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Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. It is prescribed to treat severe pain, such as pain from...
Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. It is prescribed to treat severe pain, such as pain from surgery or cancer. However, fentanyl is also produced and used illegally, and is a major contributor to the current opioid crisis in the United States. Misuse of fentanyl can lead to addiction, overdose, and death. It is often sold illegally in the form of powders, tablets, and patches, and is sometimes mixed with other drugs such as heroin or cocaine.
Fentanyl is a highly potent drug that can cause respiratory depression, which is a slowing or stopping of breathing, especially when taken in large amounts. This is why it is important for fentanyl to be used only as prescribed and under the supervision of a healthcare professional.
In recent years, fentanyl has been increasingly associated with overdose deaths, as it is often mixed with other drugs without the user's knowledge, making it even more dangerous. There have been reports of illegally produced fentanyl causing overdoses and deaths in various parts of the world.
Due to its potency and the risks associated with its use, there have been widespread efforts to increase awareness of the dangers of fentanyl misuse and to provide access to overdose-reversing medications such as naloxone. Additionally, authorities have been working to reduce the availability of illicitly produced fentanyl and to prosecute those involved in its illegal production and distribution.
Ngoài việc sử dụng trong lĩnh vực y tế, fentanyl cũng đã trở thành một vấn đề nghiêm trọng trong việc sử dụng ma túy. Fentanyl được chế tạo một cách bất hợp pháp và thường được pha trộn vào các loại ma túy khác như heroin, cocaine, ecstasy, và các loại thuốc phiện tổng hợp khác. Sự pha trộn này tạo ra một mối nguy hiểm lớn khi người sử dụng ma túy không biết chính xác họ đang sử dụng loại chất gì, đặc biệt là với sự khác biệt về độ mạnh của fentanyl so với các chất ma túy khác.
Việc kiểm soát việc sử dụng fentanyl là một vấn đề cấp bách, và cần có sự chú trọng vào việc giáo dục cộng đồng về nguy hiểm của việc sử dụng chất này, cũng như tăng cường các biện pháp an toàn và giám sát trong việc sử dụng các loại thuốc gây mê.
The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis Current Opinion in Psychiatry - Tập 34 Số 4 - Trang 344-350 - 2021
Purpose of review
This review provides an update on recently published literature on the rise of illicit fentanyls, risks for overdose, combinations with other substances, e.g. stimulants, consequences, and treatment.
Recent findings
Overdose due to illicit synthetic opioids (e.g. fentanyl and fentanyl analogs) continues to rise in the US both preceding and during the COVID-19 pandemic. Fentanyl-related overdose is rising in new geographic areas e.g. the western USA. Stimulant-related overdose is also increasing nationwide driven by methamphetamine and cocaine. Polysubstance use, e.g. the use of a stimulant along with an opioid is driving stimulant-related overdose. Other medical consequences of injection drug use are rising including HIV and hepatitis C infections. Medication approaches to treating opioid use disorder remain the standard of care and there are new promising pharmacological approaches to treating methamphetamine use disorder.
Summary
A ‘fourth wave’ of high mortality involving methamphetamine and cocaine use has been gathering force in the USA. Availability and use of illicit fentanyls are still the major drivers of overdose deaths and the current rise in stimulant-related deaths appears entwined with the ongoing opioid epidemic.
Dose-titration, multicenter study of oral transmucosal fentanyl citrate for the treatment of breakthrough pain in cancer patients using transdermal fentanyl for persistent pain. American Society of Clinical Oncology (ASCO) - Tập 16 Số 10 - Trang 3238-3245 - 1998
PURPOSE Supplemental, "as-needed," administration of an opioid is a common approach to the problem of breakthrough pain in cancer patients. Oral transmucosal fentanyl citrate (OTFC) is undergoing investigation as a new treatment for breakthrough pain. The primary purpose of the study was to demonstrate that a single-unit dose of OTFC can safely and effectively treat breakthrough pain. A secondary goal was to determine appropriate dosing guidelines. PATIENTS AND METHODS This was a multicenter, randomized, double-blind, dose-titration study in 62 adult cancer patients using transdermal fentanyl for persistent pain. Consenting patients provided 2 days of baseline data to evaluate the performance of their usual breakthrough pain medication. Patients then randomly received 200 microg or 400 microg OTFC in double-blind fashion. (Patients were always assigned, rather than randomized, to 200 microg if 400 microg represented > 20% of around-the-clock medication.) Pain intensity (PI), pain relief (PR), and global satisfaction scores were recorded. OTFC was then titrated until the patient received adequate PR for each episode using one OTFC unit. Orders to titrate up were ignored one third of the time to improve the blind. Two days of baseline data were compared with 2 days of OTFC data after titration identified an effective dose of OTFC. RESULTS Most patients (76%) found a safe and effective dose of OTFC. There was no meaningful relationship between the around-the-clock opioid regimen and the effective dose of OTFC. In open-label comparisons, OTFC produced a faster onset of relief and a greater degree of PR than patients' usual breakthrough medication. Somnolence, nausea, and dizziness were the most common side effects associated with OTFC. CONCLUSION Most patients find a single OTFC dosage that adequately treats breakthrough pain. The optimal dose is found by titration and is not predicted by around-the-clock dose of opioids.
