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Discussion in 'Politics, Religion, Social Issues' started by steve knight, Sep 9, 2016.
Fentanyl should be schedule 1 and any company or executive making it should be thrown in jail. It's extremely deadly and one of the major causes of the overdose epidemic going on in this country right now.
Yah, fentanyl may be too dangerous even for supervised use after surgeries like knee replacement sometimes. People can suddenly just quit breathing. The respiratory depression effect is a little unpredictable (i.e. dosage v. body weight) and can be sudden and severe. Someone in my family who was a nurse said that more doctors now use IV acetaminophen instead. None of the side effects of the opioids; just not indicated for patients who have pre-existing liver function issues.
It should not be schedule one considering in extremely traumatic surgeries it's one of the few viable painkillers strong enough to help people. It's also entirely necessary for long term cancer patients with a tolerance to lesser drugs.
It's also an ideal pain killer in the military for a number of reasons.
In the opioid epidemic fentanyl is not typically a gateway opiod. It has been however been replicated in often illegal labs and put into heroin. The source of fentanyl is not legit US manufacturers. When people are prescribed fentanyl outpatient it most commonly comes in a difficult to abuse patch, not a solid dosage form.
You could shut down all legit fentanyl manufacturing in the US and you'd still have the issues of heroin being cut with illegally sourced fentanyl. And at that point your just punishing the people who need it.
The people who are getting legit pain meds from responsible docs actually have a pretty low risk of addiction. The majority of people who are getting addicted are teens and young adults looking to have fun or cope with emotions.
Thanks for your informed and detailed post.
Out of (somewhat ghoulish) curiosity: What would be an example of a "traumatic" surgery?
No facts please....
Anything involving (nonsuperficial) trauma of the abdomen, getting your gonads mangled in an explosion, breaking your spine, compound fracture of one's femur, burn victims, highly invasive oral surgery, etc.
You also have to consider some people are allergic to morphine, therefore you have to go with something like dilauded or fentanyl. Also factor in that not all opiates that come in oral dosage forms come in IV dosage forms due to the chemical properties of the drug.
Some people on the very strong painkillers have brain tumors which is causing pain that doesn't actually exist and opioids are the only way to treat them.
Something Morphine and Fentanyl may be able to produce similar therapeutic effects of you use enough morphine, but then you have a higher risk of unwanted side and toxic side effects.
Fentanyl, or even Sufentanil (even stronger) are also used in treating pain in people who are on a drug that happen to block most standard opiods such as naltrexone or buprenorphine.
Fentanyl is also commonly used in children because it can be put into lollipop form, which is safer from a dosing perspective and less invasive than a shot or patch.
The military likes fentanyl lollipops for the same reason, the the thing in the persons mouth and when they've had enough they'll pass out, then you take it out. With an IV it's possible to give way too much and cause an overdose. The lollipops are much more fool proof.
And like I said earlier, cancer patients quickly become tolerant to typical opiods, so you need to have enough options.
Don't get me wrong, it sucks that Fentanyl has been hijacked by illegal drug manufacturers and is killing thousands of drug abusers, but I don't know how you can un-invent it. Fentanyl is a pretty rarely prescribed drug in the outpatient world as is. Oxycodone and hydrocodone are far more prevalent.
Interesting posts here. One option that might be underutilized is Toradol (ketorolac). Unfortunately not really safe enough for unsupervised use. But, no abuse potential either, and, at least for some people it is pretty effective for severe pain.
Ketorolac is a pretty cool drug, but there are a lot of instances when you simply cannot give it and it's side effect profile is pretty serious. Therefore you cannot give it in the US for more than 5 days orally or 2 days IV. There are a lot of contraindications with other drugs and health conditions, not to mention a reasonable number of people who are allergic to it. For example you can't give it to people on diuretics, with heart failure, who are dehydrated, pregnant (sometimes), or have kidney insufficiency.
Often times Toradol is still given with narcotic painkillers, just a smaller dose, which is still a good thing. Remember Toradol is an NSAID, so it's target is inflammation. Inflammation may only be one aspect of the cause of pain and therefore only helpful in certain circumstances.
Ketamine is also another pain killer many people do not often think about at first glance. It's a narcotic but not particularly addictive, and given in low doses or even topically or intrathecally.
Maybe I'm missing something, but I don't really see marijuana (legalized or otherwise) being much of a competitor to Fentanyl.
Certainly from a purely medical/therapeutic standpoint, I don't see too many anesthesiologists using pot to put their patients under. And I certainly hope the drug maker isn't looking to protect an off-label recreational market for Fentanyl.
You are correct, the two aren't exactly interchangeable drugs on any level. Sure marijuana might help with some pain, but probably not the level of pain fentanyl would be involved in treating.
I was wondering about the relationship myself. My guess is they feel guilty about all the street fentanyl floating around, so they're trying to get in the good graces of the anti-drug public by working against marijauna. Fentanyl as you can see here has had a lot of bad press.
Like I said before though street fentanyl isn't typically from a legit manufacturer. It's not like the OxyContin/Oxycodone issue with false claims, overmarketing, overprescribing, etc. Perdue Pharma basically knew OxyContin sales came through addiction. Street Fentanyl is coming from "clandestine labs", some within our country, others from places like Mexico, China, etc.
Subsys is not a common form of fentanyl. It's an inhaled version of fentanyl. That's the only other marijuana relation I see. Subsys is super expensive and personally inhaling opiates is very dangerous and not something I'd reccomend. I imagine most insurances won't even cover Subsys.
One thing about this article, the say legal recreational pot might prevent life ruining addictions like pot. The fact of the matter is there are people who get addicted to marijuana and destroy their lives. There are people who are prone to psychotic conditions that get trigger by pot. Just have to throw that out there for a fair argument for/against.
File under anecdotal: I live in Oregon. I now have access to high-cbd, low THC weed that treats my numerous pains from being a runner/triathlete for 20 years. I get relief. I can still go to work. The pot world is very nuanced, so don't throw the baby out with the bathwater...
No doctor would ever prescribe FENTANYL for mild or moderate aches and pains. Fentanyl is more for "organs are falling out of the hole in my body" grade pain. It's somewhere between 50-100x stronger than morphine and reserved as one of the last options.
It's not like you would give marijuana to someone who is in that level of pain either either. Theyre on two very different levels.