3 ms·

Considering we routinely give children fentanyl this is concerning.

• refurb 6y ago
  Fentanyl is actually a very safe opioid. It doesn't have metabolic products that can cause side effects. If I'm remembering correctly, it has a larger therapeutic index (toxic dose / therapeutic dose) than other opioid options like morphine or oxycodone. The problem is it's incredibly potent. For an adult, you might start at 25 ug. Not a big deal when you're drawing up a 100 ug/mL solution, but it's a big problem when you're trying to eyeball a powder of unknown purity. Plus fentanyl is showing up as an adulterant in street drugs like cocaine, where no one is expecting it. I was reading that in Canada there were seeing a number of overdoses where the blood levels of fentanyl were >200ng/L. That's an absolutely massive overdose as typical therapeutic concentrations are 1-3 ng/L. People end up needing a naloxone infusion for a day or more until their body metabolizes all of the drug.
  • mr__y 6y ago
    It has also much shorter half-life than most opioids making managing the overdose much easier (in hospital setting). For anesthetic it is a valid and safe choice. It is of course different in non-hospital setting and non-pharmaceutical grade products - since fentanyl is very potent it requires much more precision in measuring the dosage which, when combined with unknown and varying purity makes overdose much more likely than with less potent opioids. If that is in turn combined with lack of or a significant delay of naloxone administration the risk of death is significantly higher than with less potent opioids