A drug authorized in France, Fentanyl is misused as a drug, especially in the United States.
Who has not already seen the images of men and women walking the streets of Chicago or San Francisco, suffering from the devastating effects of Fentanyl? In the United States, on average, every seven minutes, one person dies from the effects of this drug. A real health crisis linked to the misuse of opioids has affected this country since the beginning of the 2000s. After having been at the origin of death of singer Prince in 2016, fentanyl also caused the death of the American rapper Coolio in September 2022.
Definition: what is Fentanyl?
Fentanyl is a pain medication in the class of “opioids”. Opioids are semi-synthetic (heroin) or synthetic (fentanyl) compounds manufactured in the laboratory, while opiates (opium, morphine, codeine) are natural derivatives of the poppy. Discovered in the late 1950s, its analgesic effect is 80 to 100 times more powerful than that of morphine and at least 50 times more powerful than that of heroin. Fentanyl has been classified as an international narcotic since 1964, due to its health dangers. In humans, the lethal dose of fentanyl is estimated at 2 mg.
It acts on the body’s opioid receptors, present in the brain, spinal cord and digestive system. It then modulates the response to pain, mood, physical dependence and gastrointestinal motility. The desired therapeutic action of fentanyl is primarily pain relief. Its absorption is very rapid through the oral mucosa (tablets), but it can also be administered by injection or transdermally (patch). The action of fentanyl on pain is rapid, as is its duration of action.
How is Fentanyl used in France?
Fentanyl has marketing authorization in France for its medical use as an analgesic. It comes in the form of patches, lollipops, sublingual tablets, nasal spray or injectable solution. In France, the prescription of Fentanyl (by prescription only) is indicated in the management of chronic pain, particularly of cancer origin. “There is currently no risk in France of an “opioid crisis” comparable to that occurring in North America (…) but their high lethal dimension nevertheless requires active surveillance” indicate the authors of the French Observatory of Drugs and Addictive Tendencies.
What are the effects of Fentanyl on the body?
Fentanyl has strong painkilling and sedative effects. It aims to relieve “very intense” pain. It also provides a feeling of relaxation, a feeling of well-being and appeasement, it reduces anxiety, sadness and causes euphoria, hence its misuse as a drug. The effects lead to increasing doses. This is where addiction can develop.
What are the side effects of Fentanyl?
- nausea, constipation, drowsiness
- dizziness and headaches, difficulty breathing
- dry mouth, sweating, feeling tired
- in the mouth: pain, irritation of the oral mucosa, mouth ulcer, cavities, tooth loss
More rarely :
- hypersensitivity,
- a loss of appetite or even anorexia,
- psychiatric disorders (including euphoria),
- memory loss, changes in taste,
- tremors, sleep problems,
- blurred vision, narrowing of the pupil,
- hypotension, hypothermia,
- various digestive disorders, skin manifestations, erectile dysfunction,
- a withdrawal syndrome or even an accidental overdose.
Repeated use of fentanyl or its derivatives, even when prescribed by a doctor, can lead to a risk of dependence. In case of significant consumption, there is a risk of overdose. In the event of an overdose of Fentanyl (overdose), respiratory depression, shock, severe hypotension, muscle rigidity or even coma may occur. These signs should be taken seriously, they can lead to death.
What medications contain Fentanyl?
- Abstral® in sublingual tablet (100 mcg, 200 mcg, 300 mcg, 400 mcg, 600 mcg and 800 mcg) as well as its generics,
- Actiq® tablet with oral applicator (200 mcg, 400 mcg, 600 mcg, 800 mcg, 1200 mcg and 1600 mcg),
- Breakyl® orodispersible film (200 mcg and 400 mcg),
- Durogesic® transdermal device or patch (12 mcg/h, 25 mcg/h, 50 mcg/h, 75 mcg/h and 100 mcg/h) and its generics fentanyl and Matrifen®,
- Effentora® oral-gingival tablet (100 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg) and its generic fentanyl,
- Fentanyl Piramal® solution for injection in ampoule (100 mcg/2ml and 500 mcg/10 ml) and its fentanyl generics,
- Fentanyl Renaudin® solution for injection IV/epidural in ampoule (50 mcg/ml),
- Instanyl® solution for nasal spray in single-dose container or multi-dose container (50 mcg, 100 mcg, 200 mcg),
- Pecfen® solution for nasal spray (100 mcg/pulv, 400 mcg/pulv),
- Recivit® sublingual tablet (133 mcg, 267 mcg, 400 mcg, 533 mcg and 800 mcg).
What are the contraindications of Fentanyl?
► Intraoral fentanyl is contraindicated in cases of allergy to fentanyl or to an excipient contained in the medication, in the absence of background opioid treatment (increased risk of respiratory depression), apart from paroxysmal pain attacks , in case of severe respiratory depression, in case of severe obstructive pulmonary pathology as well as in case of simultaneous treatment with a medicine containing sodium oxybate.
► The buccogingival film form (Breakyl®) is contraindicated in case of simultaneous administration or within two weeks following stopping an MAOI.
► Fentanyl patches are also contraindicated in acute or postoperative pain, and the severe or even fatal hypoventilation that could result. They are contraindicated in combination with buprenorphine or nalbuphine.
► The injectable form is also contraindicated in combination with agonist-antagonist opioids or naltrexone. Finally, increased vigilance is required when taking fentanyl due to the risk of physical and psychological dependence and abuse that it can cause, as well as the risk of withdrawal syndrome (including neonatal), serotonin syndrome, and risks associated with the concomitant use of sedative medications and alcohol.
Prescription conditions: Fentanyl only by prescription
Fentanyl can only be obtained through a medical prescription. It must be prescribed on a secure prescription because it is one of the narcotic drugs, for which the regulations are strict and very regulated.
