Fentanyl is a synthetic opioid prescribed for treating severe pain, typically associated with advanced stages of cancer. It is 50 to 100 times more potent than morphine. Fentanyl is often misused in the United States and is a leading cause of the opioid epidemic in the United States.
Recently, fentanyl-related overdoses and deaths in the U.S. have been linked to illegally made fentanyl. Drug dealers sell it for its heroin-like effect. It is often mixed with heroin and cocaine, with or without the user’s knowledge, to increase its powerful effects.
Fentanyl deaths are on the rise. 100,000 people died from a drug overdose in 2021, and fentanyl was responsible for more than 60%. That same year, there were almost 123,000 fentanyl-related emergency department visits. Those numbers reveal a significant increase over the past several years.
Rates of overdose deaths involving synthetic opioids, including fentanyl, increased by over 56% from 2019 to 2020. The number of overdose deaths involving synthetic opioids in 2020 was more than 18 times the number in 2013. More than 56,000 people died from overdoses involving synthetic opioids in 2020. The latest drug overdose death counts through June 2021 are believed to be accelerated by the COVID-19 pandemic.
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Fentanyl — Approved Medical Uses
Fentanyl is prescribed to treat severe pain in individuals. Examples include after intensive surgery or when a person is experiencing extreme pain from the late stages of cancer. When prescribed, it can be administered by patch, lozenge, nasal spray, or injection, which is given in the hospital. Fentanyl patches are used for individuals with severe chronic pain.
Most adults can use fentanyl, and some patches can be used for children two years and older. However, young children and older adults are more likely to experience side effects.
Treatment of Pain After Surgical Procedures
Fentanyl is a pain medication frequently used after surgery. It is a synthetic opioid used to relieve pain. Fentanyl is a pain medication similar to morphine but approximately 100 times stronger. It is a controlled substance and requires a prescription from your healthcare provider.
Fentanyl is known as fentanyl citrate, Sublimaze, Actiq, Duragesic, Fentora, and Matrifen.
In the hospital, Fentanyl is most commonly given as an IV injection. The drug can also be given with a patient-controlled pump, where the patient presses a button to deliver a small dose of pain medication through their IV.
Fentanyl doses vary widely based on the reason for the pain, the duration of usage, and the tolerance the patient may have to pain medications. Fentanyl is a very potent pain medication.
Many patients will not qualify for the fentanyl patch or Actiq lollipops, as they are only appropriate for patients with a tolerance for fentanyl or other opioid pain medications.
Due to the potency, initial doses of fentanyl are minimal. For example, an adult one-time IV dose may be 50 to 100 mcg. However, quantities may be significantly higher for long-term patients, such as cancer patients.
Pain Relief for Injuries & Illnesses
It is rare for fentanyl to be given to patients other than long-term chronic pain, advanced cancer pain, or severe pain from surgery. This is because of the risks involved and the dependency that can develop when used.
However, a study analyzed fentanyl vs. morphine for pain relief for individuals with traumatic limb injuries. The study concluded that fentanyl could decrease pain more rapidly than morphine in opioid-addicted patients with fewer adverse effects. More patients in the morphine group 31.6% of patients) needed additional pain medication.
Why Fentanyl Instead of Morphine?
Fentanyl is used more often than morphine because it has been found to reduce pain more quickly than morphine and has shown fewer adverse side effects. However, between the two opioids, fentanyl is much more potent than morphine. This is because morphine is a chemical derived from poppy plants, while fentanyl is synthetic. Fentanyl is usually only reserved for the most severe types of pain because of its high potency.
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How Does Fentanyl Help With Pain Management?
Fentanyl is from a group of drugs called opioids or narcotics. It works in the central nervous system and the brain to block pain signals to the rest of the body. It also reduces the anxiety and stress caused by pain. A fentanyl injection into a vein gives the quickest pain relief. It works almost immediately and is usually only administered in the hospital.
Fast-acting fentanyl tablets, lozenges, and nasal sprays take 15 to 30 minutes to work but wear off after 4 to 6 hours.
Fentanyl patches can take up to a day or two to start working, but they will last longer. Patches are usually given after fentanyl tablets. This is to ensure you have pain relief from the pills until the patches start to work.
Are There Risks Associated With Pharmaceutical Fentanyl?
Yes, there are several risks associated with pharmaceutical fentanyl due to the drug’s complications, risks, and severe side effects, even when administered by a medical professional.
Fentanyl and other synthetic opioids are the most common drugs involved in overdose deaths. Even in small doses, it can be deadly. Over 150 people die daily from overdoses related to synthetic opioids like fentanyl.
Fentanyl may cause severe breathing problems or death if used by people not being treated with other narcotic medications or who are not tolerant to narcotic drugs.
How Much Fentanyl Is Administered to Prevent Dependence or Overdose?
Fentanyl comes in an injectable form of 50 mcg. Dosing is as follows by indication:
Preoperative:
- 50 to 100 mcg IV for a single dose 30 to 60 minutes before surgery.
- Consider lower dosing in patients 65 and older.
Anesthesia:
- 2 to 50 mcg IV for a single dose.
Regional anesthesia:
- 50 to 100 mcg IV for a single dose.
- Consider lower dosing in patients 65 and older.
General anesthesia:
- 20 to 50 mcg IV for a single dose.
- Consider lower dosing in patients 65 and older.
Post-operative pain control:
- 50 to 100 mcg IV every 1 to 2 hours as needed.
- Alternately 0.5 to 1.5 mcg IV as needed.
- Consider lower dosing in patients 65 and older.
Patient-controlled pump:
- 10 to 20 mcg IV every 6 to 20 minutes as needed.
- Start at the lowest effective dose for the shortest effective duration.
Why Is Fentanyl Integrated Into Illegal Drugs?
Fentanyl is integrated into illegal drugs because of the intense high people may receive from the drug on its own or combined with other illicit drugs such as cocaine and heroin. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
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