Fentanyl: Ingestion methods

Last modified: Sunday, 31. May 2009 - 3:30 pm

Fentanyl is administered by medical personnel in several ways. Originally it was developed and used primarily as an anesthesia administered through an intravenous (IV) hookup. It is still used in this form during surgery, it is not used in this way for chronic pain because it entails either having a constant IV drip or repeated shots throughout the day. Today it is also administered by epidural, which is a shot administered directly into the spine. For a local anesthetic during surgery, fentanyl is administered via needle directly into a muscle.
Oral ingestion of fentanyl is the most common way it is used to relieve chronic pain today. This is achieved primarily in a lollipop or lozenge that allows for a slow ingestion into the body. Most of the lollipops and lozenges are cherry flavored; for children in cancer wards, this is the preferred method of administration because they seldom view the “treats” as medication. Rectal administration is sometimes used as well if the patient cannot receive oral medication or if they have a strong nausea reaction to the fentanyl. This method is used only as a last resort, and few patients opt for it.
Fentanyl is also available in a patch form (much like a nicotine patch used for smoking cessation) that can also be used for long-term treatment. This form of administration is referred to as transdermal fentanyl and is sold under the trade name Duregasic. The fentanyl is absorbed directly into the skin from the patch and enters the bloodstream, which carries it to the mu receptors. This form of administration appears much easier than it is. When applying the patch, much caution is needed in making sure that the side with the fentanyl does not come in contact with the applier’s hands. The sweat on our palms speeds the absorbtion of fentanyl into the bloodstream, and more of the drug is taken in than is desired at one time.
The street versions of fentanyl are ingested in the same ways as heroin. It is usually sold in a powder form and either smoked, snorted, or injected into a vein. Since fentanyl is water-soluble, the powder form can be cold-stirred into a solution and does not need to be boiled like other opioids. However, injection is the most common method used for ingestion on the street. It is so much more potent than heroin that in many of the overdose deaths, the user is found with the needle still in an arm, in some instances with plunger not fully compressed. Some of the designer fentanyl today is made into pill form, but in this form of ingestion, more time elapses before the user feels its effects.
The transdermal patches and lollipops are also stolen and sold on the streets. Instead of wearing the patch as intended, users will get the fentanyl out to either inject or inhale the drug. Lollipops and lozenges are used on the street in high dosages and generally in connection with other drugs. Rather than letting the lozenges dissolve in the mouth, street users may crunch several at a time.

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