What Is The Concern With Fentanyl?

As prom approaches, parents and students are getting ready for all of the festivities and activities associated with this special time of year. It is such an exciting time for kids and their parents. While I am excited and happy for them, I am also afraid. This week, I know that high schools have been sending out notifications to warn parents and students about drug overdoses related to drugs that are mixed or contaminated with fentanyl. The Los Angeles department of public health recently sent out a health alert about 3 individuals who suffered drug overdoses with ecstasy contaminated with fentanyl. While using any single illicit drug is concerning, mixing different agents together may generate unanticipated and deadly side effects.

Fentanyl is a synthetic opioid (or narcotic). The classic opioid is morphine. Other agents in the opioid class include oxycodone, hydrocodone, methadone, codeine, and others. Fentanyl is 50-100 times more potent than morphine. "At lower doses, opioids may make you feel sleepy, but higher doses can slow your breathing and heart rate, which can lead to death. The feelings of pleasure that result from taking an opioid can also make you want to continue experiencing those feelings, which may lead to addiction."  Unfortunately, fentanyl has made its way into the public domain and has resulted in numerous drug overdoses and deaths. Deaths from illicit fentanyl use are on the rise.

Fentanyl is a particularly dangerous agent because of its potency and the known effects that it causes. Fentanyl is a medication that is typically used for pain and sedation. I use it on patients in the pediatric intensive care unit for painful procedures or for those who require invasive mechanical ventilator support. While using fentanyl, we monitor a patient’s level of consciousness and breathing effort closely because we know that the medication has the potential for causing altered mental status and can even depress the desire to breath to the point of actually stopping someone from breathing. While this is not as much of a concern for infants and children on mechanical ventilator support because a machine is pushing air into the lungs and helping them breath, those without this kind of support can actually stop breathing altogether. If someone stops breathing, the obvious consequence is that oxygen is not brought into their body and they die from lack of oxygen.

While in a controlled situation or under close supervision, fentanyl can be used relatively safely with some apparent risks. However, when used in an illicit manner without an understanding of the potential side effects, fentanyl can be deadly. This is what scares me when kids get ahold of it or when it is unintentionally used because it is mixed with something else. Other drugs or agents that cause their own side effects of altered mental status and respiratory depression can be accentuated by the addition of fentanyl. So, the combination is much more dangerous than each drug by itself.

While this prom season is one of joy and excitement, it can be marred by tragedy with a drug overdose. Parents and schools should be wary about any drug use by their teens. Educating kids and adults about the risks and dangers of illicit drug use is critical to preventing unwanted consequences. Also, knowing that there are substances out there that may contain combinations of illicit drugs that make their use even more dangerous is even more important. This information should be stressed in the education as well. The only thing that is more important than a joyful and exciting prom season is a safe and secure prom season.

Please send this information to students, parents, or schools that may benefit from understanding why there is a concern with fentanyl.