What is Fentanyl?
Fentanyl is a generic product. It comes as either a patch that you can put on your skin or you can rub it on your gum, put it under your tongue. You can even spray or use it as a lollipop.
It has a bunch of different kinds trade names. You can put the patch on your skin, you can suck it as a lollipop over a period of 15 minutes. A quarter of it is going to be absorbed right through the mouth. You can swallow the rest and it will be absorbed normally.
We know that it is a synthetic opioid. It's similar to morphine, but its much more potent (50 – 100 times potent as morphine).
Obviously, it's a schedule 2 narcotic. However, a lot of it is brought in from China, and it is altered either in China or over here in the United States. Those are scheduled 1 illegal drugs.
Fentanyl was originally synthesized in 1960. It's an analog structurally similar to Demerol was first marketed as sublimate. In the 1990s it came out as a patch, 2000 it came out as the lollipop. Then it came as the dissolving tablet and the sublingual spray.
You know the fentanyl was initially approved by the Food and Drug Administration in 1968 available in generic products to the present time.
It is most commonly used as a transdermal patch, which you can apply to the skin that releases anywhere between 12,5 and 100 micrograms – not even milligrams - per hour into the skin. The difference between a therapeutic dose, that is going to take care of your pain, and a lethal dose, that is going to kill you is very small. Unfortunately, quick tolerance develops to this kind of drug, so there always the need for more.
The effects of this drug are basically exactly the same as of heroin. You start off with euphoria and then you may have the following issues:
- respiratory depression;
- respiratory arrest;
- the loss of consciousness;
Fentanyl Street Names
It is also a drug of abuse. The street names for this kind of medicine are known as Apache, China girl, China white since it is imported from China. It could be called "Dance fever", "friends", "cash", a "goodfella". It is also known as "Jackpot" or "TNT". It is often sold as "white heroine".
It is a significant problem, especially back on the Eastern seaboard, where white heroin is very frequently used and abused. It is sold, unfortunately, as a powder, which is very concentrated and incorrectly diluted. It is put on paper that you can put in your mouth.
Fentanyl is mixed with or its substituted for heroin. You can swallow it, snorted it, take the blotter paper in, inject it.
The problem is, remember, that it is 50 or even 100 times more potent than heroin and, as a result, there are a lot of deaths. It is estimated that every day in the United States 30 people die from the overdose of Fentanyl.
Do not use this drug in people, who have not used or have become tolerant to the action of one of the opioids, like hydrocodone or oxycodone. You have to be using those drugs first. This is not a drug to be used for acute pain, intermittent pain or after surgery. Fentanyl is not used for short periods of time or even for mild pain. It is not for people, who have some sort of respiratory disease, not for people, whose intestines do not work correctly, people who have slow intestines or what we call a paralytic ileus. It is not used for people, who have a spasm of gallbladder area.
You have to be very careful if you either have a personal or family history of addiction. If there is any mental illness or depression in the family if you use alcohol or even if you take sleeping pills. In this case, this is not the drug for you. There is a possibility of side effects if you take other kinds of medicines like sedatives, sleeping pills, tranquilizers, alcohol or any of the other opioids.
Fentanyl may also interact with antidepressant drugs that we call a MAO inhibitor, anticholinergics that are used for certain lung diseases or even with just the over-the-counter Benadryl. As a result of such interaction, it can cause urinary retention and problems with your intestines, respiration.
Avoid using the drug if you have you any history of chronic obstructive lung disease or if you have a very slow heart rate. In this case, you have a high chance of getting a respiratory depression, when you initiate the dose or when you change the dose.
Accidental exposure to children is often fatal. Using Fentanyl during pregnancy can lead to the intoxication of a fetus and borning of a baby with a withdrawal syndrome.
There is a black box warning on the drug about the respiratory depression that goes along with it, the medical errors that may occur and can kill you and the potential for abuse, even if you use the drug the way you are supposed to.
Fentanyl is an analgesic medication. However, the drug use can lead mood swings from a euphoria to a depression. It can also induce drowsiness, nausea, vomiting, respiratory depression, hypoventilation. The drug can decrease the propulsive movement of the intestine. The substance binds to the opioid receptors in the brain and in the intestine. The problem it is what we call lipophilic.
Fentanyl can stimulate the release of a chemical known as dopamine from the reward center of the brain, leading to some euphoria, good feeling, and relaxation.
The drug also binds into fat. If you're taking the drug for appropriate reasons and, let's say, unfortunately, you have cancer, or severe infectious disease, or maybe terminal heart disease or as you lose the weight very suddenly, a lot of Fentanyl is going to be released into the bloodstream, which can kill you because you get too much quantity.
If you happen to have lung disease and you retain carbon dioxide that causes the skin blood vessels to dilate, and you absorb more of the drug.
Fentanyl Side Effects
Fentanyl has enormous number of other side effects like:
- horrible constipation;
- sexual dysfunction;
- abdominal pain;
- weight loss;
- headache lead;
- shortness of breath;
- flu-like symptoms;
- biliary system problems.
Certainly, people who are taking drugs like this have impaired mental state. That is why it is very hard to drive.
Fentanyl metabolized in the liver through an enzyme called CYP3A4 with 75% of the drug is going through that system.
It is very important to realize that if you do something to prevent that enzyme from working normally, that means that the drug is not going to be metabolized. It is not going to be excreted in the urine and is going to build up in the system.
So, you can take a medicine that's prescribed for some other reason, have it work on this particular liver enzyme and then all of a sudden you are short of breath, you have a respiratory arrest, you go into coma, convulsions and then you die. Clarithromycin, the medicine for a fungus infection like ketoconazole or fluconazole, Diflucan, verapamil can inhibit this enzyme.
Even drinking grapefruit juice can influence this particular enzyme and it is very harmful to people, who are taking Fentanyl.
Fentanyl Withdrawal Symptoms
If you have discontinued Fentanyl too quickly, you could have withdrawal symptoms, because it is a narcotic. You can have the following side effects:
- watery eyes;
- runny nose;
- increased heart rate;
- dilated pupils;
- back and muscle pain;
We also know that this drug is potentially lethal to law enforcement. When the police arrest people and a policeman touches even a few grains of this medicine, it can lead to respiratory arrest. This is a highly toxic stuff. Unfortunately, it's used as a substitute for white heroin.
Johnson and Johnson company, which manufacture Duragesic, reformulated the product in 2009 to hopefully make it less likely to be abused. Because as we remember, it can be fatal with just one single-dose. Duragesic should only be used in people who are already tolerant of opioids.
If you are on some kind of a narcotic already and you have been on it for at least a couple weeks, and you have severe pain that requires round-the-clock treatment. If you take a patch, put it on the skin and you leave it on for about three days – there is a problem. It is on the skin and it's going to be absorbed through the skin, but what happens if you get hot? If you get hot, you are going to absorb more and you can become toxic. You can have the respiratory arrest, a problem with convulsions, coma and even death simply by taking a hot bath, using a heating pad, an electric blanket.
Maybe you go do some strenuous exercise. Exercise is good for you, but it is not good if you happen to have a Duragesic patch on your skin.
Fentanyl is not for use in anyone who is consuming alcohol. It includes alcohol for recreational purposes or social purposes. It also includes the alcohol that you find in syrups that you buy. When getting at the drugstore, remember, all of those carrots contain alcohol.
How To Use Fentanyl Patch
Put the patch on flat, non-irritated, non-inflamed impact skin. It deposits on the upper surface of the skin, gets into the blood after a period of about 12 to 24 hours its stable. After about 72 the dose amount in the bloodstream does not seem to change unless you increase or decrease the size of the patch. It also depends on how much facts in your skin, the skin type you are and even which delivery system the manufacturer is using.
There are a lot of variables here, this is not an exact science, but if you get too much of it, remember, it could kill you.
The problem is that once you start using Duragesic and once you reach a certain level and you decide to stop using it. So, if you take the patch on even a day later, there is still a half of the quantity left in your system. It is a potential problem because when you have an overdose and the paramedics come and they give you a shot of naloxone to reverse the respiratory depression. But you already have a half of Fentanyl dose in your system. It means you have to be under close observation. If you are not under close observation for three or four days, you might go back into respiratory depression and die if there is nobody around.
Duragesic should not be used by people, whose pain can be controlled through any other mechanism. Especially we have problems with the elderly people, people who are losing weight and who are debilitated.
Use Duragesic with caution if you have a respiratory or renal disease, low blood pressure, head injuries, slow heart rate, liver and kidney disease.
It is very important that a patch is taken care of and disposed in an appropriate fashion in order avoid a child chew or touch it.
Fentanyl is a dangerous drug and it is definitely not to be messed with. Fentanyl kills about ten thousand people every year. About 30 people a day are going to die because they abuse the drug. So when you think of Fentanyl, reserve it for the most disastrous kind of pain that you can possibly imagine.