested forms of fentanyl when used according to a doctor and manufactures recommendations is safe.  However, law enforcement agencies say the problems are when patients have addictive disorders that cause them to use “any” drug in a way that it was not met to be used.

Patients that are prescribed these patches must also be aware of the following precautions, especially if they are using other medications.  Do not use these patches unless you are already opiate and morphine tolerant, or know you don’t have bad reactions to the following types of pain killers:  Kadian, MS Contin, and others).  Hydrocodone (Lortab, Vicodin), oxycodone (Oxycontin), and Hydromorphone (Dilaudid)

Only a doctor can determine through patient consultation whether or not you are intolerant.  Also if you use a MAOI (Monoamine Oxidase inhibitor, “antidepressant drugs”) in the last 14 days, a dangerous drug interaction using fentanyl could lead toward serious side effects.  MAOI drugs to be aware of: furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate).

Also, if you have the following medical conditions and before using the patch, tell your doctor if you suffer from any of the following:  COPD (Cardio Obstructive Pulmonary Disease), irregular heart rhythm, epilepsy/seizures, depression, hallucinations, kidney/liver disease, low blood pressure, head injury/brain tumor, or a history of alcohol/drug abuse (addiction).  You also must be aware that the medications you use to regulate these conditions may also adversely react to the patch.  Instead of attempting to list all of the possible medications that may cause an adverse reaction with the use of fentanyl, your pain management specialist and medical doctors would be your best source of information and prior to prescription use advisement regarding these matters.

Handling fentanyl and use: do not freeze, or store this medication in warm or humid room conditions.  Use only dry fingers when handling tablets or film.  And do not use a tablet that has been left outside of its blister pack for more than a few minutes.  Simply flush down the toilet.  The FDA working with the manufacturer had determined this method to be the best for disposal to prevent accidental death.  And this type of disposal is only recommended with very few types of prescription drugs due to the lethality if it should be accidentally swallowed by a child.  The human safety aspect outweighs this drugs disposition recommendations compared to disposition instructions of other pharmaceuticals.

Only use 1 tablet or film to be consumed at a time.  When consuming, allow the film, or tablet to dissolve slowly in the mouth, do not chew, suck or swallow it.  Simply allow it to dissolve between your cheek and gum.  To ingest immediately may cause a severe health reaction.  If you feel dizzy, nauseated or bad in general spit the medicine out of your mouth.  Rinse your mouth out well with water and call your doctor.  On the flip side, if your pain doesn’t go away after the first tablet or film and if approved by your pain management specialist when break through pain occurs, wait 2 hours before applying another fentanyl buccal film, and at least 4 hours to treat a new pain episode with fentanyl buccal tablets.

Ensure, if you have pets, children, and you don’t finish a Popsicle type fentanyl pain killer to run hot water over it until completely dissolved.  If you have extra buccal tablets lock them up.  To not secure these types of medications could potentially kill those that might consume them intentionally or accidentally.  Speak to your doctor if breakthrough pain is occurring more than four times a day while using this medication.  Also do not abruptly stop using this medication as it can have some serious withdraw side effects.  Never share fentanyl with anyone. There is no way you could know the effect the strength of this type of pain killer could have on another individual.  Also, it is not known if fentanyl will harm an unborn baby.

What are the overdose symptoms? Pinpoint pupils, extreme dizziness and weakness, shallow and slow breathing, weak pulse and clammy cold skin.  The side effects of an allergic reaction: hives, and swelling of throat, lips, face and tongue to include difficult breathing.  And the most serious side effects: heavy sweating, hot and dry skin, weak or shallow breathing, rapid heart rate, pale skin and extreme thirst to include concentration difficulties.  If you need medical attention call 911, or the Poison Help line at 1-800-222-1222.  An overdose using fentanyl can be fatal.

Less serious effects that you should call your doctor and you may report to the FDA at 1-800-FDA-1088, or your primary care physician, or pain specialist:  swelling hand and feet, mouth sores at spots of medicine placement, headache, vomiting, nausea, constipation, dizziness and drowsiness.

References,

Novella, Steven.  Does Acupuncture Work or Not?  Neurologica blog.  Sep 25, 2007.  http://theness.com/neurologicablog/index.php/does-acupuncture-work-or-not/

MedicineNet.com. Fentanyl Tablet (Cancer Pain Only) – Buccal, Fentora.http://www.medicinenet.com/fentanyl_tablet_-_buccal/article.htm

Answers.com.  Fentanyl Citrate Oral Lozenge.  http://www.answers.com/topic/fentanyl

Drugs.com.  What is Fentanyl.  http://www.drugs.com/fentanyl.html

University of Florida.  Fentanyl Pain Patch Abuse Can Be Deadly.  July 7, 2005.  http://alcoholism.about.com/od/prescription/a/bluf050706.htm

Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET. 2011 Copyright, All rights reserved, Mirror Athlete Publishing @: http://www.mirrorathlete.org,  Sign up for your Free eNewsletter.