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Attitude Toward Opioids, Fentanyl Changing Again

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Buffalo, NYThe existence of Duragesic Fentanyl is commonplace in the lives of patients prone to chronic pain—but it wasn't always that way, as the February 1 issue of the Harvard Health Letters points out. In fact, opioid pain medications (once known more commonly as narcotics) were shunned for mainstream management of pain. Concern about addiction and side effects were augmented by mood-altering consequences.

There were laws and regulations that made it difficult to prescribe opioids like the Duragesic patch. But that all changed in 1990 says the Harvard Health Letters, which was published in the Buffalo News at the start of the new month. Attitudes shifted, and doctors began to see chronic pain as something that should be actively treated.

But now the pendulum is swinging back, because people are dying.

Nine years after that initial attitudinal shift, about 4,000 Americans were identified as having died from opioid poisoning by 1999. To be fair, that number includes both unintentional, accidental deaths from the drugs, as well as suicides.

By 2007—a mere eight years on—that number had mushroomed to 14,500. While the Harvard Letters did not identify the source, more Americans overdosed or died using prescription opioid drugs than either cocaine or heroin. That year, there were more reports of people overdosing on opioids than corresponding overdoses of heroin and cocaine combined.

The Fentanyl Duragesic patch is an example of the initial shift in thinking on the role of opioid drugs in management of chronic pain. Patients needed to be conditioned to be receptive to opioid drugs. And the transdermal patch satisfied the need to administer the opioid in a more controlled fashion, minimizing the chances for addiction.

However, there have been problems that may or may not have been foreseen.

For one, fentanyl is an intense opioid about 80 times more potent than morphine. Without controlled administration, the drug can kill, and it has. A previous Fentanyl patch recall was initiated after a manufacturing defect in a small number of skin patches allowed an increased concentration of fentanyl to be released too quickly, with catastrophic results.

However, there have been other issues. Some doctors have been found to prescribe fentanyl without first conditioning patients toward opioids. Other patients have been found to not fully understand the complexity and the toxicity of the drugs they are using.

And Fentanyl patches—as well as other prescription opioid drugs—have found their way to the wrong hands. A study of fatal overdoses in West Virginia showed that half of the people who died from opioid overdoses had never obtained a prescription from a doctor, according to the Buffalo News.

It should be noted that results of a study published in the Annals of Internal Medicine of 10,000 people who were presumed to be taking long-term opioids legally over long periods showed that 51 experienced overdoses, with six deaths. That translates to one overdose in every 200 cases.

Not a high number. However, critics argue that even one overdose—from a Duragesic pain patch or any prescription opioid—is one overdose too many. The US Food and Drug Administration (FDA) has proposed requiring drugmakers to work with an independent organization to develop special prescriber training programs for long-acting opioids such as Duragesic Fentanyl.

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READER COMMENTS

Posted by

on
I could not agree more with the other comments. I had never used narcotics until sciatic pain and losing control of my legs. It's hard enough to find a good doctor both one that knows what they are doing and that cares. I finally found one after 4 years of hell and many diagnostic tests and procedures. Without exhaggeration I have been stuck with needles at least 200 times during these tests. After finally being diagnosed correctly with herniated/leaking discs at L4-S1(now fused) 50% or less disc space at C4-7, bone spur from a fracture at T11-12, 2 knee replacements (same knee) in 10 months bc the first doc did the wrong surgery and broke a drill bit off in my femur and for some reason when I tried to sue him the panel didn't think he committed malpractice. We tried many combos of meds nothing would manage the pain. The patches atleast made it tolerable, now insurance says they won't pay for them, they will anything else but not them.

Posted by

on
I had my first spinal fusion using my own femur as the donor bone when I was 12 y/o.I have had 3 revision, including insertion of the rods. I was fused from T1-to my sacrum A couple of hrs ago my cervical vertbrae had to be fused due to the severity of the pain. Due to a complication I am left with severe left leg pain that never goes away. I have been on every medicine,I had a medtronic pump inserted in my abdomen for five hrs. the only pain med that helps relieve my pain is the Actiq lollipop. My pain management dr.has known me for many years and is extremely helpful. I have to recieve multiple steroid injections in my back and hip just so I can walk and sleep at night. If I did not have the Actiq lollipops to help with the pain,well I would have little option left. My problem now is BCBS doesn't want to pay for it anymore. Before they make their decisions,they should have to walk in mt shoes. That is on the days I can walk which are fewer and fewer.

Posted by

on
I have the same problem. I served my country in the US NAVY for 6 years and suffered several debilitating issues. I go to the doctor now, and I am treated like a crack-cocaine addict when I try to get a pain care plan. I am legit, do not abuse the medications, and follow orders strictly. I am a full-time student and self employed. I am not a street junky. I wish that doctors could get a grip on this thing and give those of us who have serious chronic pain some relief without emotional distress upon leaving the office or complete rejection. This is a sad situation because pain under treatment is now more common and chronic pain sufferers are left fend for themselves.

Posted by

on
I would respectfully add that it's my contention that the majority of the overdoses in these studies were because the "patient" was trying to get HIGH. A lot of these people really do not have chronic pain problems, but TELL their doctors that they have "back pain" in order to get these type medication. Yes, the doctor should do more testing to determine what is wrong, but many times the doctors just hand them a prescription for some pain reliever -- and the patient goes on their way -- to get HIGH. In the meantime, we who are REAL chronic painers and who have suffered for a very long time, are finding it much more difficult to be treated because NOW the doctors are gun-shy. People have died because of the over-dosing and the DEA getting involved -- so we can't get the treatment WE DESERVE. i've been a severe chronic pain patient for 26 YEARS - and you wouldn't believe what I've had to go thru to just get adequate care -- and I'm not alone. This isn't acceptable.

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