Fentanyl Citrate Abuse among Health Care Professionals

Silsby, Harry D.; Kruzich, David J.; Hawkins, M. R. S.

doi:10.1093/milmed/149.4.227

Cited by 23 publications

(7 citation statements)

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“…(Stanley, 2014). Reports of misuse and illicit use by clinicians, primarily anesthesiologists and surgeons with access to the drug, were first reported in the 1980s and continued into the early 2000s (Ward et al, 1983;Garriott et al, 1984;Silsby et al, 1984;Rosenberg, 1986;Pare et al, 1987;Kintz et al, 2005;Bryson and Silverstein, 2008;Jugerman et al, 2012). In the 1990s fentanyl transdermal patches were introduced for widespread palliative use and access extended from clinicians to include patients.…”

Section: Study Selectionmentioning

confidence: 99%

Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review

et al. 2018

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Section: Study Selectionmentioning

confidence: 99%

Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review

et al. 2018

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“…Fentanyl's popularity stems from its lipophilicity, potency, fast onset, short action duration, and amenability to parenteral, transdermal, and transmucosal delivery . These characteristics, together with high abuse liability when injected intravenously and difficulty of detecting overt intoxication in the tolerant user, explain fentanyl's current predominance over morphine and meperidine as the most abused opioid among health care providers …”

Section: Discussionmentioning

confidence: 99%

Nosocomial hepatitis C virus transmission from tampering with injectable anesthetic opioids

Hatia¹,

Dimitrova²,

Skums³

et al. 2015

Hepatology

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The extent of provider-to-patient hepatitis C virus (HCV) transmission from diversion, self-injection, and substitution ("tampering") of anesthetic opioids is unknown. To quantify the contribution of opioid tampering to nosocomial HCV outbreaks, data from health care-related HCV outbreaks occurring in developed countries from 1990 to 2012 were collated, grouped, and compared. Tampering was associated with 17% (8 of 46) of outbreaks, but 53% (438 of 833) of cases. Of the tampering outbreaks, six (75%) involved fentanyl, five (63%) occurred in the United States, and one each in Australia, Israel, and Spain. Case counts ranged from 5 to 275 in the tampering outbreaks (mean, 54.8; median, 25), and 1-99 in the nontampering outbreaks (mean, 10.4; median, 5); between them, the difference in mean ranks of counts was significant (P < 0.01). To estimate HCV transmission risks from tampering, risk-assessment models were constructed, and these risks compared with those from surgery. HCV transmission risk from exposure to an opioid preparation tampered by a provider of unknown HCV infection status who is a person who injects drugs (PWID; 0.62%; standard error [SE] 5 0.38%) exceeds 16,757 times the risk from surgery by a surgeon of unknown HCV infection status (0.000037%; SE 5 0.000029%) and 135 times by an HCV-infected surgeon (0.0046%; SE 5 0.0033%). To pose a 50% patient transmission risk, an infected surgeon may take 30 years, compared to <1 year for a PWID tamperer, and weeks or days for a PWID tamperer who intensifies access to opioids. Conclusion: Disproportionately, many cases of HCV infection from nosocomial outbreaks were attributable to provider tampering of anesthetic opioids. Transmission risk from tampering is substantially higher than from surgery. (HEPATOLOGY 2015;62:101-110)

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“…However, in a study of recreational drug abusers in Canada ( n = 42), fentanyl was considered a highly desirable drug (oral fentanyl rated higher than the patch but both were considered more desirable than oxycodone tablets) [53]. Fentanyl is also one of the most frequently abused opioids among US healthcare professionals [53–55]. From these reports, it appears that drug preferences in specific subpopulations may emerge due to a variety of factors such as familiarity with the agent, accessibility, price, ability to conceal the drug, and reputation of the agent within that population.…”

Section: Opioid Attributes Liked/disliked By Abusersmentioning

confidence: 99%

Designing Opioids That Deter Abuse

Raffa

Pergolizzi

Muniz³

et al. 2012

Pain Research and Treatment

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Prescription opioid formulations designed to resist or deter abuse are an important step in reducing opioid abuse. In creating these new formulations, the paradigm of drug development target should be introduced. Biological targets relating to the nature of addiction may pose insurmountable hurdles based on our current knowledge and technology, but products that use behavioral targets seem logical and feasible. The population of opioid abusers is large and diverse so behavioral targets are more challenging than they appear at first glance. Furthermore, we need to find ways to correlate behavioral observations of drug liking to actual use and abuse patterns. This may involve revisiting some pharmacodynamic concepts in light of drug effect rather than peak concentration. In this paper we present several new opioid analgesic agents designed to resist or deter abuse using physical barriers, the inclusion of an opioid agonist or antagonist, an aversive agent, and a prodrug formulation. Further, this paper also provides insight into the challenges facing drug discovery in this field. Designing and screening for opioids intended to resist or deter abuse is an important step to meet the public health challenge of burgeoning prescription opioid abuse.

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Fentanyl Citrate Abuse among Health Care Professionals

Cited by 23 publications

References 0 publications

Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review

Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review

Nosocomial hepatitis C virus transmission from tampering with injectable anesthetic opioids

Designing Opioids That Deter Abuse

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