# Fentanyl suckers



## LucidResq (Mar 7, 2008)

Apparently a local FD is investing in fentanyl lollipops for their ALS units. 

Whatcha think? Sounds kind of ridiculous to me.

I hope it's just a rumor because I can see so many problems with that just as a basic student... like calculating dosages and stuff. Why not just give it IV so you can say "this is how much I gave them" without a doubt?


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## firecoins (Mar 7, 2008)

LucidResq said:


> Apparently a local FD is investing in fentanyl lollipops for their ALS units.
> 
> Whatcha think? Sounds kind of ridiculous to me.
> 
> I hope it's just a rumor because I can see so many problems with that just as a basic student... like calculating dosages and stuff. Why not just give it IV so you can say "this is how much I gave them" without a doubt?



It is measured in how many licks it tkes to get to the morphine bubble gum center.


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## Ridryder911 (Mar 7, 2008)

There great! They come in measured 100, 200, 300 mcg (per weight based) dosages. A great way of providing analgesics. I used them a lot before establishing large IV lines, they take only a few minutes to work and wear off in about 20 minutes without all the s/e of other analgesics. 

Not ridiculous at all. 

R/r 911


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## el Murpharino (Mar 7, 2008)

Do they come in cherry and grape flavors?


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## Ridryder911 (Mar 7, 2008)

el Murpharino said:


> Do they come in cherry and grape flavors?


Yes, they do (both flavors)


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## EMT19053 (Mar 7, 2008)

Gee Rid, I think they wanted to have a good laugh with this one and you burst their bubble (gum center). lol


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## SwissEMT (Mar 8, 2008)

LucidResq said:


> Apparently a local FD is investing in fentanyl lollipops for their ALS units.
> 
> Whatcha think? Sounds kind of ridiculous to me.



I'm envious. I wish my medical director had the common sense to allow multiple pharmacological options to the provider.


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## eggshen (Mar 9, 2008)

Hola Lucid,
Are you in the metro area? Which FD? 

You're talking for the patients right? Not the FF's?  I mean...seems like a lot of those cats might be jacked on Fentanyl most of the time anyway. That or an anoxic hit....either way.

Egg


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## LucidResq (Mar 9, 2008)

I am in the metro Denver area. I believe the dept. is Castle Rock Fire Rescue, but again as far as I know this is a rumor.


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## AZFF/EMT (Mar 9, 2008)

the army has been using them for a while.


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## Ops Paramedic (Mar 10, 2008)

As per usual, we don't have them here, bummer!!  Are these for use mainly in Peads??  It sounds like a good idea, becuase of the small dose (As per Rid), yet easy enough to get into the system (Without posing a threat to the airway) without having to do an IV.


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## Katie (Mar 10, 2008)

i believe they're used for both adults and peds


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## Ridryder911 (Mar 10, 2008)

We only used them for pediatric, but I am sure they can be used on adults as well (dosages available?). 

I liked them over other analgesics because they did not have the s/e of others. 

R/r 911


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## ccmedoc (Mar 10, 2008)

Ridrider911 said:
			
		

> We only used them for pediatric, but I am sure they can be used on adults as well (dosages available?).



We use them for peds pain control as well. I think the "sucker" part starts them on their way and settles them down for the drug to take effect. 

Far better than coming at them with needles right away. Makes IV access MUCH easier on all concerned, especially the parents seeing their child settled down. 

I have seen them for adults, but usually the needle anxiety is not as great for them. Notice I said *'Usually'*



			
				Ops Paramedic said:
			
		

> without having to do an IV


I would still advise starting a lock with these patients..

Just an opinion


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## Jon (Mar 11, 2008)

The brand I am familiar with is Actiq. Taking a look at my ePocrates listing, it lists the approved FDA dosing as being for "Breakthrough cancer pain, opioid-tolerant pt's." Their website http://www.actiq.com states that the product is ONLY for use in opioid-tolerant cancer patients with breakthrough pain, and that use with any other patients could be dangerous, because they could easily OD on the "sucker."

I know I've heard of concerns that pain-managment physicians (and other docs) are prescribing these to more and more patients who don't meet the manufacturer's dosing criteria.

Is there another brand, or are EMS services carrying Actiq? If they are, is this a liability concern because of a use other than the approved dosing instructions provide for? Could the FDA or even the manufactuer sue the EMS provider, EMS service, or EMS Physician?

I'm not trying to trash the idea... in fact, it isn't a bad idea, and if it provides pain relief in a reasonable manner, it actually might be a great idea... but keep the Narcan handy just in case.

Jon


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## mikie (Mar 11, 2008)

I never heard of these, seems like a good idea.  

However, it seems like something that would end up 'on the streets'  -"officer, it's just candy!"


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## Ridryder911 (Mar 11, 2008)

mikie333 said:


> I never heard of these, seems like a good idea.
> 
> However, it seems like something that would end up 'on the streets'  -"officer, it's just candy!"



I doubt you will find them on the streets. You dispense them one at a time and observe them eating them (there not very big). The dosage strength is
minimal as well in comparison to other med.'s. Now, what is popular is Duragesic and Fentanyl patches. I have heard of them freezing them and "cubing" them. As well as "melting" them down and injecting the med. 
Consequences is that Fentanyl is several times stronger than even Morphine Sulfate. 

R/r 911


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## MedicPrincess (Mar 11, 2008)

The sucker sounds like a great option.  We carry Fentanyl, Morphine, and Toradol for our pain control options.


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## Airwaygoddess (Mar 11, 2008)

*Fentanyl use for Oncology*

Not on th ambulances here but I have seen them used on th oncology floor for break though pain.  Wonderful for pain control.


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## LucidResq (Mar 11, 2008)

Ridryder911 said:


> I doubt you will find them on the streets.



They are on the streets. Google "perc-a-pop" or "morphine lollipop" (incorrect, but most people on the street recognize morphine rather than fentanyl). 

There have been some good points raised about the use of Actiq with kids, however.


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## Jon (Mar 11, 2008)

Anything will eventually end up on the streets... Duragesic patches, Morphine, etc... it just costs money.

I just looked at the wikipedia page... it says that 90-99% of the first 1/2 of 2006's scripts for Actiq were for off-label use (not for breakthough cancer pain).


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## fma08 (Mar 12, 2008)

ccmedoc said:


> We use them for peds pain control as well. I think the "sucker" part starts them on their way and settles them down for the drug to take effect.
> 
> Far better than coming at them with needles right away. Makes IV access MUCH easier on all concerned, especially the parents seeing their child settled down.
> 
> ...


lock would be good.... specially when ya gotta give the narcan when they quit breathing lol


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## Ridryder911 (Mar 12, 2008)

fma08 said:


> lock would be good.... specially when ya gotta give the narcan when they quit breathing lol



I realize that you were joking but: If that was the case, you were the idiot and overdosed them. Await, for the med to take affect then start your line. The main reason of administering the Fentanyl lollipop. Like I described, the strength is based upon weight, as well it does not have the s/e associated alike other analgesics, with length of time. Just monitor their breathing, and if they do stop, ventilate them and allow the med to wear off (since your the culprit). 

Too many medics rush to give Narcan nowadays. If you give Narcan, now they cannot treat the pain with regular opioid medications. 

R/r 911


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## fma08 (Mar 12, 2008)

Ridryder911 said:


> I realize that you were joking but: If that was the case, you were the idiot and overdosed them. Await, for the med to take affect then start your line. The main reason of administering the Fentanyl lollipop. Like I described, the strength is based upon weight, as well it does not have the s/e associated alike other analgesics, with length of time. Just monitor their breathing, and if they do stop, ventilate them and allow the med to wear off (since your the culprit).
> 
> Too many medics rush to give Narcan nowadays. If you give Narcan, now they cannot treat the pain with regular opioid medications.
> 
> R/r 911



obviously don't let that happen in the first place, my service carries fentanyl and it is pretty awesome about not having much of the side effects of other narcs, and while i don't think that too many medics rush to give narcan, i think they are too... text book about giving a certain dose. if a pt is in resp. distress/failure due to a narcotic overdose, narcan should be titrated to restore the pt's breathing ability, not completely reverse the effect of any opiates in the pt's system. and we can look at that on both ends of the spectrum (and i may be running into different scenarios than you since i'm doing mostly field work and you are in a critical care unit). A. coming across a pt who is not breathing due to recreational drug use. ABC's, 02, IV, monitor, and narcan titrated to effect, i.e., the pt starts breathing on their own. Now, if we were to give a "standard" dose and completely block all effects of the opiate, pt wakes up and becomes highly agitated at us for ruining their several hundred dollar high that they just had thus creating an unsafe scene.  On the other end of the spectrum, pt is on fentanyl or other opiate of pain control due to... terminal cancer or whatever. pt is overdosed on opiate, and stops breathing, give narcan titrated again to effect of pt able to breath on their own (with good perfusion and all that) but not to block out the needed pain relief of narcotic therapy. Again, working streets and the area i'm in i run into scenario A. more often so the patient is the idiot for making him/herself stop breathing into the first place.


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## Airway Junkie (Mar 12, 2008)

Its about time some tasty treats got put on the rigs!


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## fma08 (Mar 12, 2008)

for sure, fentanyl works great, we dont have the PO version though, just IV


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## Ridryder911 (Mar 12, 2008)

fma08 said:


> obviously don't let that happen in the first place, my service carries fentanyl and it is pretty awesome about not having much of the side effects of other narcs, and while i don't think that too many medics rush to give narcan, i think they are too... text book about giving a certain dose. if a pt is in resp. distress/failure due to a narcotic overdose, narcan should be titrated to restore the pt's breathing ability, not completely reverse the effect of any opiates in the pt's system. and we can look at that on both ends of the spectrum (and i may be running into different scenarios than you since i'm doing mostly field work and you are in a critical care unit). A. coming across a pt who is not breathing due to recreational drug use. ABC's, 02, IV, monitor, and narcan titrated to effect, i.e., the pt starts breathing on their own. Now, if we were to give a "standard" dose and completely block all effects of the opiate, pt wakes up and becomes highly agitated at us for ruining their several hundred dollar high that they just had thus creating an unsafe scene.  On the other end of the spectrum, pt is on fentanyl or other opiate of pain control due to... terminal cancer or whatever. pt is overdosed on opiate, and stops breathing, give narcan titrated again to effect of pt able to breath on their own (with good perfusion and all that) but not to block out the needed pain relief of narcotic therapy. Again, working streets and the area i'm in i run into scenario A. more often so the patient is the idiot for making him/herself stop breathing into the first place.



My point was that the dosage of Fentanyl lollipop is minute in comparison, as well as they are used as transient analgesic. Yes, I work part time in a unit/ED but in the field full time. I do see more and more medics not using Narcan appropriately. In fact, if you explorer some you will find many EMS Medical Directors removing it from the formulary. 

I agree you with on your description and intent and purpose of when and how Narcan is supposed to be administered. The problem is when attempting to administer another analgesic, either a different derivative or increasing dosage. Not that it cannot be achieved, just another hurdle to overcome by some that do not understand pain management and analgesics. 

R/r 911


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