Fentanyl  Patch 
                                     a.k.a
       Actiq, Duragesic,  Sublimaze, Fentora, onsolis,                             Instanyl,  Abstral

FENTANYL (Duragesic®, E-TRANS® Fentanyl) is a powerful synthetic opioid
stronger than Morphine. It is typically used to treat severe pain, to manage pain after surgery or to treat those suffering from chronic pain.                                

Fentanyl is also used for patients who express a great physical tolerance to opiates. Like Heroin, opioids and other drugs, Fentanyl acts upon specific receptors in your brain and spinal cord to decrease the feeling of pain and reduce your emotional response to pain.Fentanyl comes in many forms such as a patch, lollypop & the traditional pill.

One of the most potent opioid analgesics, Fentanyl is used to treat severe chronic pain. It is a Schedule II  controlled substance was introduced  in the 1960’s as an intravenous anesthetic under the trade name Sublimaze. 

Fentanyl Uses
In the mid 1990’s, the Duragesic Fentanyl  was introduced to provide slow-release pain relief over a 48-72-hour period. Fentanyl also comes in lozenge form (Actiq), for fast-acting  relief of breakthrough pain.Because Fentanyl, in all of its forms, can be habit-forming and has a high potential for abuse, the U.S. Food and Drug Administration has issued public health alerts regarding its use.  The patch comes in five sizes, delivering between 12.5 and 100 micrograms per hour. The lozenges are berry- flavored lollipops that dissolve slowly in the mouth and are intended for opiate-tolerant users. It is available in six dosages, from 200-1600 micrograms. 

Fentanyl Warnings
The FDA said the transdermal patch is “only intended for treating persistent, moderate to severe pain in patients who are opioid-tolerant, meaning those patients who take a regular, daily, around-the-clock narcotic pain medicine.” The agency received several reports of deaths and  life-threatening side effects despite a July 2005 advisory that emphasized safe use. The FDA said some doctors prescribe the patch appropriately for pain following surgery, headaches and occasional or mild pain.

Fentanyl has similar biological effects to that of heroin, but is thought to be a stronger      sedative and much more powerful than street heroin. Some heroin dealers mix
Fentanyl with low-grade heroin to add bulk and make it more potent.

A mix of Fentanyl, with either cocaine or heroin, has caused an outbreak of overdoses in  different parts of the country. Regular users of Fentanyl may become addicted quickly. It is most often used orally but like heroin can be smoked, snorted or injected. On the black market, Fentanyl is most often sold in patch form. The patch can be cut up or eaten and the gel inside the patch can be smoked. The FDA  says some patients use the patch incorrectly, by replacing it more frequently than prescribed or applying a heat source to the patch. This causes dangerously high levels of the drug in the bloodstream, it said.

In 2006, the FDA began investigating several respiratory deaths linked to Fentanyl use. The agency said the use of Fentanyl by those not tolerant to opiates is very, very dangerous and could lead to numerous deaths. Even those with a tolerance are at a risk of overdosing if the drug is used improperly, the agency said.

source: www.opiates.com

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     Abuse of High-Potency Fentanyl Skin Patches
            Linked to Hundreds of Deaths

By Hugh C. McBride


 
  A synthetic drug with a significantly greater potency than morphine has been linked to hundreds of overdoses and deaths among individuals who were using it improperly.

  Fentanyl, an opioid, has two primary legal uses: as an anesthetic in operating rooms and intensive care units, and as a means of easing severe pain, usually in cancer    patients. When used for pain management, the drug is administered either in lozenge form or through a transdermal (skin) patch that allows for steady extended release of the medication into the bloodstream.

Though not necessarily as well known as other commonly abused opioids (such  as heroin, codeine, and oxycodone), fentanyl's strength makes it an attractive substance for drug abusers. A study in the March 17, 2004 edition of the Journal  of the American Medical Association noted that fentanyl's potency can be 50 to 100 times stronger than morphine.

 Information provided by the Ohio Resource Network for Safe & Drug Free
 Schools & Communities links fentanyl's illicit appeal with its ability to
 provide "a day's worth of narcotics in a single dose."  One of the many           problems with that mindset is that a fentanyl patch, which is designed to slowly release the drug over a period of up to three days, may contain a dose much larger than even a hardened addict can withstand. "Because the patch is a sustained release form of the drug, if one withdraws the 72 hours' worth of drug and uses it in a form that it wasn't designed to be used for, then it can rapidly result in death," Bruce Goldberger, Ph.D., the lead researcher of a 2005 University of Florida study into fentanyl abuse, told the News  Medical online news service.

 Individuals who abuse fentanyl patches usually employ one of the following methods to rapidly ingest high amounts of the drug:

 
• Applying multiple patches to the body at one time.
  
• Eating or sucking on a patch.
  
• Extracting the drug from a patch, mixing it with an alcohol solution,         and  injecting it with a hypodermic needle.

  Because the drug is not completely eliminated from the patch even after a
 3-day period of use, discarded patches remain a sought-after commodity by
 some abusers, and can pose a risk to young children who may come into contact with them. To prevent both intentional and accidental misuse, health professionals urge approved fentanyl users to be sure to properly dispose of their used patches.

  As Dr. Nora D. Volkow, the director of the National Institute on Drug Abuse, wrote in an advisory message posted on the NIDA website, "Fentanyl's superior  potency makes it a good medication for pain and a good target for abuse.  And while it may not be as familiar as the many other prescription opiates or street drugs like heroin, it is causing a wave of overdoses and deaths."

  In July 2005, the U.S. Food and Drug Administration responded to reports of hundreds of fentanyl-related deaths by issuing a public health advisory
 regarding the use of fentanyl skin patches. Noting that it continued to receive reports of fatal and near-fatal responses to improper use of the patches, the FDA released a Dec. 21, 2007 update that stressed the severity of complications  associated with fentanyl abuse:
 
  The fentanyl patch contains ... a very potent narcotic pain medicine. It
  is only intended for treating persistent, moderate to severe pain in patients
  who are opioid-tolerant, meaning those patients who take a regular, daily,
  around-the-clock narcotic pain medicine. ... For patients who are not
  opioid-tolerant, the amount of fentanyl in one fentanyl patch of the lowest
  strength is large enough to cause dangerous side effects, such as respiratory
  depression (severe trouble breathing or very slow or shallow breathing) and
  death.

  Among the reasons cited by the FDA for issuing its initial fentanyl-related
  advisory was a spate of deaths related to the drug in Florida. According to a
  fact sheet provided by the University of Florida, the drug was responsible for 379 deaths in that state alone in 2003 and 2004.

  In Aiken County, S.C., the Aiken Standard reported that between January 2006  and May 2008, 11 county residents died as a direct result of "either injecting, scraping, chewing or even overloading on fentanyl pain patches." The paper quoted Aiken County Coroner Tim Carlton as noting that scraping a patch and  injecting it with a solvent "amounts to taking 40 times the dose typically prescribed."

  But individuals who willingly abuse the drug are not the only ones who have suffered fentanyl- related consequences. In May 2008, a foster mother in New York City was arrested after giving a fatal dose of fentanyl to a child in her care. According to The New York Times, Joanne Alvarez put a fentanyl patch on the neck of her 6-year-old foster daughter after the girl complained of a  headache, then sent the child to bed. The next day, a relative discovered that  the girl was not breathing. The child was taken to Mount Sinai Medical Center,  where she was pronounced dead.

  "The mother gave the child Motrin and also put one of these [fentanyl]
  patches on the child, and it appears that this may have caused the child's
  death," New York Police Commissioner Raymond Kelley told Times reporter Al  Baker, adding that initial indications were that the foster mother's actions  constituted "gross negligence that rises to the level of criminality."

  Though fentanyl poses significant risks to individuals who misuse it, the
 drug can serve as a safe and powerful source of pain relief when used properly  by patients under the care of a qualified physician. For this reason, health professionals and other experts are not calling for fentanyl to be banned, but rather are advocating increased awareness to enhance the public's understanding of the proper application, use, and disposal of the drug.

  As Pat Clarke of the FDA said in a podcast posted on the agency's website,
"Healthcare professionals who prescribe the fentanyl transdermal system, or  fentanyl patch, should be fully aware of all the prescribing information and  should instruct patients on the proper use of the fentanyl patch."


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VIDEO:  Local Problem in WNY - Fentanyl Use

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          Fentanyl  is estimated to be
                  8O  X's  STRONGER 
                      than Morphine.
                         source: AccessRx.com

 The History  Of :  FentanyL

Fentanyl was first synthesized by Paul Janssen under the label of his relatively newly formed Janssen Pharmaceutical in 1959. In the 1960s, fentanyl was introduced as an intravenous anesthetic under the trade name of Sublimaze. In the mid-1990s, Janssen Pharmaceuticals developed and introduced into clinical trials the Duragesic patch, which is a formation of an inert alcohol gel infused with select fentanyl doses which are worn to provide constant administration of the opioid over a period of 48 to 72 hours. After a set of successful clinical trials, Duragesic fentanyl patches were introduced into the medical practice.

Following the patch, a flavored lollipop of fentanyl citrate mixed with inert fillers was introduced under the brand name of Actiq, becoming the first quick-acting formation of fentanyl for use with chronic breakthrough pain. More recently, fentanyl has been developed into an effervescent tab for buccal absorption much like the Actiq lollipop, followed by a buccal spray device for fast-acting relief and other delivery methods currently in development.

A new fentanyl product has been approved by the FDA for breakthrough cancer pain called Onsolis. It uses a new drug delivery technology called BEMA (fentanyl buccal soluble film) which is placed in the mouth on a small disc. There appears to be less abuse potential because the drug can not be crushed up and snorted like other fentanyl products.
                                                                                                                                      SOURCE: Wikipedia

 Pharmacokinetic  Data

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Bioavailability
92% (transdermal)
89% (intranasal)
50% (buccal)
33% (ingestion)
Protein binding
80-85%
Metabolism
hepatic,
primarily by CYP3A4
Half-life
(IV)= 2.5 minutes
Intranasal = 6.5 mins
Transdermal = 7 hours (range 3–12 h)
Excretion
60% Urinary (metabolites, <10% unchanged drug)
 

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              issue:
  *Fentanyl Abuse*
With the surge of prescription opiate abuse over the past ten years there is no doubt that the Fentanyl patch abuse has made its way to the top of the popularity list. The list of opiate abused prescriptions gets longer and stronger every year.
Most people that engage in Fentanyl patch abuse likely started out taking a prescription that was less potent such as Vicodin, Oxycontin, or Dilaudid.

Fentanyl, also known as Sublimaze or Actiq, is one of the strongest prescription pain narcotics on the market today. In fact, Fentanyl is dispersed in micrograms and is over 75% stronger than Morphine. It is a Class II scheduled narcotic and while it works very well for pain management; it is also highly addictive.

The early 1990's brought forth the approval of the Fentanyl patch which delivers pain control for 72 hour intervals while releasing doses of the drug periodically. The patch contains a lot of medicine, so much so that it is the top choice of pain management for cancer patients. Those that engage in Fentanyl patch abuse usually tamper with it so that they can get more of the drug much faster. This is extremely dangerous and because the disbursement cannot be regulated and overdose is likely. This is especially true with those who do not have a tolerance to opiates and do not realize the dangers associated with the Fentanyl patch abuse outside of a hospital setting.

The Fentanyl patches are usually stolen from pharmacies or from family members that have had them prescribed.  It is also common for people to obtain them from garbage at hospitals and other various medical facilities. Even though the discarded patches have been used they still contain a good amount of Fentanyl, at least enough to get high on. The active ingredients in the patch are in the form of a gel and people that engage in Fentanyl patch abuse will actually bite holes in the patch itself which allows the release of the gel to then be ingested. The danger here is that the individual will receive a three day dose at one time. Others that engage in Fentanyl patch abuse will smoke, snort or inject the drug.
 
On the streets, Fentanyl patches can cost as much as $40 per patch, depending on the strength. Street names for Fentanyl include China girl, TNT, dance fever, friend, tango and cash, and jackpot.

Fentanayl patch abuse will lead to eventual addiction, which is very similar to other opiate addictions such as Heroin, Methadone, and Morphine so the withdrawal is also similar. Opiates, including Fentanyl, change the way that the brain functions and handles pain as well as emotion. This is how the drug works to cause a physical dependence. The side effects that are most associated with Fentanyl patch abuse are similar to other opiates including sedation, tiredness, confusion, tolerance, even coma, unconsciousness and even respiratory arrest. 

If you or someone that you care about has fallen prey to the dark world of Fentanyl patch abuse then please understand that help is available. The negative consequences have likely spiraled out of control and it is time for help, it is the only hope. Fentanyl will and does cause death by slowing down the respiratory system so much that it induces a coma and then death for even the most seasoned drug abusers.

source: http://www.genesishouse.net/article-Fentanyl-Patch-Abuse.html

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Nurse Steals Meds from Patient During Surgery

February 10, 2011
By: Brian Bujdos

You couldn’t dream up some of the headlines these days.
Even taking into consideration that a nurse in Minnesota was addicted to pain killers, it is hard to fathom that she would steal more than two thirds of the 500 micrograms of fentanyl reserved for a patient who was about to undergo surgery to have kidney stones removed.

Fentanyl is considered to be highly addictive because the opium-based  medication is about 80 times stronger than morphine. Hospitals use fentanyl for  anesthesia because it is powerful and fast-acting.

Here’s the skinny…
A male patient at Abbott Northwestern Hospital in Minneapolis was scheduled to have surgery for kidney-stone removal on Nov. 8 last year. The surgery took place, but it was excruciatingly painful for the patient, who screamed and yelled, and had to be held down by medical staff in order for the procedure to be completed. The procedure involves a tube being inserted through the patient’s back and into one of their kidneys. Hospital staff told authorities that, during the surgery, registered nurse Sarah May Casareto acted intoxicated, slurred her speech, stopped attending her patient, fell asleep and also knocked over some medication near the end of the procedure. During the surgery, and as the patient was moaning, Casareto told the patient to “Go to your beach… Go to your happy place.” That was according to a technician who assisted with the procedure. After the surgery, hospital staff found that Casareto’s scrubs contained empty syringes with labels peeled off, which violates hospital policy.

When approached after the surgery, Casareto resigned instead of submitting to a drug test.

The patient filed a formal complaint with local police on Dec. 4, and an investigation was launched. The complaint states that, before the surgery, Casareto told the patient, “You’re gonna have to man up here and take some of the pain because we can’t give you a lot of medication.”

Casareto has been licensed as a nurse in Minnesota since 2006, and there was no record of any disciplinary action taken against her before this incident. County Attorney Mike Freeman said the investigation into the incident is not yet complete, and that if Casareto is convicted, prosecutors will seek jail time instead of the probation that is prescribed by sentencing guidelines for the offense.

Certainly, the powers of addiction can cause people to do some things they would normally not do. It’s just a shame that finding out what other people are truly capable of comes at the expense of innocent victims. And at the expense of everyone else, due to the victim’s slam-dunk lawsuit that will surely bring him a large sum of money.

Healthcare is costly enough without incidents like this.

source: AccessRx.com

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