Introduction
• Increase in fentanyl related deaths in UK
• National Crime Agency statement re: vigilance, high index of suspicion etc
• Unclear whether there is a genuine increase in demand
• Heroin has a high purity fraction on the UK street market, therefore the actual demand for fentanyl is questionable – i.e. it is unnecessary to increase its effect by mixing it with fentanyl
Fentanyl Facts
• Powerful synthetic opioid, 50-100x more potent than morphine
• Since 2012 it is the most commonly used synthetic opioid in clinical practice in the UK
• Extremely lipid soluble so rapidly and extensively distributed with a relatively long half-life compared to other synthetic opioids
Recreational Use
• Also known as Apache, China Girl, China Town, Dance Fever, Goodfellas, King Ivory, Murder 8…and more…
• Sometimes mis-sold as heroin/cocaine or mixed (“China White”)
• Because of high potency illicit manufacturing has unpredictable concentration
• High financial return compared to heroin
Overdose
• Can be immediately fatal
• Mass overdoses in Yorkshire area
Fentanyl as a Threat to Public Health
• New England Journal of Medicine review article – risk vs harm reduction
• Public Health England – identifying high risk, building communication, resilience and increasing availability and user friendliness of naloxone in vulnerable communities
Substance Misuse in Anaesthetists
• Fentanyl most commonly abused IV opioid
• Onset of tolerance is rapid, detected earlier in addiction than other substances
• Many report prior use of weaker opioids
• Signs and symptoms of abuse
• Intervention
Discussion in Journal Club
• Comment re: fentanyl deaths reported in media not necessarily related to opioid overconsumption in general, and UK has limited market in counterfeit prescription
• Intranasal fentanyl becoming more widely used in A&E for paediatric population – ? scope for misuse
Summary by Dr E Morino. Presentation and discussion 19 October 2017.
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