How Is Fentanyl Used?
Fentanyl is also clinically used in the following ways:
- To treat surgical pain
- In combination with anesthesia during surgery in intubated patients
- As general anesthesia
- For severe pain that is nonresponsive to other medications or treatment methods
As an opioid drug, fentanyl is a powerful pain reliever that binds to opioid receptors in the brain to block pain sensations. It is also a central nervous system depressant medication, which is why it is used as a sedative during surgery.
Fentanyl is extremely powerful. It is commonly misused, and abuse can easily lead to drug dependence and addiction.
Key Facts About Fentanyl Use
- In 2015, there were 6.5 million prescriptions of fentanyl dispensed in the United States, which dropped to 4 million in 2018.
- One dose of 100 mcg of fentanyl is equal to about 10 mg of morphine.
- Fentanyl acts quickly to manage pain. It has an onset of action of less than 60 seconds when administered intravenously, which is twice as fast as that of morphine.
- Fentanyl abuse is increasing and driving opioid overdose deaths. In 2020, more than 56,000 people died from an overdose involving a synthetic opioid — more than 18 times the number of synthetic opioid-involved overdose deaths in 2013.
Clinical Use of Fentanyl
Fentanyl is a Schedule II controlled substance by the Drug Enforcement Administration (DEA) due to its potency and high potential for diversion, abuse, and addiction. As such, it must commonly be prescribed through special programs or pharmacies and by physicians who are certified and have received the proper training to dispense it safely. Patients on fentanyl must be closely monitored for signs of misuse and addiction.
Fentanyl was initially designed to treat extreme pain in cancer patients who were not getting any relief from other medications or treatments. Opioid drugs can cause drug tolerance with regular use, which means that regular doses will no longer be effective.
The medication can be helpful for pain on those who are opioid tolerant to other narcotics, as it is more potent in lower doses. It is a fast and effective pain medication for extreme pain.
Fentanyl is also used as a sedative during surgery due to its central nervous system depressant properties. It can be used with or without other medications for anesthesia. It can be used both pre- and post-operatively to manage surgical pain.
There are several different formulations of fentanyl prescription products, which include the following:
- Lozenges (Actiq)
- Sublingual tablet (Abstral)
- Transdermal patch (Duragesic)
- Injection (Sublimaze)
- Buccal tablet (Fentora)
- Nasal spray (Lazanda)
An oral transmucosal lozenge, Actiq is often referred to as fentanyl “lollipops.” Actiq is intended for use on breakthrough cancer pain in patients ages 16 or older who are already opioid tolerant. Cancer patients who take around-the-clock opioid pain medication to manage their cancer pain can take Actiq to reduce breakthrough pain.
It is available in dosages of 200 mcg, 400 mcg, 600 mcg, 800 mcg, 1200 mcg, and 1600 mcg. Patients are to take the lowest dose possible to manage the breakthrough pain, starting at 200 mcg. They should also take at least 15 minutes to consume the lozenge completely.
Similar to Actiq, Abstral is intended for breakthrough cancer pain in patients who are already opioid tolerant. Abstral is prescribed to patients ages 18 and older who need a method of managing breakthrough pain beyond what their around-the-clock opioid medications are minimizing.
Abstral is a sublingual (under the tongue) tablet that is dispensed in 100 mcg, 200 mcg, 300 mcg, 400 mcg, 600 mcg, and 800 mcg. Patients are to start with the lowest dose and not take more than two doses to manage a breakthrough pain episode. The tablet should be allowed to completely dissolve under the tongue.
Duragesic is a transdermal patch that can deliver around-the-clock fentanyl in an extended and controlled manner to control extreme pain in opioid-tolerant patients. Due to the risks for abuse, addiction, and overdose, Duragesic is only recommended for use when other methods of controlling pain are not working.
Duragesic is distributed in doses of 12 mcg/hour, 25 mcg/hour, 37.5 mcg/hour, 50 mcg/hour, 75 mcg/hour, and 100 mcg/hour. The patch is placed on the skin and worn continuously for 72 hours.
An injectable formulation of fentanyl, Sublimaze is used before, during, and/or after surgery to control surgical pain. It is also used with anesthesia for its sedative properties. It is commonly used with other medications with general or regional anesthesia. It is also commonly given along with oxygen in patients who are intubated.
Sublimaze is dosed in solutions equal to 50 mcg/mL in 2 mL, 5 mL, 10 mL, and 20 mL ampules. Injectable fentanyl is dispensed in a hospital setting by a trained medical provider.
Fentora is a buccal tablet formulation of fentanyl that is placed inside the cheek or under the tongue and allowed to dissolve. Also prescribed to treat breakthrough cancer pain in patients who are at least 18 years old, Fentora is for patients who are opioid tolerant.
It can only be prescribed on an outpatient basis to patients enrolled in the TIRF REMS (transmucosal immediate-release fentanyl risk evaluation and mitigation strategy) FDA program. Fentora is available in doses of 100 mcg, 200 mcg, 400 mcg, 600 mcg, and 800 mcg.
A nasal spray formulation of fentanyl, Lazanda is also only available through the TIRF REMS program. It is prescribed to treat breakthrough cancer pain in patients who are at least 18 years old and who are opioid tolerant.
The medication is sprayed into one nostril as a single spray or into each nostril with two sprays. Each spray of Lazanda delivers 100 mcL of solution that has either 100 mcg or 400 mcg of a fentanyl base. Each bottle of Lazanda is 5 mL and contains 8 sprays.
The Problem With Fentanyl: Addiction & Abuse
Fentanyl is an extremely potent and addictive drug that causes drug dependence even when used as directed through a necessary prescription.
Fentanyl is powerful in extremely small doses, and it can easily cause a euphoric, pleasurable, and mellow “high” that people are eager to recreate. It can also lead to difficult withdrawal symptoms(a “crash” that can include emotional regulation difficulties, sleep problems, and flu-like symptoms) when it is not active in the body.
Due to its habit-forming nature, even when people are taking it clinically, this can quickly turn to misuse. It can be tempting to start taking fentanyl in between doses, to take more of it at a time, to try and “doctor shop” to get more prescriptions, to keep taking it after a prescription has run out, or to exaggerate pain symptoms to get more fentanyl. Any use of fentanyl outside of the way it was prescribed is abuse.
Fentanyl is also a common drug of abuse. This abuse is a massive public health concern, as fentanyl and synthetic opioids accounted for more than 80 percent of all opioid overdose deaths in 2020.
Fentanyl can be manufactured in illicit labs. It is commonly mixed into the illegal drug supply, such as into counterfeit prescription pills and heroin. The problem with fentanyl is its potency. You can more quickly become addicted or suffer a potentially life-threatening overdose on fentanyl than most other opioids.
What to Do if You Are Addicted to Fentanyl
Fentanyl can trigger difficult and even potentially dangerous withdrawal symptoms when you try to stop taking it after dependence and/or addiction is present.
Due to the strength of fentanyl, medical detox is recommended if you’ve been using it. Your doctor may supervise a tapered approach to detox, or you may use medication-assisted treatment (MAT), which involves the use of buprenorphine or methadone to aid withdrawal and ongoing recovery.
Often, an opioid addiction treatment program is optimal for managing fentanyl addiction and helping to foster recovery. This can include the following approaches:
- Detox in a specialized facility, including medical and mental health management and support
- Group and individual therapies, commonly including behavioral therapies, such as cognitive behavioral therapy (CBT)
- Life skills trainings and educational programs to promote healthy habits and positive lifestyle changes
- Support groups, including NA (Narcotics Anonymous), for peer support and assistance achieving and maintaining recovery while minimizing relapse
- Medication management, often including MAT to manage drug cravings, withdrawal symptoms, and minimize relapse risk
Fentanyl is extremely addictive, and it is easy to get addicted to it even if you are using it clinically. Fortunately, addiction is also highly treatable. With the right tools and support, recovery is sustainable for the long term.
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