Fentanyl Patches

Fentanyl is a synthetic opioid analgesic that’s typically used to manage acute, severe pain.1 It may also be used to treat chronic pain when a doctor determines a patient is physically tolerant to morphine or other opioids.1 Fentanyl is 50 to 100 times stronger than morphine.

In the medical setting, such as a hospital or even in the back of an ambulance, fentanyl administration and dosing is closely monitored by medical professionals and is given to patients in acute pain by mouth via a pill, directly into the bloodstream via IV, or by placing a dissolvable film beneath the tongue.2

A transdermal fentanyl patch with the brand name Duragesic allows for the drug to be absorbed through the skin in a continuous and time-released fashion over 72 hours.2,3 The fentanyl patch is intended only for those who suffer from chronic and breakthrough pain, such as the type caused by cancer or other painful debilitating diseases.2

Fentanyl: Fueling America’s Opioid Crisis

Similar to other opioids, fentanyl is abused for its euphoric effects like heroin.1–3 However, fentanyl is also much higher in potency than heroin or other prescription opioids and often results in overdoses causing severe respiratory depression and death.3

Synthetic opioids, primarily fentanyl, are now the most common drugs involved in drug overdose deaths in the U.S. In 2017, fentanyl was involved in about 59% of opioid-related deaths, compared to 14.3% in 2010.3,4 This increase is largely due to fentanyl-laced heroin or the presence of fentanyl in other illicitly manufactured opioids vs. use or misuse of prescription fentanyl.5

Despite an increased risk of overdose and death, studies show some drug users actually seek out fentanyl or fentanyl-laced opioids.6,7 Research suggests those who do are seeking an ability to surpass their tolerance of heroin or another opioid.6

Fentanyl Patch Abuse

Opioid drugs work by blocking pain sensations and altering the way the brain responds to and regulates feelings of pleasure.3 Functions of the central nervous system are depressed as brain chemistry is changed.3

With continued and regular use, a person can become tolerant to opioids and feel the need to take more frequent and higher doses in order to keep feeling the desired effects.3,8 Fentanyl may provide an intense and significant high—especially for frequent and long-term opioid users who have built up a tolerance to high-potency opioids—and transdermal fentanyl patches may be attractive to these individuals.

Despite being specifically designed for safe and continuous delivery of a highly potent opioid, fentanyl patches are abused in a number of ways, including:2

  • Changing the patch more often than medically necessary.
  • Scraping the gel off and injecting it.
  • Swallowing, suck on or chewing the patches.
  • Putting the patch into tea and drinking it.
  • Inserting the patch into the rectum.
  • Inhaling the gel or vapors following combustion.

A transdermal fentanyl patch contains a significant amount of fentanyl intended to keep intense pain at bay. The patch’s design is meant to slowly release the medication in a continuous fashion over a set period of time, up to 72 hours, and is not meant to be taken all at once.9

Given the high potency of fentanyl, bypassing the patch’s ability to safely—and slowly—release the drug into the body is highly dangerous and puts individuals at risk of a fatal opioid overdose.9

A fentanyl overdose looks like any other opioid overdose: difficulty breathing, cold and clammy skin, mental confusion, weak pulse and heart rate, possible loss of consciousness, and cessation of breathing altogether. A fentanyl overdose can be reversed with the prompt administration of an opioid antagonist such as naloxone, although may require multiple doses.10

References

  1. National Institute on Drug Abuse. (2016). Fentanyl.
  2. Nelson, L., & Schwaner, R. (2009). Transdermal fentanyl: Pharmacology and toxicologyJournal of Medical Toxicology: Official Journal of the American College of Medical Toxicology, 5(4), 230–241.
  3. National Institute on Drug Abuse. (2019). DrugFacts: Fentanyl.
  4. Centers for Disease Control and Prevention. (2019). Synthetic Opioid Overdose Data.
  5. Diversion Control Division. Drug Enforcement Administration. (2018). Fentanyl.
  6. Kenney, S. R., Anderson, B. J., Conti, M. T., Bailey, G. L., & Stein, M. D. (2018). Expected and actual fentanyl exposure among persons seeking opioid withdrawal managementJournal of Substance Abuse Treatment, 86, 65–69.
  7. Meier, A., Moore, S. K., Saunders, E. C., Metcalf, S. A., McLeman, B., Authy, S., & Marsch, L. A. (2017). National Drug Early Warning System HotSpot Report: Understanding Opioid Overdoses in New Hampshire.
  8. Kimergård, A., Dunne, J., Bøgen, A., Hindersson, P., & Breindahl, T. (2018). Characteristics of opioid-maintained clients smoking fentanyl patches: The importance of confirmatory drug analysis illustrated by a case series and mini-reviewDrug Testing and Analysis, 10(6), 917–926.
  9. Food and Drug Administration. (2019). Drug Label: Duragesic.
  10. Rzasa Lynn, R., & Galinkin, J. L. (2018). Naloxone dosage for opioid reversal: current evidence and clinical implicationsTherapeutic Advances in Drug Safety, 9(1), 63–88.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More