Fentanyl and california's physician diversion program
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The document discusses the history and pharmacology of fentanyl, an opioid analgesic that is hundreds of times more potent than heroin. It was first synthesized in the 1950s and approved for use as an anesthetic in the 1960s. While used in clinical settings for anesthesia and pain management, it has also been abused by medical professionals due to its availability and potential to be undetected in drug tests. The document also mentions California's Physician Diversion Program but does not provide any details about it.
Fentanyl and california's physician diversion program
- 1. Fentanyl and California's Physician Diversion Program 10/12/12 1
- 2. History of Fentanyl Illicit use of pharmaceutical fentanyl first appeared in mid 1970s in the medical community Biological effects indistinguishable from heroin- EXCEPT that fentanyl may be hundreds of times more potent Most commonly used by intravenous administration, but like heroin, may be smoked or snorted First synthesized in Belgium in late 50s as a synthetic narcotic Approved by FDA in 1968 Introduced into clinical practice in 60s as an IV anesthetic (Sublimaze) Thereafter Alfenta and Sufenta introduced Today extensively used for anesthesia and chronic pain management 10/12/12 2
- 3. DESCRIPTION Only used in hospital or clinical setting Especially prone to creating dependency early on Used to aid induction and maintenance of general anesthesia and to supplement regional and spinal anesthesia May be administered IV, IM, transdermally, epidurally, or in lozenze/lollipop form Drug of abuse of choice by anesthesiologists, for myriad reasons, including availability, often undetectable in less sophisticated urine sample screens, and personality characteristics unique to many physicians (Vaillant, 1972) 10/12/12 3
- 4. PHARMACOLOGY OF FENTANYL An opioid analgesic, lipid soluble, metabolized in liver Fentanyl interacts with the m-receptor, sites that are distributed in the brain, spinal cord, and other tissues Exerts primary pharmacologic effects on CNS Increases toleration of pain, decreases perception of suffering, produces alterations in mood, EUPHORIA, dysphoriia, and drowsiness Stimulatory effect is result of disinhibition as the release of inhibitory neurotransmitters, such as Dopamine, acetylcholine, norepinephrine, and substance P are blocked Exact process of how opioid agonists cause both inhibitory and stimulatory processes not well understood Side effects myriad, but include respiratory depression, gastrointestinal motility, and physical dependence Significant drug-drug interactions Metabolites and unchanged drug are excreted in urine, which can take several days Residual fentanyl from one dose can potentiate the effect of subsequent doses, such as serious respiratory complications 10/12/12 4
- 5. 遺粥晦鴛酷或檎鰻鴛粥S PHYSICIAN DIVERSION PROGRAM Details about this topic Supporting information and examples How it relates to your audience 10/12/12 5
- 6. Topic Three Details about this topic Supporting information and examples How it relates to your audience 10/12/12 6
- 7. Real Life Give an example or real life anecdote Sympathize with the audiences situation if appropriate 10/12/12 7
- 8. What This Means Add a strong statement that summarizes how you feel or think about this topic Summarize key points you want your audience to remember 10/12/12 8
- 9. Next Steps Summarize any actions required of your audience Summarize any follow up action items required of you 10/12/12 9