Good drug, killer drug
So this begs the question: What happens when a person who is not opioid-tolerant takes fentanyl?
Anesthesiologists give fentanyl and are expert at controlling a patient’s airway and keeping them breathing while they are being observed. Pain physicians prescribe fentanyl in a very controlled manner and only after a patient has been observed and deemed tolerant to weaker opioids.
So, when someone who is not tolerant to opioids takes fentanyl, it is very easy to overdose, to stop breathing and to never wake up. It is very easy for those who do not use these potent painkillers as prescribed to overdose.
Fentanyl can be used safely if used as prescribed, but it is a killer on the streets. Fentanyl analogues are relatively easy to synthesize and are often mixed with heroin or benzodiazepines to quicken the onset and enhance the high. A simple Reddit search reveals the many forms of fentanyl that are being synthesized and sold illegally and the countries it is being smuggled in from. Even the users and dealers there warn about its potential for easy overdose. Indeed, many users don’t even know the heroin or xanax they have bought on the street is laced with fentanyl until it is too late.
Do we need fentanyl, and have we contributed to its abuse? This is a question we ask ourselves as we struggle to get a grip on the modern opioid epidemic, tragedies like the death of Prince and patients who suffer from pain and addiction.
Can we do without medications like fentanyl altogether? Right now, we cannot do without opioids entirely. We would need potent alternatives with limited side effects. The alternative tools we have are insufficient to enable us to quit opioids cold turkey.
A sort-of transition plan has developed in the medical community where we use multiple non-opioid pain medications in combination with nonmedication treatments, such as mindfulness, behavioral therapy and education to minimize the need for opioids. In many instances, these creative efforts have enabled opioid-free options for specific major surgeries. The good news is that the demand for change has reached the top levels of government, hospitals and patient organizations. Money for research and education is being made available. New laws are being enacted. A revolution in pain management is necessary and, hopefully, imminent.