Let’s talk about fentanyl…

The other week, I wrote about how wrong the president was when he said that fentanyl is “just a painkiller”.

From that blog post, we learned that it’s not just a painkiller. Because it is part of a group of drugs called opioids, this class of drug interacts with opioid receptors in the brain and elicit a wide range of responses in the body – from a feeling of relief from pain to relaxation, pleasure and contentment.

We talked about it’s licit (approved and proper) use for medicinal purposes. It’s approved indication include: managing acute and chronic pain particularly that due to cancer, nerve damage, back injury, major trauma and surgery. The caveat here is to use this only when all other lesser potent and addicting analgesics (narcotic or non-narcotic) fail.

It’s illicit (illegal) use is multiple and dangerous. Drug addicts get hold of the patch and extract the fentanyl from the patch and inject it. More commonly, however, is “diverting” method.

Diversion occurs when a medication that is prescribed by a medical professional, is not used appropriately, or is given or sold to a third party. (Alcohol and Drug Foundation, Australia)

Prescribed fentanyl can be “diverted” when:

  • individuals obtain medication inappropriately through their profession (e.g. doctors prescribe for themselves or among their peers)
  • individuals use their own prescribed medication recreationally for a non-medically intended purpose (e.g., to get euphoric effects or use it for sleep problems and not as a pain reliever)
  • individuals use medication prescribed to another person

There is NO safe level of drug use and what may be good for the goose, may not be good for the gander.  This means that its effect varies within and among different persons using the drug.

The most common side effects or “experiences” are:

  • nausea, vomiting
  • constipation and/or diarrhea
  • reduced appetite
  • wind, indigestion, cramps
  • drowsiness, confusion
  • weakness or fatigue
  • dizziness
  • euphoria
  • headache
  • incoherent or slurred or impaired speech and thought process
  • impaired balance
  • slow pulse (bradycardia) and hypotension (lowering of blood pressure)
  • rash (especially inflammation, itching, swelling at the patch site for those on the transdermal preparation

Since we know what fentanyl does and what its side effects are, let’s talk about withdrawing from this drug.

Withdrawing after using it for a long time is very challenging.  That’s because the body has gotten used to having opiates work at the receptor sites and withdrawing will mean that the body has to get used to functioning without it.  That’s what addiction is.  Whether you are a nicotine, alcohol, caffeine or drug dependent, the physiological function and response of your body has been altered to adapt to these.  Your body craves and longs for it.  Anything that changes your physiological function by craving for a substance that has made your body adapt to the pharmacologic effects of the regulated products.

The problem with fentanyl is that the withdrawal symptoms start as early as 8-12 hours after the last dose.  Withdrawal symptoms include:

  • goose bumps
  • bouts of chills alternating with bouts of flushing and excessive sweating
  • irritability
  • insomnia
  • loss of appetite
  • yawning and sneezing
  • watery eyes and runny nose
  • vomiting and nausea
  • diarrhea
  • increased heart rate and blood pressure
  • pains in the bones and muscle
  • general weakness
  • depression alternating with bouts of anger and confusion

Fentanyl is NOT JUST a pain killer.  It’s use and abuse are dangerous if not used properly (I heard that someone doesn’t really like following his doctors and takes an extra pop of the drug if he feels like it).

I am writing this to educate people that quitting after being on addicting agents is challenging and difficult to do.  That the side effects are sometimes difficult to differentiate from the actual disease (example is pain in bones and muscle during withdrawal versus using the drug for treatment of pain).  That when we are addicted to a substance, we will always rationalise why and how it is used.