Attitude Toward Opioids, Fentanyl Changing Again

Buffalo, NYThe existence of Duragesic Fentanyl is commonplace in the lives of patients prone to chronic pain—but it wasn't always that way, as the February 1 issue of the Harvard Health Letters points out. In fact, opioid pain medications (once known more commonly as narcotics) were shunned for mainstream management of pain. Concern about addiction and side effects were augmented by mood-altering consequences.

There were laws and regulations that made it difficult to prescribe opioids like the Duragesic patch. But that all changed in 1990 says the Harvard Health Letters, which was published in the Buffalo News at the start of the new month. Attitudes shifted, and doctors began to see chronic pain as something that should be actively treated.

But now the pendulum is swinging back, because people are dying.

Nine years after that initial attitudinal shift, about 4,000 Americans were identified as having died from opioid poisoning by 1999. To be fair, that number includes both unintentional, accidental deaths from the drugs, as well as suicides.

By 2007—a mere eight years on—that number had mushroomed to 14,500. While the Harvard Letters did not identify the source, more Americans overdosed or died using prescription opioid drugs than either cocaine or heroin. That year, there were more reports of people overdosing on opioids than corresponding overdoses of heroin and cocaine combined.

The Fentanyl Duragesic patch is an example of the initial shift in thinking on the role of opioid drugs in management of chronic pain. Patients needed to be conditioned to be receptive to opioid drugs. And the transdermal patch satisfied the need to administer the opioid in a more controlled fashion, minimizing the chances for addiction.

However, there have been problems that may or may not have been foreseen.

For one, fentanyl is an intense opioid about 80 times more potent than morphine. Without controlled administration, the drug can kill, and it has. A previous Fentanyl patch recall was initiated after a manufacturing defect in a small number of skin patches allowed an increased concentration of fentanyl to be released too quickly, with catastrophic results.

However, there have been other issues. Some doctors have been found to prescribe fentanyl without first conditioning patients toward opioids. Other patients have been found to not fully understand the complexity and the toxicity of the drugs they are using.

And Fentanyl patches—as well as other prescription opioid drugs—have found their way to the wrong hands. A study of fatal overdoses in West Virginia showed that half of the people who died from opioid overdoses had never obtained a prescription from a doctor, according to the Buffalo News.

It should be noted that results of a study published in the Annals of Internal Medicine of 10,000 people who were presumed to be taking long-term opioids legally over long periods showed that 51 experienced overdoses, with six deaths. That translates to one overdose in every 200 cases.

Not a high number. However, critics argue that even one overdose—from a Duragesic pain patch or any prescription opioid—is one overdose too many. The US Food and Drug Administration (FDA) has proposed requiring drugmakers to work with an independent organization to develop special prescriber training programs for long-acting opioids such as Duragesic Fentanyl.