There are many reasons why prescription drug abuse is such a big problem today; the relative ease of getting prescription medication is one of them, but another is that people become so desperate for relief from pain and distress that they throw caution to the wind and pump their bodies with pills and powders until their problems go away.
Of course, the truth of the matter is that these patients are substituting one ailment for another. The abuse of fentanyl and Duragesic patches is no exception.
Fentanyl and Pain Management
People who have chronic pain and need pharmaceutical help keeping that pain under control will be very familiar with fentanyl. WebMD describes how fentanyl intake can be prescribed in a number of ways:
- Skin patches
- Nasal sprays
- Filmstrips that dissolve in patients’ mouths
The method of the prescribed intake is very important; a doctor will decide which one is best for the patient, depending on her level of pain, the presence of any other drugs, as well as her overall physical health and family medical history.
‘Synthetic Opiate Analgesic’
One of the key reasons fentanyl has to be prescribed so carefully is because it can be very habit-forming, especially in patients who are willing to risk developing a dependency on the drug because they desperately want to do something about their pain. As the National Institute on Drug Abuse explains, fentanyl is a “powerful synthetic opiate analgesic.” Each one of those terms describes how and why fentanyl can be, and is, abused.
Fentanyl is an opioid, which means that when a patient takes it, it seeks out the opioid receptors in the brain, which are responsible for emotional and pain regulation. When fentanyl makes contact, the patient feels an initial burst of euphoria, which then tapers off as the fentanyl depresses the nervous system. As a result of this reaction, the emotional response to pain is calmed; the patient feels very powerfully and pleasantly sedated, so much so that the pain becomes manageable.
Following from this, the analgesic part of fentanyl comes from the medical term for a painkilling agent. Analgesics come in many forms: paracetamol, non-steroidal anti-inflammatory drugs, and opioids, like fentanyl (which is sold under the brand name Duragesic). Other examples of opioid analgesics include:
- Hydrocodone (sold as Vicodin)
- Morphine (Avinza)
- Oxycodone (Percocet and OxyContin)
- Hydromorphone (Exalgo)
As a synthetic opioid analgesic, fentanyl is not found in nature; morphine, by contrast, is derived from the opium plant. Fentanyl was created by a pharmaceutical company as recently as 1960, and perhaps due to being manufactured, it is very, very powerful.
More Powerful than Heroin
Describing fentanyl as “a drug of abuse,” the Centers for Disease Control warn that it is 80 times as powerful than morphine, and “hundreds of times” more powerful than heroin.
Heroin itself is so notorious that the U.S. Drug Enforcement Administration’s website lists it as the first example of a Schedule I drug, whereby a substance has no medicinal value and causes severe physical and psychological dependence in its users.
It’s unsurprising, then, that the DEA includes fentanyl in its list of Schedule II drugs. It has a high potential for abuse (albeit less than heroin and other Schedule I drugs), but its legitimate use in medicine keeps it a viable, if risky, option for doctors and patients.
One of the ways fentanyl can be taken in this matter is by way of a transdermal patch. A transdermal patch is like a bandage that is placed on the skin and will gradually deliver controlled doses of medication through the skin.
Transdermal patches enjoy popularity because oral administration of drugs is prone to abuse, and the patient’s digestive system not responding well to the medication is a possibility. Patients enjoy transdermal patches because they are non-invasive, and they can be administered at home by the patients themselves. Patches provide enough doses to last patients for up to a week, and the Nature Biotechnology journal says that using transdermal patches improves patient compliance at a low cost.
Mayo Clinic advises that fentanyl patches (sold under the brand name Duragesic) are intended for patients who can tolerate the presence of opioids in their bodies. However, even fentanyl transdermal patches can be abused. Despite the warnings on the packaging, patients have been known to chew the patches, dissolve them in liquid, use them in bulk (or apply multiple patches together), and leave patches on for extended periods of time.
One reason for this is because fentanyl patches are designed to work slowly, to the point where patients may wonder if they are working at all. Patients may assume that by unilaterally increasing their transdermal patch application, they are speeding up the process. While they may experience a faster onset of relief, they are also flooding their body with opioids. Even if they are opioid-tolerant, that rush of a substance 80 percent more powerful than morphine, and literally hundreds of times more powerful than heroin, will be too much for anyone to bear. The director of toxicology and an associate professor of pathology, immunology, laboratory medicine and psychiatry at the University of Florida’s College of Medicine explains that three days’ worth of fentanyl from a Duragesic patch being taken recreationally “can rapidly result in death.” The university quotes figures from the Florida Department of Law Enforcement as saying that 115 people died as a result of fentanyl patch abuse in 2005.
The Dangers of Abusing Fentanyl
Despite what recreational fentanyl users may think about abusing a prescription medication, there is absolutely nothing safe about abusing fentanyl.
The VICE writer said that his nausea was “insane,” that his insides felt like they were being mashed together, and he was terrified of what might happen if he stopped taking fentanyl. The writer in The Fix describes throwing up so violently that she gave herself a nosebleed, and desperately chewing and re-chewing her Duragesic patch to try and extract any last traces of the drug so she could get high again.
Some other signs of a fentanyl abuse problem might look like:
- Dilated pupils
- Sudden periods of fatigue or sleep
- Irritability and agitation
A 2008 article in the Journal of Forensic Sciences explained a study conducted by researchers to understand the toxicity of fentanyl patches. Over a period of three years, they established that the oral abuse of Duragesic patches was a factor in the deaths of seven people. Two of those deaths were determined to be via a fentanyl overdose alone, while the others were the result of a combination of fentanyl and other drugs.