High opioids tolerance due to transmucosal fentanyl abuse

Eiden, Céline; Mathieu, Olivier; Donnadieu‐Rigole, Hélène; Marrot, Cécile; Peyrière, Hélène

doi:10.1007/s00228-017-2272-9

Cited by 11 publications

(7 citation statements)

References 7 publications

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“…The search resulted in 4437 studies after de-duplication, 132 were selected for full-text review, and 41 were included ( Figure 1 ). Of the 41 studies included, 23 were in the United States ( 13 – 35 ); seven in Canada; ( 36 – 42 ) two in Sweden; ( 43 , 44 ) one each in Australia, ( 45 ) Germany, ( 46 ) Denmark, ( 47 ) France, ( 48 ) Estonia, ( 49 ) the UK, ( 50 ) and Turkey. ( 51 ) Two studies were done online with no note of specific country involvement ( Table 1 ) ( 52 , 53 ).…”

Section: Resultsmentioning

confidence: 99%

Systematic review on intentional non-medical fentanyl use among people who use drugs

Tsang,

Wong,

Westenberg

et al. 2024

Front. Psychiatry

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ObjectivesFentanyl is a highly potent opioid and has, until recently, been considered an unwanted contaminant in the street drug supply among people who use drugs (PWUD). However, it has become a drug of choice for an increasing number of individuals. This systematic review evaluated intentional non-medical fentanyl use among PWUD, specifically by summarizing demographic variance, reasons for use, and resulting patterns of use.MethodsThe search strategy was developed with a combination of free text keywords and MeSH and non-MeSH keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO. Studies included were human studies with intentional use of non-medical fentanyl or analogues in individuals older than 13. Only peer-reviewed original articles available in English were included.ResultsThe search resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. Out of 41 papers included, it was found that individuals who use fentanyl intentionally were more likely to be young, male, and White. They were also more likely to have experienced overdoses, and report injection drug use. There is evidence that fentanyl seeking behaviours are motivated by greater potency, delay of withdrawal, lower cost, and greater availability.ConclusionsAmong PWUD, individuals who intentionally use fentanyl have severe substance use patterns, precarious living situations, and extensive overdose history. In response to the increasing number of individuals who use fentanyl, alternative treatment approaches need to be developed for more effective management of withdrawal and opioid use disorder.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42021272111.

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Section: Resultsmentioning

confidence: 99%

Systematic review on intentional non-medical fentanyl use among people who use drugs

Tsang,

Wong,

Westenberg

et al. 2024

Front. Psychiatry

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“…The most common side effects may include nausea, dizziness, vomiting, fatigue, headache, and constipation. The repeated use of fentanyls leads to the development of tolerance and dependence [ 13 ]. Typical withdrawal symptoms involve sweating, anxiety, diarrhea, bone pain, abdominal cramps, and shivers or goose “flesh” [ 12 , 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…The autopsy findings collected from the case reports treated in the literature were homogeneous with respect to the detected findings. The routine histological data were not very specific and did not reveal indicative signs of intoxication [ 13 , 55 ].…”

Section: Resultsmentioning

confidence: 99%

Novel Synthetic Opioids: The Pathologist’s Point of View

et al. 2018

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Background: New Psychoactive Substances (NPS) constitute a broad range of hundreds of natural and synthetic drugs, including synthetic opioids, synthetic cannabinoids, synthetic cathinones, and other NPS classes, which were not controlled from 1961 to 1971 by the United Nations drug control conventions. Among these, synthetic opioids represent a major threat to public health. Methods: A literature search was carried out using public databases (such as PubMed, Google Scholar, and Scopus) to survey fentanyl-, fentanyl analogs-, and other synthetic opioid-related deaths. Keywords including “fentanyl”, “fentanyl analogs”, “death”, “overdose”, “intoxication”, “synthetic opioids”, “Novel Psychoactive Substances”, “MT-45”, “AH-7921”, and “U-47700” were used for the inquiry. Results: From our literature examination, we inferred the frequent implication of fentanyls and synthetic opioids in side effects, which primarily affected the central nervous system and the cardiovascular and pulmonary systems. The data showed a great variety of substances and lethal concentrations. Multidrug-related deaths appeared very common, in most reported cases. Conclusions: The investigation of the contribution of novel synthetic opioid intoxication to death should be based on a multidisciplinary approach aimed at framing each case and directing the investigation towards targeted toxicological analyses.

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“…A search of the literature by the authors found only 3 additional case studies demonstrating a similar phenomenon: an 11-year-old boy with presumed graft-versus-host disease which was later demonstrated to be chemical coping titrated to high doses on fentanyl (max dose ¼ 9720-10,908 morphine equivalent daily dose) 3 ; a 40-year-old woman prescribed oxycodone postoperatively on an escalating dose (max dose ¼ 16,500 morphine equivalent daily dose) 4 ; and a 59-year-old man who was using his palliative wife's transmucosal fentanyl (max dose ¼ 11,520-12,928 morphine equivalent daily dose). 5 We are not able to calculate NC's morphine equivalents due to her methadone and its dose equivalency being poorly established. 6 These cases did not focus on socially relevant outcomes such as parenting a sick newborn nor did they explore treatment of these high opioid tolerances with OAT.…”

Section: Discussionmentioning

confidence: 99%

Patient With Very High Opioid Tolerance Enrolled in Opioid Agonist Treatment: A Case Report

Wilson

Lim

2021

Journal of Addiction Medicine

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Background: Fentanyl and fentanyl analogs have invaded the streetsourced opioid market in North America which has resulted in an unprecedented number of unintentional opioid overdoses. Existing guidelines to treat opioid use disorder are based on evidence that was developed when heroin was the primary street-sourced opioid and proposed dosages of opioid agonist treatments are increasingly inadequate to address patients with high opioid tolerances. Case Summary: The authors examine one case study of a patient with an extremely high opioid tolerance and review how responsive dose adjustments outside of the recognized maximum doses allowed for meaningful functional outcomes. Discussion: This case demonstrates how patient-centered dose responses with a focus on functional outcomes supersede existing opioids agonist treatment dosing ranges, especially in the context of a patient with a higher than typical opioid tolerance.

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High opioids tolerance due to transmucosal fentanyl abuse

Cited by 11 publications

References 7 publications

Systematic review on intentional non-medical fentanyl use among people who use drugs

Systematic review on intentional non-medical fentanyl use among people who use drugs

Novel Synthetic Opioids: The Pathologist’s Point of View

Patient With Very High Opioid Tolerance Enrolled in Opioid Agonist Treatment: A Case Report

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