Is the Fentanyl Problem Overstated?

mgr22

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I think it's a reasonable response to the hysteria about topical Fentanyl exposure.
 

Remi

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What?!? You mean the media has been sensationalizing an issue and law enforcement (and other parts of government) has been taking advantage of the public ignorance and fear in order to play up their status as heroes and increase their funding and power?? How novel a script.

I remember saying on this forum and others that the whole “it touched me and my body immediately shut down” and “if you even walk into a building that has carfentanil in it you’ll die immediately” thing was absolute BS and the entire threat was overblown, and each time being told by people who don’t even know what the word pharmacodynamics means that I had no idea what I was talking about.

Good article, BTW.
 

CCCSD

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Interesting....since there are equally as many articles and instructional alerts regarding exposure to, and the resulting documented medical issues, to it.

So...if it’s that false, then BBP exposure is also a myth, right?
 

DrParasite

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Has the news media pushed bad info on fentanyl’s danger to fire, police & EMS?

BTW, here is the CDC statement on fentanyl: https://www.cdc.gov/niosh/topics/fentanyl/risk.html and https://www.cdc.gov/niosh/topics/fentanyl/healthcareprevention.html

And I know the CDC aren't cops, but they have some smart people working there Fentanyl Exposure Risks for Law Enforcement and Emergency Response Workers

And the DEA recommendation: https://www.dea.gov/press-releases/2016/06/10/dea-warning-police-and-public-fentanyl-exposure-kills

Part of the issue likely comes from bad information coming out of law enforcement, where cops are exposed to narcotics, and "saved" by their fellows brothers in blue, who administer narcan.... regardless of whether they were in any danger, or needed narcan in the first place.

https://www.eastbaytimes.com/2018/06/26/opioid-antidote-saves-alameda-sheriffs-officers-lives/
https://www.nbcbayarea.com/investigations/I-Was-Dying-Alameda-County-Detective-Breaks-Silence-on-Fentanyl-Poisoning-494294131.html
https://www.jems.com/articles/pt/2018/07/two-alameda-county-sheriff-s-investigators-survive-potentially-lethal-fentanyl-exposure.html

So it really boils down to, are you going to believe the reports that come from law enforcement, who have given it to their fellow responders and "saved their lives," or from the medical toxicologists, who are experts in this field, who say it's not needed based on sound medical science?
 

CCCSD

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I remember back in ‘84 while sitting in a Paramedic Base Station meeting. The MD (Stanford no less), made the statement that Ricin “wasn’t a threat and the stories about it are bull ****...”

Glad I listened to the LE and Intel guys...
 

Remi

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I remember back in ‘84 while sitting in a Paramedic Base Station meeting. The MD (Stanford no less), made the statement that Ricin “wasn’t a threat and the stories about it are bull ****...”

Glad I listened to the LE and Intel guys...
Except that we know infinitely more about fentanyl and it analogues now than they knew about ricin in the early 1980's.
 
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chriscemt

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from article said:
...journalism should not be dictated simply by what sells...
Larger point is that if we learn that journalists are motivated by the same things the rest of us are, we might take the articles we read with a pinch of salt.
 

johnrsemt

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All of the stories that you hear of people being exposed to or OD'd from Fentanyl from steering wheels of cars sold at police auctions that were confiscated from drug dealers are funny.
If that was true then the dealers would have died, the cops that drove the cars would have died, the people at the auction lots would have died (or overdosed), not just the person who bought it at the end of the chain.
 

mgr22

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All of the stories that you hear of people being exposed to or OD'd from Fentanyl from steering wheels of cars sold at police auctions that were confiscated from drug dealers are funny.
If that was true then the dealers would have died, the cops that drove the cars would have died, the people at the auction lots would have died (or overdosed), not just the person who bought it at the end of the chain.
Could be an opportunity for a Narcan-eluting steering wheel.
 

CWATT

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Have any other providers experienced push-back from their patients not wanting to receive Fentanyl? I have and it’s a adifficult situation when you’re providing aeromedical transport and want to avoid Morphine due to its pro-convulsant effects. I struggle with the ethics of this one as I’ve seen providers ask their patients if ‘they want something for the pain’ to avoid saying the word Fentanyl and dealing with the public’s low-quality understanding of the drug. Ironically, since most people mispronounce the name as Fen-ta-nOl not Fen-ta-nYl, if you say it correctly patients they seem to assume it’s a different albeit related drug.

I was once told of a pregnancy-related drug in the ‘80s or ‘90s that also received a bad rep and fell out of use due to public pressure but was superseded by an equally dangerous but lesser known alternative (perhaps some of the senior medics remember this one), and I’m fairly confident every provider has heard ‘Levophed — leave ‘em dead’ before. I don’t think we’ll see it disappear from our kits but I’m curious to know if anyone else has had a patient refuse it due to fear.
 

chriscemt

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Have any other providers experienced push-back from their patients not wanting to receive Fentanyl?
We have patients regularly deny wanting Fentanyl or any pain medication due to general disinterest in drugs. I would think this would be common.
 

johnrsemt

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I had a 16 year old a few weeks ago that told me he didn't want any pain medication until I reminded him that it would take the pain away (or mostly away). Then he decided to take it. He then sung to me the rest of the way to the hospital. Fentanyl is a nice med
 

DrParasite

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I heard about this too... most of the symptoms they are describing are actually panic attacks, not chemical suicides.

here is one of the problems:
When Fire Rescue arrived on the scene, two firefighters reportedly began to feel ill as well, and one of them had to be given Narcan. Brennan Dowling, 30, one of the people in the van, also eventually began to feel ill.
despite what PD does, and even what some FDs do, filling ill is not criteria for narcan administration. Even passing out doesn't mean you should be narcanned. And then there is this:
The Drug Enforcement Administration said Fentanyl is a powerful synthetic opioid that is almost 50 times stronger than heroin. Fentanyl can be absorbed through the skin, or you can accidentally inhale it.
that's not entirely accurate, and is probably leading to more panic attacks among LEO than actual overdoses. Yes, it can be absorbed through the skin, but tends not to be when in powder form (think fent patches and such). Liquids much more easily. However, you can't inhale liquids (ok, you can, if it evaporates, and you hover over it breathing deeply, and the room is small, and the windows aren't close... but in general, 10 minutes of being near it isn't isn't to cause this). Further, inhaling the powder is not like aerosolizing the fentanyl. it's not like a speck of fent is going to make you stop breathing (but I wouldn't recommend snorting it).

Even the picture above is over the top. You don't need a level B hazmat suit to deal with a traffic stop. Otherwise all the fentanyl drug labs would need to be in level B suits (which includes SCBA) or else their workers would all be dying from the smallest exposure. Do hazmat teams sometimes err on the side of caution? sure, as this picture likely demonstrates. But is it really necessary?

There is so much misinformation, inappropriate Narcan administration (often by our brothers in blue, and then the media just runs with it because it gets them clicks), and unfounded fears that spead like wildfire that people see fentanyl, and suddenly experience symptoms that resemble a panic attack, are given Narcan, which saves the day. And when the toxicologists review the experience, they often say it wasn't an overdose at all.

If you are going to handle drugs, wear nitrile gloves. Don't snort the stuff, don't rub it on your skin. don't lick it to see if it's real. And remember, your mind can make you do some interesting things, even if those things are not caused by the drugs you are in the vicinity of.
 
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Remi

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Have any other providers experienced push-back from their patients not wanting to receive Fentanyl? I have and it’s a adifficult situation when you’re providing aeromedical transport and want to avoid Morphine due to its pro-convulsant effects. I struggle with the ethics of this one as I’ve seen providers ask their patients if ‘they want something for the pain’ to avoid saying the word Fentanyl and dealing with the public’s low-quality understanding of the drug. Ironically, since most people mispronounce the name as Fen-ta-nOl not Fen-ta-nYl, if you say it correctly patients they seem to assume it’s a different albeit related drug.
There are plenty of reasons to avoid morphine when other (cleaner) opioids are an option, but I don't think fear of inducing seizures is a good one. Seizures are an extremely rare side effect and I believe have only ever been demonstrated with very high doses (general anesthetic doses) of morphine. Take a look: The Epilepsy Foundation's Position on Opioids Causing seizures with morphine is probably roughly analogous to causing chest rigidity with fentanyl, in terms of the causes and the risk.

However, I don't see any moral dilemma whatsoever with substituting morphine for fentanyl if the patient wishes to avoid fentanyl, even if fentanyl is an objectively superior drug for most uses, and even if the patient's concerns are unfounded. That's what patient autonomy is all about.

I also don't see any dilemma with just avoiding use of the word "fentanyl". I rarely tell a patient in pain what I'm giving them (unless they ask, of course, but they usually don't), I just say "I've got some IV pain medicine for you, this should work pretty quickly". Also, when I do pre-ops for patients planning to undergo deep sedation or general anesthesia, I never mention the names of any of the multiple drugs the patient is going to receive. So As long as you aren't giving them something that they've explicitly said they don't want, I don't see a problem with giving them "an IV pain medicine" that is routinely used and known to be safe and effective.

I don't remember ever seeing someone express concern over IV fentanyl, but I've heard plenty of people comment on propofol. "Are you gonna use that Michael Jackson drug on me during my colonoscopy?" is something I've heard many times. Sometimes they are just trying to be funny, but sometimes they are legitimately concerned. I always say something like "Yep. It's an excellent drug and it is very safe when you are having it given by and being closely monitored by a properly trained clinician. Unfortunately, that wasn't the case for Michael Jackson, but we're going to take much better care of you than his doctor did him". Maybe you could come up with a similar line to say when people express concern over fentanyl.
 
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Phillyrube

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There are plenty of reasons to avoid morphine when other (cleaner) opioids are an option, but I don't think fear of inducing seizures is a good one. Seizures are an extremely rare side effect and I believe have only ever been demonstrated with very high doses (general anesthetic doses) of morphine. Take a look: The Epilepsy Foundation's Position on Opioids Causing seizures with morphine is probably roughly analogous to causing chest rigidity with fentanyl, in terms of the causes and the risk.

However, I don't see any moral dilemma whatsoever with substituting morphine for fentanyl if the patient wishes to avoid fentanyl, even if fentanyl is an objectively superior drug for most uses, and even if the patient's concerns are unfounded. That's what patient autonomy is all about.

I also don't see any dilemma with just avoiding use of the word "fentanyl". I rarely tell a patient in pain what I'm giving them (unless they ask, of course, but they usually don't), I just say "I've got some IV pain medicine for you, this should work pretty quickly". Also, when I do pre-ops for patients planning to undergo deep sedation or general anesthesia, I never mention the names of any of the multiple drugs the patient is going to receive. So As long as you aren't giving them something that they've explicitly said they don't want, I don't see a problem with giving them "an IV pain medicine" that is routinely used and known to be safe and effective.

I don't remember ever seeing someone express concern over IV fentanyl, but I've heard plenty of people comment on propofol. "Are you gonna use that Michael Jackson drug on me during my colonoscopy?" is something I've heard many times. Sometimes they are just trying to be funny, but sometimes they are legitimately concerned. I always say something like "Yep. It's an excellent drug and it is very safe when you are having it given by and being closely monitored by a properly trained clinician. Unfortunately, that wasn't the case for Michael Jackson, but we're going to take much better care of you than his doctor did him". Maybe you could come up with a similar line to say when people express concern over fentanyl.
I likes propyfol, having had 3 lower borescopes and having an upper later this month. What I don't like is it seems to take forever to clear out, once awake. I feel wiped out for 6 hours after the procedure, although I wake up feeling pretty good, no effects then. An hour later, ZZZZZZzzzzzzzz.
 
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