nj.com: Patches, pills and lollipops: 4 things to know about fentanyl

6/29/2017

BY STEPHEN STIRLING AND ERIN PETENKO

NJ Advance Media for NJ.com

 

 

Fentanyl has only made its way into illegal drugs in the past five years, but its history goes far further back: The powerful opioid was first synthesized by Janssen Pharmaceuticals in 1960.

At first only used as an anesthetic, fentanyl's approval as a patch and oral drug in the mid-1990s allowed it to expand into pain management. It's now one of the most common synthetic opioids on the market, with 127,000 prescriptions filled in New Jersey in 2016.

Yet its wide usage has not made it less deadly. A fatal dose of fentanyl is only three milligrams - the mass of a snowflake.

1. It's meant as a last resort

Fentanyl is approved by the Food and Drug Administration for breakthrough pain episodes, mostly for adults with cancer. It is intended for patients with around-the-clock pain who are already tolerant to other opioids. Even then, the FDA warns that its abuse potential is high, as is its risk of adverse effects - several studies show that fentanyl is a strong respiratory depressant, even compared to other opioids.

"When you have exhausted all other possibilities, then you turn to fentanyl.  You have to tell the patient, this is a strong painkiller," said Iqbal Jaffri, medical director of the Pain Management Program at JFK Medical Center.

2. It's prescribed in many forms

The FDA has approved a wide breath of fentanyl options beyond the conventional pill. Patients can take fentanyl as a sublingual (under the tongue) spray, dissolving tablets, skin patches and even lollipops, in the case of Actiq. Sublingual sprays, marketed as Subsys, are the fastest-acting method, bypassing typical body absorption to deliver immediate relief from pain -- or an immediate high.

3. It's easy to get a deadly dose of the drug

Experts expressed concern about the fentanyl patch, which operates on a heat-release system.

"With the patch, it's transdermal, so it's triggered by body heat. If a patient has a fever over 101, it can cause death from respiratory depression," Jaffri said.

In 2008, the UK body that regulates medicine warned doctors about unintended overdoses from the patch. In 2012, the FDA required one manufacturer to change the color of their fentanyl patches after reporting 12 deaths of children from accidental ingestion.

4. It's synthetic - helping to make it popular for illegal use.

Rather than being derived from natural ingredients, fentanyl is created in a lab, which appeals to illegal drug distributors looking for a cheap and easy way to get opioids to sell. 
 
When the government has tried to ban or restrict chemicals needed to create fentanyl, drug dealers have responded by coming up with new ways to synthesize it. Fentanyl is also easier to transport, as one supplier showed by concealing it in a package of urine test strips.

 

A picture of Actiq, one name brand of fentanyl citrate that comes as a lollipop. (Crohnie | Wikimedia Commons)