The opioid fentanyl is becoming an increasingly popular drug of abuse across the United States. With a potency up to 100 times greater than the common opioid morphine, fentanyl use can easily lead to overdoses. This is especially true as fentanyl is increasingly found mixed into other illicit drugs without users’ knowledge. However, there exists an antidote for opioid overdoses called naloxone. Naloxone is a pure antagonist at μ-opioid receptors in the brain and produces little known side-effects. Recently, the FDA has approved naloxone delivery devices designed for individuals without medical training, making naloxone layperson friendly. Under today’s policy, naloxone is a prescription medication. This means physicians must write a prescription for take-home naloxone or issue a standing order allowing other healthcare professionals to distribute naloxone. However, there are little federal laws governing naloxone as most of the statutes discussing naloxone access and administration are determined by individual states. For example, only some states allow physicians to prescribe naloxone to non-patients. Additionally, many states have differing laws regarding criminal liabilities for physicians who prescribe the drug and for laypersons who administer the drug. In the U.S. there exists a dilemma with naloxone, as topics ranging from public policy to insurance coverage are controversial. With increasing information on fentanyl and naloxone being published, the U.S. is currently looking into the idea of making naloxone more accessible as a way to reduce overdose deaths.

Os opióides de curta duração e de alta potencia analgésica, como o fentanil, embora amplamente utilizados em cães, ainda são pouco empregados pela via epidural nesta espécie. O presente estudo teve como objetivo avaliar a associação do anestésico local lidocaína à morfina ou à combinação morfina-fentanil, pela via epidural. Foram analisados os efeitos cardiovasculares, respiratórios bem como a analgesia pós-operatória, em cães submetidos a cirurgia de joelho. Para tanto, 24 animais da espécie canina foram aleatoriamente divididos em 2 grupos. Todos os animais receberam acepromazina (0,05 mg/kg), foram induzidos com propofol (5 mg/kg) e mantidos em anestesia inalatória. Os animais do GRUPO I foram tratados com lidocaína (5mg/kg) associada a morfina (0,1mg/kg) e os animais do GRUPO II receberam, pela via epidural, a combinação lidocaína-morfina-fentanil, sendo este último na dose de 2µ/kg. Parâmetros como frequência cardíaca, respiratória, pressão arterial (sistólica, média e diastólica) foram mensurados, bem como pH e gases sanguíneos. Para a avaliação da analgesia foram utilizadas a escala Analógica-visual (EAV), a escala proposta por Lascelles, 1994 e a termoalgimetria. Amostras de sangue foram coletadas para posterior dosagem de cortisol e Interleucina-06. O período de avaliação imediata foi de 06 horas após a cirurgia, sendo os animais reavaliados no período de 24 horas após o procedimento. No tocante aos parâmetros cardiorrespiratórios os grupos se comportaram de maneira muito semelhante. Entretanto, pode-se observar que os animais tratados com a combinação lidocaína-fentanil-morfina apresentaram menor escore de dor quando avaliados pelas escalas do estudo no período pós-operatório. De fato verificou-se diferença significativa nos escores da EAV (p <0,05) nos tempos T180 e T360; na escala de Lascelles obteve-se diferença estatística nos tempos T180, T360 e T24h e na termoalgimetria houve diferença estatística nos tempos T180, T360 e T24h. A analgesia de resgate foi necessária em 3 animais do Grupo II, enquanto no Grupo I a necessidade desta medicação foi observada em 6 animais. Pode-se concluir, com os resultados obtidos, que a associação do fentanil no protocolo de anestesia epidural, promoveu adequada analgesia perioperatória, além de produzir um efeito sinérgico-residual, o que melhorou a analgesia pós-operatória, diminuindo a necessidade de analgesia de resgate. / Short duration opioids and high potency analgesics such as fentanyl, although widely used in dogs are seldom used for epidural anesthesia in this species. This study aimed to evaluate the association of lidocaine with morphine or morphine-fentanyl combination, epidurally. 24 dogs were randomly divided into two groups. All animals received acepromazine intramuscularlly (0.05 mg / kg), were induced with propofol (5 mg / kg) and maintained under inhalation anesthesia. The animals in group I were treated with lidocaine (5 mg / kg) combined with morphine (0.1 mg / kg) epidurally and the animals of group II received epidurally, the combination lidocaine-morphine-fentanyl, the latter at the dose of 2µ/kg. Parameters such as heart and respiratory rate, blood pressure (systolic, mean and diastolic), blood gases and pH were measured. For the assessment of analgesia were used visual-analogue scale (VAS), the scale proposed by Lascelles and thermoalgimetry. Blood samples were collected for later determination of cortisol and interleukin-06. The evaluation period was 06 hours after surgery, the animals were re-evaluated within 24 hours after the procedure. Except the cardiorespiratory parameters, the groups were similarly. However, was observed that animals treated with the combination lidocaine-fentanyl-morphine had lower pain scores in the postoperative period. In fact there were significant differences in VAS scores (p <0.05) at times T180 and T360; in Lascelles scores at times T180, T360 and T24h and there were no statistical diferences in thermoalgimetry at times T180, T360 and T24h. The rescue analgesia was required in three animals in Group II, and six animals in Group I. It can be concluded that the combination of fentanyl in epidural anesthesia protocol, promoted adequate perioperative analgesia, producing synergistic and residual effects, which improved postoperative analgesia.

No description available.

The opioid epidemic has become a serious public health problem in the United States. The increasing abuse of synthetic opioids has raised concerns in the society. Fentanyl is a synthetic opioid analgesic which has resulted in an increasing number of drug overdoses since 2013. In addition, fentanyl analogs, originally manufactured for use as analgesics or animal tranquilizers, have emerged in the United States drug market. Fentanyl and its analogs, similar to other opioids, work as full µ-agonists, binding with µ-receptors in the brain. Fentanyl and its analogs elicit more potent effects compared to the traditional opioids being abused such as morphine or heroin. With the emergence of fentanyl analogs in the drug market, identifying and differentiating those analogs becomes a challenge due to their structural similarities to fentanyl. The purpose of this research was to develop a method of identifying and quantifying nine fentanyl analogs in urine and oral fluid using the QSight® Triple Quad LC-MS/MS, coupled with a Halo® C18, 2.7µm column. The method was validated based on AAFS Standards Board (ASB) Standard 036, Standard Practices for Method Validation in Forensic Toxicology. The analytes in this research included fentanyl, norfentanyl, acetyl fentanyl, carfentanil, cyclopropyl fentanyl, methoxyacetyl fentanyl, valeryl fentanyl, furanyl fentanyl and 4-anilino-N-phenethylpiperdine (4ANPP). All samples, calibrators, and quality controls (QC) were prepared by spiking certified reference standards into donated human urine or human oral fluid. Supported liquid extraction (SLE) was performed as the sample preparation method using ISOLUTE® SLE+ 1mL columns followed by evaporation. All samples were reconstituted with 200 µL methanol. The mobile phases used in this method were 5mM ammonium formate in Millipore water with 0.1% formic acid and methanol with 0.1% formic acid. A 10-minute LC method achieved complete resolution of the analytes, with specific retention times ranging from 3.5 to 5.7 minutes. For urine and oral fluid analysis, the calibration range for all analytes was established from 1 to 70 ng/mL. The resulting r2 values were greater than 0.988 for all analytes. Bias and precision were evaluated at 3, 25 and 60 ng/mL, and bias and percent coefficient of variation (%CV) for within and between run precision had acceptable values within ±20%. The limit of detection (LOD) was 0.1 ng/mL for most fentanyl analogs, with a LOD of 0.01 ng/mL for valeryl fentanyl and furanyl fentanyl. Carryover was not detected for any analytes in either matrix. Recovery of all compounds following SLE for both urine and oral fluid was above 50%. For urine, the ion enhancement and suppression of all analytes was within 25%. For oral fluid, the ion enhancement and suppression of most analytes was within 25% except valeryl fentanyl, which experienced suppression of 35%. The matrices analyzed had no interference effect on the detection or quantitation of analytes in this method. The interference effects of different commonly encountered drugs were studied and showed minimal impacts on the results generated from this method. All analytes were stable for up to 72 hours at room temperature, except cyclopropyl fentanyl. In conclusion, using the QSight® Triple Quad LC-MS/MS following SLE effectively identified and quantified fentanyl analogs present in both urine and oral fluid. This method has shown its potential to be applied to casework samples for fentanyl analogs detection.

Purpose of review: Overdose deaths have increased significantly over the last 5 years. This review analyzes the severity and nature of the epidemic, its impact on society, factors driving the increase in mortality, special populations disproportionately affected, and solutions to decrease overdose deaths. A thorough understanding of opioid overdose rates and deaths position the reader to respond most effectively in their sphere of influence. Recent findings: Final statistics for 2017 show a continued worsening of the epidemic. Recent studies focus on the evolving role of synthetic fentanyl, risk factors for fatal overdose, variation of mortality across demographic and socioeconomic regions, and the effectiveness of harm reduction strategies such as naloxone. Summary: The national overdose death rate continues to rise unabated with a 9.6% increase during 2017, with an estimated cost over $550 billion in 2019. There are, however, effective strategies to identify and treat individuals at risk for a fatal overdose. The root cause of addiction is the brain’s response to despair, social stressors, and societal structural inequities. It is unlikely we will see a significant decrease in addiction and its consequences until these root causes are addressed. Additional research is needed on the role of social determinants in addiction, strategies to treat incarcerated individuals, the role of suicidal ideation in fatal overdose, and risk factors, and frequency of non-fatal overdose.

No description available.

Zusammenfassung: Fentanyl und Sufentanil sind zwei synthetisch hergestellte Opioide, die in der Anästhesiologie für die intraoperative Analgesie eingesetzt werden. Sie weisen ein unterschiedliches pharmakodynamisches Profil auf. Im Jahr 2014 wurde das Opioidregime für minimal-invasive Standardeingriffe im Klinikum Fulda von Fentanyl auf Sufentanil umgestellt. In der geplanten retrospektiven Datenerhebung sollten Daten von Patienten, die vor 2014 mit Fentanyl analgesiert wurden, verglichen werden mit Daten von Patienten, bei denen nach 2014 Sufentanil in die Narkoseführung implementiert war. Untersucht werden sollte, ob der Wechsel auf ein Opioid mit einem vermeintlich geeigneteren Profil für die Narkoseführung tatsächlich die kalkulierten Vorteile erbracht hat. Die retrospektive Datenerhebung sollte aufzeigen, ob Patienten während und nach MIC-CHE oder MIC-TEP von einer Sufentanil-Gabe gegenüber der Fentanyl-Gabe profitieren: Verkürzt sich die Ausleitungsphase, haben die Patienten bei Ankunft im Aufwachraum (AWR) eine bessere Oxygenierung und/oder eine stabilere Kreislaufsituation? Leiden die Patienten nach Sufentanil unter weniger postoperativer Übelkeit und Erbrechen (PONV), benötigen sie weniger Schmerzmittel? Die Untersuchung sollte zudem klären, ob biometrische Faktoren wie Geschlecht, Alter, Gewicht und BMI in Zusammenhang mit dem eingesetzten Opioid eine relevante Rolle für das postoperative Befinden der Patienten spielten, und ob sich aus der Umstellung von Fentanyl auf Sufentanil ökonomische Vorteile ergaben. Ergebnis: Kombination Desfluran mit Sufentanil für alle untersuchten Gruppen von klinischem Vorteil. Bevorzugter Einsatz bei MIC-Eingriffen in der Allgemein- und Viszeralchirurgie empfehlenswert. - Geringerer postoperativer Schmerzmittelbedarf - Bessere postoperative Oxygenierung - Kürzere postoperative Aufwachzeit - Niedrigerer intraoperativer Opioidbedarf - Wirtschaftlich/ökonomische Gleichwert Begründete Aussage, dass Sufentanil bei MIC-Eingriffen in der Allgemein- und Viszeralchirurgie im Vergleich zu Fentanyl das überlegene Medikament ist. (überwiegend statistisch signifikant) Steigerung dieses Effekts über die Kombination mit Desfluran möglich. / Summary: Fentanyl and sufentanil are two synthetically produced opioids that are used in anesthesiology for intraoperative analgesia. They have a different pharmacodynamic profile. In 2014, the opioid regime for minimally invasive standard interventions at the clinic in Fulda was changed from fentanyl to sufentanil. In the planned retrospective data collection, data from patients who were analgesized with fentanyl before 2014 should be compared with data from patients in whom sufentanil was implemented in anesthesia after 2014. It should be investigated whether the change to an opioid with a supposedly more suitable profile for anesthesia has actually produced the calculated benefits. The retrospective data collection should show whether patients benefit from administration of sufentanil compared to administration of fentanyl during and after MIC-CHE or MIC-TEP: Shorter elimination phase? Better oxygenation-situation on arrival in the recovery room or a more stable circulatory situation? Do the patients suffer less postoperative nausea and vomiting (PONV) after sufentanil, do they need less pain-medication? The investigation should also clarify whether biometric factors such as gender, age, weight and BMI in connection with the opioid used to play an important role in the postoperative condition of the examined patients and whether there were any economic benefits in switching from fentanyl to sufentanil. Result: The combination of desflurane with sufentanil was of clinical advantage for all examined groups. Recommended for use in MIC- operations in visceral surgery. - Less need for post-operative pain medication - Better post-operative oxygenation - Shorter post-operative wake-up time - Lower intraoperative opioid requirement - Economic / economic equivalence Well-founded statement that sufentanil is the superior drug compared to fentanyl in MIC-procedures in visceral surgery. (mostly statistically significant) This effect can be increased by combining it with desflurane.

Bakgrund: Barn inom ambulanssjukvården är sällan förekommande patienter. Bland de barn som bedöms och behandlas är smärta ett vanligt förekommande symtom. Forskning har visat att smärtlindringen av barn prehospitalt fungerar suboptimalt. Intranasalt fentanyl är en metod för smärtlindring som är både enkel och effektiv. Dock är det ringa undersökt hur prehospital vårdpersonal upplever metoden.Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att smärtlindra barn med intranasalt fentanyl prehospitalt. Metod: Studien inkluderade tio semistrukturerade intervjuer med sjuksköterskor från ambulanssjukvården i Mellansverige. Intervjuerna analyserades med hjälp av kvalitativ innehållsanalys. Resultat: Resultatet består av tre kategorier: I. Utmaningar med barn som patienter. Där det framkom att barn som patient var utmanande möten som ofta väckte känslor. Närstående kunde både underlätta och försvåra vårdmötet. Vidare visade sig användningen av skalor för smärtskattning vara svår. II. Ovanlig behandling till barn. Deltagarna hade liten erfarenhet från intranasalt fentanyl till barn samt att de beskrev läkemedlet som potent, vilket ledde till ökad följsamhet till riktlinjer och höjd vaksamhet. Vidare framkom att erfarenhet skänker trygghet och både förvärvad erfarenhet samt barnspecifik utbildning ökade benägenheten ge intranasalt fentanyl. III. Praktiska färdigheter om behandlingen. Intranasal fentanyl uppfattades som en snabb och effektiv metod för smärtlindring och ansågs även underlätta omvårdnaden. Slutsats: Sjuksköterskornas erfarenhet av intranasalt fentanyl är att det är en snabb, enkel och oftast effektiv metod för att behandla smärta hos barn. Resultatet tyder också på att möten med barn som lider av smärta i prehospitalvård var en utmaning och kan upplevas som stressande.

Fentanyl is a potent narcotic analgesic that leads to countless overdoses each year. Past studies have shown that fentanyl use has been growing substantially in counties within Florida. However, little research has been done to quantify and analyze rates of fentanyl overdose within Orange County, particularly over multiple year periods of time. The goal of this study is to provide information and analysis on the rates of fentanyl overdose within Orange County, Florida from 2019 to 2021, and to explore demographic factors that correlate with fentanyl overdose. It is hypothesized that the rate of fentanyl overdoses will have significantly increased yearly from 2019 to 2021. Additionally, it is expected that a significant portion (20+%) of decedents will have other drugs identified by the Medical Examiner within their systems. Lastly, it is predicted that there will be a statistically significant difference in fentanyl overdose rates between demographic groups.

The use and abuse of fentanyl has risen drastically over the last several decades. The abuse of this substance has created a hazardous situation for law enforcement and first responders because they could arrive at locations and not necessarily know that they will encounter fentanyl or a fentanly analog. Fentanyl analogs are substances that have a similar structure to fentanyl, and while the analogs may have additional or altered groups on the molecule, the backbone structure remains the similar. This work focuses on the electrochemical characterization of fentanyl as a stepping stone for the detection of both fentanyl and later fentanyl analogs by electrochemistry. The metabolic reaction of fentanyl is an N-dealkylation to norfentanyl, occurring in the liver, and can be mimicked by electrochemistry through the irreversible oxidation of fentanyl. This electrochemical reaction is hypothesized to generate electroactive metabolites in solution. The combination of the visualization of both the irreversible oxidation with the development of the additional metabolic redox peaks would constitute a unique electrochemical signiture for fentanyl and fentanyl analogs towards a universal rapid screening assay. The electrochemical behavior of fentanyl was characterized in depth using multiple electrochemical techniques such as cyclic voltammetry (CV), square wave voltammetry (SWV), and differential pulse voltammetry (DPV). The optimization of the supporting electrolyte, the potential range, and methods to decrease the background current were explored with CV. To work toward a more portable system, screen printed electrodes were used. The observation of the metabolic peaks remained challenging, and different methods were attempted to achieve it. The quantification of fentanyl was successfully demonstrated using the different electrochemical systems proposed in this work. The electrochemical characterization of fentanyl and the optimization of multiple experimental parameters were the first step in developing a universal, rapid, electrochemical sensing method for the detection of fentanyl and fentanyl analogs. <br>