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Street Fentanyl vs Emergency Department Fentanyl

Medications such as ketamine, propofol, and certainly fentanyl have been to blame for many tragic deaths over recent years, giving them infamous notoriety...

This has caused some in the general public to perceive these pharmaceuticals as very dangerous drugs of abuse without legitimate utility, similar to schedule I drugs like methamphetamine or heroin. Unlike methamphetamine and heroin, however, these agents are very commonly used class II and III medicines. They are used on a daily basis in every emergency department and operating room in the country. Chances are if you broke a bone, ruptured a vessel in your brain, or suffered a bad burn, you would be given fentanyl in the emergency…

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  Dose

Fentanyl is dosed at 1-2 micrograms per kilogram (1 mcg/kg) actual body weight when given parenterally. Thus, the common adult dose of fentanyl is 50-200 mcg IV or IM. Frequently, the typical starting dose for a healthy 70 kg adult who requires analgesia is either 50 mcg or 100 mcg rather than 70 mcg for the following reason: Fentanyl is supplied in ampoules of varying sizes, which all have a concentration of 50 mcg/ml. Most emergency departments and ambulances stock ampoules of 100 mcg or 250 mcg, which are both multiples of 50. Thus, it is easier to calculate increments of 50 mcg when drawing up the medication in a syringe. If repeated doses are required, they can be given at 10 minute intervals.

Articles of Interest

The Fentanyl Story

Fentanyl, a potent rapid-acting synthetic opioid first synthesized more than 50 years ago, has become the opioid most commonly used intravenously for intraoperative analgesia throughout the world. This has occurred because the drug has minimal cardiovascular effects, does not result in increases in plasma histamine, is relatively short acting, is easy and inexpensive to synthesize and prepare for the marketplace, and is now familiar to clinicians working in perioperative medicine all over the planet.

Some Key Facts About Fentanyl

It’s an incredibly potent synthetic opioid. As a pharmaceutical, it’s used safely every day for anesthesia in operating rooms throughout the country, and as a prescribed painkiller. But like heroin and other opioids, it can be highly addictive. Fentanyl can be made entirely in a laboratory, unlike opioid drugs like heroin, which are derived from poppy plants.

What Is Fentanyl and Why Is It So Dangerous?

When prescribed by a doctor, fentanyl can be given as a shot, a patch that is placed on a person’s skin, as lozenges that are sucked like cough drops or film that sits between the cheek and gum, according to the American Society of Health-System Pharmacists Inc. It also can be sprayed in the nose or under the tongue. The illicit form of fentanyl, a powder that is often mixed into other drugs, has overtaken the drug market in the U.S. Fentanyl is made in clandestine labs in Mexico from easily sourced chemicals.

Resources

Fentanyl Patch

Fentanyl transdermal system should be prescribed only by healthcare professionals who are knowledgeable about the use of extended-release/long-acting opioids and how to mitigate the associated risks.

StatPearls

Fentanyl is a potent synthetic opioid, which, similar to morphine, produces analgesia but to a greater extent. This robust pharmacologic agent is typically 50 to 100 times more potent. A dose of only 100 micrograms can produce equivalent analgesia to approximately 10 mg of morphine. Fentanyl is a widely used narcotic in the hospital environment.