Fentanyl still a valuable painkiller, medical professionals say

By Catherine McCallum

Early one spring morning in a quiet neighbourhood, a fire truck followed by an ambulance stops in front of a bungalow.

Soon the fire truck and the ambulance crew leave without a patient. Within an hour, police arrive. Neighbours straggle out and talk quietly with a grieving mother.

A few hours later, the coroner’s vehicle arrives and removes the body of a middle-aged man.

This scene has repeated itself – with variations – in many Lower Mainland neighbourhoods with increasing frequency over the last eight years.

The key player in this epidemic of untimely deaths has been a synthetic opioid drug called fentanyl that has been used effectively by the medical profession since the 1960s.

Dr. Jeff Dresselhuis, a Burnaby family physician, told a Voice reporter that fentanyl can be used IV for rapid onset, short-term pain relief – particularly in emergency departments, and sometimes in obstetrics.  Fentanyl via a transdermal patch can also be used to treat chronic pain in those who already have tolerance to a moderate dose of morphine.

Fentanyl is easily absorbed through mucus membrane and blood vessels and rapidly transported to brain, heart, lungs, kidneys, spleen.  Life threatening effects can occur within two minutes of taking a dose.

The science behind the drug

According to Surrey pharmacist, Abid Raja, fentanyl causes an increase of dopamine in the brain. This produces an intense state of euphoria and relaxation. Other effects include a decrease in the level of consciousness, decreased breathing, nausea and vomiting.  Over time, people develop a decreased responsiveness to opioids like fentanyl, requiring increased doses to produce the desired effect. This is called tolerance.

Fentanyl interacts with many other drugs.  For example, taking drugs such as Benadryl or alprazolam around the time of taking fentanyl will increase the likelihood of coma, slowed or absent breathing and death.

Some drug users take stimulants simultaneously such as amphetamines, or cocaine to reduce the sedative effects and gabapentin to make the `high’ better and to reduce withdrawal effects. These drug cocktails, chosen by the users, are contributing to surging death rates.

Fortunately, there are medications such as Naloxone that can reverse the effects of opioids if given soon enough and at a high enough dose- up to 12 mg for fentanyl overdoses.

Since the effect of Naloxone wears off in 20 to 90 minutes, repeat doses should be given if opioid effects recur, until medical help is available.

Carfentanil, a much more potent analogue of fentanyl, was implicated in 126 BC deaths in 2022. Naloxone is not effective in reversing the effects of carfentanil, but another drug called Nalmephene may be.

Addiction doctors encourage those with opioid use disorder to replace the drugs that they are getting “on the street” with safer options like methadone, an oral drug has been used for many years, and more recently Buprenorphine has been used also.

Dresselhuis treated three former IV drug users with methadone for many years.  As they aged, they died of other diseases. Unfortunately, most of those who abuse fentanyl are not willing to substitute these safer options on a long-term basis, he said.

Dresselhuis said he has been told by addiction specialists that for some drug users, getting close to “the edge” between life and death is a desirable aspect of the “high”.  The element of danger and risk-taking enhances their experience.