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Fentanyl is a wonderful, miraculous, lifesaving drug when used by doctors and paramedics. In a hospital setting, it's a much better drug than morphine for acute

Fentanyl is a wonderful, miraculous, lifesaving drug when used by doctors and paramedics. In a hospital setting, it's a much better drug than morphine for acute pain management in most cases. It's also -- no question -- really freaking dangerous when abused. I worry about stories like this painting such a one-sided picture that Fentanyl will be demonized out of existence.

loeg 9y ago
Just curious -- what makes fentanyl better than morphine in a hospital setting?
- microcolonel 9y ago
  That I understand, The fentanyl lollipop has completely changed battlefield pain relief, it's also been used for cancer patients. Morphine can take 15-20 minutes to kick in, and needs to be injected into muscle, whereas the fentanyl citrate lollipops take considerably less time and can be administered and removed abruptly by putting it in or taking it out of the mouth. It also lacks some of the unpleasant side effects of morphine.
  - GordonS 9y ago
    Morphine can be administered IV too, in which case its effects will be felt immediately. If taken orally, it generally takes around 40 minutes to be felt, the same as for most opioids when taken orally. Do you have a source for fentanyl lollipops acting faster than that? Also, you say it lacks some of the side effects of morphine - do you have a source for that too? Morphine causes respiratory depression, histamine release, constipation, nausea, loss of libido, inability to orgasm; actually, any opioid that doesn't recruit beta-arrestin (such as mitragynine) will have much the same side effects.
    - JshWright 9y ago
      IV fentanyl is a lot faster than IV morphine (3-5 minutes vs 20 minutes for peak analgesia).
- stordoff 9y ago
  Searching "Fentanyl vs morphine for acute pain" will give plenty of studies comparing the two. At a quick glance through a few of them, it appears the main differences are faster onset, shorter duration, lower incidence of side-effects (primarily nausea), and less histamine release.
- zlynx 9y ago
  It is super fast. A while ago when I went to the ER with a broken arm they gave me fentanyl as an injection. As I remember it, it took less than ten seconds to go from extreme pain to not caring.
JshWright 9y ago
Paramedic here... I agree wholeheartedly. I see both the best and worst of fentanyl. I have woken up plenty of folks who took a much bigger dose than they expected (because it was cut with more fentanyl than usual), and pronounced more than a couple people dead for the same reason... That being said, it's my go-to tool for analgesia. It acts a lot faster than morphine, and wears off faster as well (which is a useful property in the event of an adverse reaction). Before we carried fentanyl, it would not be uncommon for some patient's pain to remain untouched by morphine. I've yet to have that happen with fentanyl. Carrying fentanyl means the difference between "Let's get some pain medication in place before we manipulate your broken leg in order to splint it" vs "Morphine is gonna take 20 minutes to reach a meaningful therapeutic effect, and we don't have time for that, so just grit your teeth and we'll try to be quick".

loeg 9y ago

Just curious -- what makes fentanyl better than morphine in a hospital setting?

microcolonel 9y ago
That I understand, The fentanyl lollipop has completely changed battlefield pain relief, it's also been used for cancer patients. Morphine can take 15-20 minutes to kick in, and needs to be injected into muscle, whereas the fentanyl citrate lollipops take considerably less time and can be administered and removed abruptly by putting it in or taking it out of the mouth. It also lacks some of the unpleasant side effects of morphine.
- GordonS 9y ago
  Morphine can be administered IV too, in which case its effects will be felt immediately. If taken orally, it generally takes around 40 minutes to be felt, the same as for most opioids when taken orally. Do you have a source for fentanyl lollipops acting faster than that? Also, you say it lacks some of the side effects of morphine - do you have a source for that too? Morphine causes respiratory depression, histamine release, constipation, nausea, loss of libido, inability to orgasm; actually, any opioid that doesn't recruit beta-arrestin (such as mitragynine) will have much the same side effects.
  - JshWright 9y ago
    IV fentanyl is a lot faster than IV morphine (3-5 minutes vs 20 minutes for peak analgesia).
stordoff 9y ago
Searching "Fentanyl vs morphine for acute pain" will give plenty of studies comparing the two. At a quick glance through a few of them, it appears the main differences are faster onset, shorter duration, lower incidence of side-effects (primarily nausea), and less histamine release.
zlynx 9y ago
It is super fast. A while ago when I went to the ER with a broken arm they gave me fentanyl as an injection. As I remember it, it took less than ten seconds to go from extreme pain to not caring.

JshWright 9y ago

Paramedic here... I agree wholeheartedly. I see both the best and worst of fentanyl. I have woken up plenty of folks who took a much bigger dose than they expected (because it was cut with more fentanyl than usual), and pronounced more than a couple people dead for the same reason... That being said, it's my go-to tool for analgesia. It acts a lot faster than morphine, and wears off faster as well (which is a useful property in the event of an adverse reaction). Before we carried fentanyl, it would not be uncommon for some patient's pain to remain untouched by morphine. I've yet to have that happen with fentanyl. Carrying fentanyl means the difference between "Let's get some pain medication in place before we manipulate your broken leg in order to splint it" vs "Morphine is gonna take 20 minutes to reach a meaningful therapeutic effect, and we don't have time for that, so just grit your teeth and we'll try to be quick".