I didn't mention any specific context since I was interested in the 10,000 foot view of this class of drug.
I'm hoping for a bit of an education from TLS Guy since he's a reasonable authority on this.
I have just got back from Grand Forks. This was a very sad day.
Fentanyl was introduced back in the late 60 as an anaesthetic agent. It is a highly potent synthetic narcotic agent. It has a very short half life and produces intense euphoria. It is a potent respiratory depressant. It is not absorbed via the gut, but by mucous membranes and the skin. During surgical procedures and in the ICU to patients on life support it is administered IV.
The drug has fewer vascular side effects than other narcotics. It short half life makes it very useful in procedural settings and in the ICU.
However these effects make it a very dangerous drug on the hands of non medical personnel. The shorter the half life of a drug inducing euphoria the stronger the addictive potential.
This drug has a very narrow window of safety. The margin between a high and total shut down of the respiratory center and death is razor thin.
Patches impregnated with the drug that is adsorbed though the skin became available in the eighties. There use is confined to the relief of pain in terminal cancer patients especially those who can not take drugs by mouth.
The lay press continue to refer to this drug as a pain killer. This is true to a limited extent. The main use of the drug in in surgical and procedural areas under skilled supervision. Its application for pain relief is pretty much confined to terminal conditions. It is not used by responsible practitioners to treat pain outside of end of life care.
I understand the Chinese in particular are making large quantities of Fentanyl powder and there is a rapidly escalating illegal distribution system.
This is an unfolding disaster. The potential for lethal overdose is enormous. In addition significant amounts are adsorbed though the skin in handling in addition to the amount intended for injection. In addition variable purity and potency in a drug with a very narrow window of safety in unskilled hands is obviously an urgent public health concern.
Fentanyl and very cheap street heroin are now causing an escalating death rate form narcotic overdose. Celebrity use of these compounds is very unhelpful in the overall scheme of things concerning this issue.
Narcotic deaths are now exceeding road deaths.
I leaned today that the nephew of my long term office nurse, died of a heroin overdose two months ago. His mother is a long term nurse in out OB Gyn area.
One of our ICU nurses who became a nurse practitioner and worked with my wife, has a son who became mixed up in the drug scene. He supplied Fentanyl to two individuals that died of Fentanyl over doses in Grand Forks. He was recently convicted in Federal Court in Fargo ND, and sentenced to 12 years in Federal prison. Their has been some degree of outcry on Facebook, that his sentence was too harsh. People just do not get it.
Anyone who thinks what is happening in this area is different from anywhere else is deluded.
This article of June 2 in the Grand Forks Herald, could be anywhere USA.
Note that there were 51 narcotic overdose deaths in Grand Forks County in 2014. Note that the Altru Health systems is admitting almost one serious narcotic overdose per day now and rising.
Please note that the population of Grand Forks County is just under 70,000!
A documentary has just been produced by UND on this issue. It is called "Faded Fentanyl's impact." It was shown at the Empire theater Grand Forks and is available in YouTube.
This is an appalling and rapidly evolving situation.
