SAN ANTONIO — The DEA says fentanyl is the deadliest drug our country has ever faced. You can think of fentanyl like an overcharged morphine, but it is synthetic and made in a lab, and is 50 to 100 times more potent than morphine which is one of the reasons why it can be so dangerous if not used properly.
"Fentanyl was FDA approved for release for chronic pain that if you've previously been on morphine or something similar, that just really isn't cutting it," said DeWayne Davidson who is a Clinical Pharmacy Practice Manager with University Health. He says if a patient is using morphine but has a pain spike, fentanyl is often prescribed in varying formulations. He told us, "Some that work very quickly like lollipops and lozenges. You kind of suck on like candy. But we also have patches that you wear for two to three days even to kind of provide some of that background pain."
Fentanyl is often prescribed for cancer patients in palliative care, those who are allergic to morphine, patients who take medication several times a day, people who recently had surgery and need to control their pain. and for patients on weaker pain medication that is no longer working for them.
And there is a system in place to not just protect the patient from having too much medication, but also to protect the public. Davidson said, "Since it is a controlled substance it's a class to a few things, the same way as morphine. And so physicians are actually limited to how much they can prescribe at one time. If it's for chronic pain, they can prescribe up to a 30 day supply with two additional refills on separate prescriptions. We're just trying to prevent too much being out in the public, but also just trying to prevent the patient from having too much available to them. Certainly want to try and control their pain, but we don't want to have just so much excess that they say, what do I do with all this when I don't need it anymore. Even before prescribing it, the physicians are supposed to check our Texas State website to see if that patient has other opioids that maybe a different prescriber had given them. So that way we don't give a patient too much."
The pharmacy has to check too to make sure they are on the same page as the prescriber. And if you are prescribed fentanyl and have some concerns talk to your doctor about alternatives. Davidson said, "There's some other options out there that may work that we typically don't use in terms of pain control. But just ask the doctor, hey, is this is this right for me before they actually prescribe it?"
If you are prescribed fentanyl make sure to talk to your doctor about side effects and any danger. Davidson added, "Ideally, when your doctor is prescribing something to you, they should tell you what it's for. Some common side effects, things to watch out for, and how to use the medication safely when you need to use it is kind of some general. It's really true for all medications. Same thing goes with fentanyl. There's also talking about some warnings. You certainly don't want to take it with alcohol or other things that may make you drowsy. Or even there's some drug interactions that with certain medications that also cause drowsiness that may be too much for you and may result in overdose or loss of consciousness."
And with fentanyl being such a huge drug crisis here in the U.S. Davidson says there is also more awareness about it in the medical community. He told us, "I think there definitely there's larger awareness around opioid overdose and addiction. And here in Texas laws have been put in place that limit how much a physician can prescribe in terms of opioids. If it's for acute pain, meaning it's just something planned to be short term, usually no more than seven days worth and try to do even less than that if it's for chronic ongoing pain. They can prescribe up to 30 days with some additional refills if necessary. But I think this larger awareness is really brought to our prescribers."
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