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Fentanyl and California's Physician Diversion Program

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History of Fentanyl

Illicit use of pharmaceutical fentanyl first appeared in mid 1970’s in the medical community

Biological effects indistinguishable from heroin-EXCEPT that fentanyl may be hundreds of times more potent

Most commonly used by intravenous administration, but like heroin, may be smoked or snorted

First synthesized in Belgium in late ’50’s as a synthetic narcotic

Approved by FDA in 1968 Introduced into clinical practice in ’60’s as an IV

anesthetic (Sublimaze) Thereafter Alfenta and Sufenta introduced Today extensively used for anesthesia and chronic

pain management

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DESCRIPTION

Only used in hospital or clinical setting Especially prone to creating dependency early on Used to aid induction and maintenance of

general anesthesia and to supplement regional and spinal anesthesia

May be administered IV, IM, transdermally, epidurally, or in lozenze/lollipop form

Drug of abuse of choice by anesthesiologists, for myriad reasons, including availability, often undetectable in less sophisticated urine sample screens, and personality characteristics unique to many physicians (Vaillant, 1972)

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PHARMACOLOGY OF FENTANYL An opioid analgesic, lipid soluble, metabolized in liver Fentanyl interacts with the m-receptor, sites that are distributed in the

brain, spinal cord, and other tissues Exerts primary pharmacologic effects on CNS Increases toleration of pain, decreases perception of suffering,

produces alterations in mood, EUPHORIA, dysphoriia, and drowsiness

Stimulatory effect is result of “disinhibition” as the release of inhibitory neurotransmitters, such as Dopamine, acetylcholine, norepinephrine, and substance P are blocked

Exact process of how opioid agonists cause both inhibitory and stimulatory processes not well understood

Side effects myriad, but include respiratory depression, gastrointestinal motility, and physical dependence

Significant drug-drug interactions Metabolites and unchanged drug are excreted in urine, which can take

several days Residual fentanyl from one dose can potentiate the effect of

subsequent doses, such as serious respiratory complications

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CALIFORNIA”S PHYSICIAN DIVERSION PROGRAM Details about this

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