Fentanyl is an opiate, but no oral form exists. It comes in IV and transdermal patch forms. It is plenty stronger than morphine, but so are Dilaudid and other opiates. The big benefit and reason we use it in the hospital is that it is rapid-acting, but also wears off quickly. That makes it titratable - we can run it in an IV continuously or in frequent boluses (every 15-60 minutes) to keep patients’ pain down with less risk of overdosing them. In more progressive ICUs, you can treat patients with fentanyl for the discomfort of an endotracheal tube and ventilator and be able to stop sedative and hypnotic medications so they can function better. So we had patients who had to be on ventilators still able to walk laps around the ICU with physical therapy.
Outpatient, fentanyl patches are helpful for cancer and hospice patients, but there are plenty of chronic pain patients who end up with them too. Fentanyl is fat soluble, so it may not be a good choice in skinny/cachectic patients (they’ll just pee it out). One guy came in to clinic with 200mcg of fentanyl patches, but that’s what “worked” for him so he would not be convinced that at 200mcg it really was NOT working for him at all.
As far as abuse goes, some people will heat up the patches to cause the drug to be released faster (normally they’re 72 hour patches). The liquid form would be injected.
I didn’t really know about inhaled fentanyl. Cool! for anesthesia. I didn’t realize it could contaminate things per the CDC, including agriculture and water. I would have thought it would break down faster. Most likely the intent for the Boston fentanyl was sale to IV drug abusers, though.
I'm just curious due to Q's drop that seems to insinuate that the big fentanyl bust was an attack on "big pharma". And the attack on DJT was revenge for that attack. AND how MS-13 or any other gang or cartel may be involved.
So many questions.
p.s. Thanks so much for that very educational post.