Palliative easily a killer

Fentanyl is an extraordinarily effective drug when it comes to pain relief. But abuse it and the chance of deadly complications is high.

A synthetic medication, fentanyl belongs to a class of drugs known as opioids. Others in the class include morphine, heroin, methadone, hydrocodone (Vicodin) and oxycodone (OxyContin).Opioids work by binding to parts of nerves responsible for perceiving and transmitting pain. These opioid receptors are found primarily in a person’s brain and spinal column.For people in distress, relief can come in a matter of seconds after a fentanyl injection. For others, a feeling of euphoria is common, said Dr. Allen Burton, an Associate Professor of Pain medicine at M.D. Anderson Cancer Centre in Houston.Potency is fentanyl’s hallmark: It is between 80 to 100 times more powerful than morphine.Whereas heroin and morphine are dosed in milligrams, fentanyl is dosed in micrograms-one 100th of a milligram, said Linda Bressler, a clinical Associate Professor at the University of Illinois at Chicago’s College of Pharmacy.Underscoring the need for caution, fentanyl has a narrower “therapeutic window”-the difference between a safe dose and a dangerous dose-than other opioids. “Overshoot the dose by just a little bit, and you can go from euphoric to unconscious or dead pretty easily,” Burton said.The greatest danger comes from fentanyl’s potential to depress the central nervous system and cause breathing to shut down if it is taken in excess.Signs of an overdose include “trouble breathing or shallow breathing, extreme sleepiness or sedation, an inability to walk or talk normally, and feeling faint, dizzy and confused,” according to a publication from the Food and Drug Administration.Heroin users may put themselves at extreme risk with fentanyl because doses are so different and because the drugs compound each other’s effects, said Dr. Bruce Goldberger, director of toxicology at the University of Florida’s College of Medicine.Fentanyl has two legitimate purposes. In hospitals and other medical settings, anaesthesiologists give it intravenously to patients undergoing surgery. The drug is also available in a skin patch or lozenge for people with severe chronic pain, such as cancer patients and patients with degenerative neurological disorders.Recently, reports from around the country indicate growing abuse of the Duragesic skin patch and an increasing number of deaths from overdoses. Users are putting on multiple patches or stripping out the drug and injecting, drinking, eating or smoking it, Goldberger said.(Source: Anderson Cancer Centre: June 2006).