Culture of Addiction and Recovery of Fentanyl - Essay Example

Fentanyl is a DEA schedule II synthetic opiate commonly used to block pain. It also remains the popular perioperative choice by Anesthesiologists and Nurse Anesthetists. Fentanyl was first formulated by Dr. Paul Janssen of Janssen Phareceutica in the early 1960’s. Shortly after, Fentanyl citrate was discovered. Commonly used to treat chronic pain, Fentanyl is a “powerful narcotic that is almost 100 times stronger than morphine” (opioids.com). Because of its potency, it quickly became a widely abused substance both on the street and among health care professionals. It comes in liquid form for intravenous use, the Duragesic patch and in lollipop form. Fentanyl effects the central nervous system, causing analgesia(pain relief) and sedation. Other effects include possible mood changes, feeling of euphoria and drowsiness. Fentanyl depresses the respiratory system, so breathing can be slowed. Side effects can include abdominal pain, nausea, dizziness, dry mouth, sweating, urinary difficulty, lack of appetite, depression, diarrhea and, in the worst cases, hallucinations. Signs of overdose include extremely slow respiration, clammy skin, low blood pressure and very slow pulse. Withdrawal should be planned and done slowly through gradual reduction in doses, as Fentanyl is processed or metabolized differently for different users. Withdrawal should always be supervised by a licensed, knowledgeable physician. Many forms or variations of Fentanyl have been manufactured and sold on the streets since its initial introduction. A common form that is almost exclusive to California is called “China White.” Though the effects of Fentanyl are similar to those of Heroine, the chemically reproduced street versions are more likely to be sought after by suburban, as opposed to urban residents. Fentanyl was often given to race horses in the 1970s as a stimulant. In 1979 a racing industry scandal brought about the arrests of several race horse owners and trainers. Use of Fentanyl in Veterinary practice “is limited to surgery in dogs because, like other narcotics, it produces behavioral excitation in some species such as the horse, cat, and mouse” (Henderson, 1998). Many of the analogous forms are not opioid derivatives, and therefore, not detected by narcotics testing. However, the form used in medical facilities does show up in hair tests. There are many new drugs available for perioperative use, which are shorter acting, quicker acting and safer. However, “because of its low cost, Fentanyl is favored by hospital administrations over newer and more specific opioid drugs” (Hopkins). Fentanyl can become toxic when mixed with other pain killing medications, particularly those such as Oxycontin. Care should be taken by health care professionals as it can cause respiratory depression and even death in patients who are especially sensitive. Other risks include occupational exposure of health care workers, who inhale the second-hand vapors possibly becoming tolerant to the substance. This can lead to abuse, addiction and personality changes. In addition, work performance may be affected, putting patients and other health care workers at risk for medical injury due to poor judgment. Not only are health care workers at risk. Abuse by patients in on the rise as well. Adding to the dilemma is the lack of resources in treatment facilities, particularly in the facilities that administer Methadone for treatment of Fentanyl and Heroine addiction. Fentanyl-related deaths peaked in the US in May, 2006. Though some are caused by abuse or misuse of prescription forms, many are caused by the analogous forms manufactured in labs in Mexico and the California coast. Of particular interest to authorities was a lab outside Mexico City owned and operated by Ricardo Valdez-Torres, a San Diego resident. Valdez hardly fits the description of the typical street drug dealer. Supporting an extending family, taking college courses and participating in normal family activities, “Valdez could pass for a prep school English teacher” (Schaefer & Swickard, 2007). Monitored by Federal agents since 1988, Valdez was finally convicted In 1993. Despite the concern of prosecutors that Valdez possessed a very dangerous knowledge of chemical drug manufacturing, he was released in 2003. The street forms of the drug Valdez manufactured is stronger and even shorter-acting than that of the Fentanyl used in IV pain management and anesthesia. Regardless of strength, abuse and addiction by health care workers is also on the rise. The difficulty in the health care setting is in detection of abuse before it escalates. Health care workers have easy access in many institutional settings. With higher patient to provider ratios, most health care workers perform their duties with little supervision or monitoring. The DOH  Bureau of Narcotic Enforcement (DOH BNE)website states that “fentanyl is most often diverted by those healthcare professionals directly responsible for its administration and safeguarding” (OASES). The injectable form of Fentanyl is often taken from operating rooms. Often vial contents are substituted with other liquids like saline. Sometimes partial doses are given to patients while health care workers keep some for themselves. Medical records indicating patient dosing are falsified. Where tracking is not routine, entire vials are removed from operating rooms and stock rooms. Other forms of theft include removing transdermal patches from stock, or removing them from the patient’s skin. When this is done, the patch is cut or sliced in some way to remove the drug it contains. In one unusual case, the CDC investigated a rash of mysterious infections in a hospital in 1998 and 1999. Fentanyl was extracted from IV bags with needle and syringe, which then introduced infection. Saline was used to replace the liquid Fentanyl, so there was no immediate suspicion. What is unusual is that the offender was a respiratory therapist. “When narcotics are misappropriated, the person implicated is usually a physician. About 4 to 6 percent of doctors become addicted to drugs” (Grady, 2002). A total of 26 post-surgical patients subsequently developed blood infections of a rare bacterium called Serratia marcescens. The therapist responsible was eventually identified and tested positive for Fentanyl. Such action costs more for health care, extends the patients’ stay and may seriously jeopardize patient health. Use of narcotics such as Fentanyl also puts the health and safety of other hospital workers in jeopardy. Additionally, it creates an environment of distrust where everyone suspects everyone else. This does little to lift staff morale and workplace relations. Though the cost of Fentanyl is less than that of comparable drugs, it can potentially cost health care institutions millions in malpractice suits. Even more difficult to imagine, is that patients are subjected to pain that is normally controlled. Though physicians and nurse anesthetists are the usual suspects, cases have been reported in which paramedics have vials of Fentanyl with Saline. "For many years, fentanyl was actually the drug of choice of the addicted anesthesiologist," said Dr.  Joel Nathan of the Addiction Recovery Institute in New York. (Caruso, 2002). As prescriptions for Duragesic patches increased by 33% from 2000 to 2001, the reports of abuse by health care workers also increased. Dr. Joel Nathan identifies the largest population of workers abusing Fentanyl as “mostly low-paid people in the nursing industry, like nursing aides and other uncertified health care workers” (Caruso, 2002). Yet specific cases mentioned in Caruso’s article identify a Licensed Practical Nurse, Anesthesiologist, two Nursing Aides, two health care administrators and a pharmacist who had recently lost his license. The former pharmacist was subsequently found dead with six Duragesic patches attached. Liquid from the patches is often extracted and boiled to inject or drink, in some cases. The likelihood that one capacity of health care is more likely to become addicted more than others is not supported. Just as the street forms know no socioeconomic boundaries, the prescription forms are likely to be abused by any health care worker who has access and an ongoing or budding addiction. Despite the increase in Fentanyl abuse and addiction, it still pales in comparison to addiction to substances like Oxycontin. In the first six months of 2001, 512 people were treated in hospital emergency rooms for Fentanyl abuse, compared to 11,000 treated for OxyContin abuse in the same time period. Statistics are provided by the Federal Substance Abuse and Mental Health Services Administration. In addition to Health care workers, patients are also increasingly abusing Fentanyl. To limit the Potential for increased abuse, the DOH BNE recommends that physicians pay close attention to prescription use, while more actively monitoring patient use. The agency also makes recommendations to health care facilities to monitor and detect any Fentanyl diversion activities that may take place. Examination of individual Duragesic patches, marking of patches applied to patients with date, time and nurse’s initials, comparison to medication records and inspection of patches for holes, cuts or dried out appearance. Treatment for abuse or dependency should begin with tapering or slow reduction of dose amount and frequency. In-patient detoxification is recommended for severe addiction, “ in a hospital or medical supervised setting is highly recommended for its multi- disciplinary approach” (drugabusehelp.com). Anyone who is treated for addiction should maintain a base of support from groups, physicians and family, depending on the situation. Care should be taken in treatment recommendations. Those who actively seek chemically manufactured forms of Fentanyl from the streets have very different needs than those who have been prescribed Fentanyl for long term control of pain, due to severe injury or illness. References Caruso, D. (2002). Abuse Rises With Spread of Painkiller Patches. The Buffalo News. Retrieved September 82007 from http://www.mapinc.org/drugnews/v02/n598/a07.html Drug Abuse Help. Retrieved September 8 2007 from http://www.drugabusehelp.com/drugs/fentanyl Grady, D. 2002. Outbreak of Hospital Infection Is Tied to Workers Drug Abuse. New York Times. September 5 2007 ed. Henderson, G. (1998). Designer Drugs: Past History and Future Prospects. Journal of Forensic Science. 33, (2), 569-575. Retrieved September 8 2007 from http://web1.caryacademy.org/chemistry/rushin/StudentProjects/ CompoundWebSites/2004/fentanyl/History.htm. Hopkins, H. More Overdose Deaths with Fentanyl. Retrieved September 9 2007 from http://www.imhr.org/news-currentnewsletter_detail.php?nd=66. New York State Offices of Alcoholism and Substance Abuse Services. Retrieved September 7 2007 from http://www.oasas.state.ny.us/AdMed/drugs/fentanyl.cfm. Opioids.com. Retrieved September 6 2007 from http://opioids.com/fentanyl/patch.html. Schaefer, J. & Swickard, J. (2007). Chapter 2: The Chemist. Detroit Free Press. Retrieved September 7 2007 from http://www.freep.com/apps/pbcs.dll/. Read More