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Fentanyl: The drug the kids call “fent.”

2010 September 1

More about fentanyl… In gratitude for two years of freedom from it.

A 33-year-old upstate New York man is facing two years in state prison after pleading guilty Tuesday to selling the fentanyl patches that caused a teenager to overdose fatally when he sucked on them.

This guy, James Slingerland, apparently stole his father’s supply of patches after his father, who was being treated at home for end-stage cancer pain, was taken to the hospital. Of course when you’re taken to the hospital, you don’t bring your drugs with you because they give you drugs from the hospital pharmacy.

So Slingerland had this brainwave: he would nick his dad’s drugs and sell them for a bit of extra pocket change. Except the middle-man sold them to a teenager who then chewed one and died.

This is what a brand-name Duragesic fentanyl patch looks like.

Duragesic fentanyl

Brand-name Duragesic fentanyl patch, 75 micrograms.

Fentanyl is so strong it’s measured in micrograms, not milligrams. (A microgram is one-onethousandth of a milligram. Very small amount.)

Can you see the gel inside there? People squeeze the gel out and suck on it. I have a friend from Opiate Detox Recovery who used to call brand-name Duragesic patches his “ketchup packets.” Because he said as soon as he tore the envelope off the first one and saw how squishy it was, he knew what he’d do with it. He couldn’t stop himself. (It’s part of addiction, the not-being-able-to-stop-yourself.)

Aside from drastically increasing the risk of fatal overdose by sucking the gel (in other words, you can kill yourself by doing this), the other agents in the gel are also toxic to organ systems. The gel is NOT GOOD FOR YOUR LIVER when it is eaten. Please do not eat it.

I used to buy the generic Mylan fentanyl patches.

Generic fentanyl patch

Generic Mylan fentanyl patch, 100 micrograms.

This is exactly what my fentanyl patches looked like. 100mcg. Boy does this bring back memories…

In the news stories about the upstate New York overdose, the cops were saying fentanyl is “about 80 times more powerful than morphine.” Morphine is the gold standard against which other opioids are compared, and I’ve heard lots of different estimates bandied about. Truth is, they don’t really know how to measure how much more powerful than morphine fentanyl is, because of the varying rates of absorption. If you have not a lot of body fat, fentanyl will metabolize more quickly than if you have more body fat. If you have more body fat, fentanyl will hang around in your body longer and take longer to excrete, because it’s fat-soluble. If you work out, or if your temperature runs even a degree high, and you put a patch on your skin, fentanyl will be absorbed more quickly.

People have found all kinds of ways to warm up the patches so they’ll be absorbed more quickly—so the blood levels will “spike” and they’ll feel some kind of high.

And if you stick it in your mouth, where it’s the warmest in the body—where does the nurse take your temperature?—the fentanyl will be absorbed the fastest of all. If you fall asleep (“nod”) with it in your mouth—it can kill you.

For all the readers out there who get to this post by searching on phrases like “is it quicker to eat fentanyl patch or stick it”—THINK ABOUT WHAT YOU’RE DOING. Think about the people who have died.

Fentanyl is, if you’ll excuse my French, Nothing To Fuck With. It is only for opioid-tolerant patients with high levels of pain who are being overseen regularly by a physician.

Extra fentanyl worked wonders when I had an appendectomy and when I broke my elbow. For pain in the tissues, opioids do a crack job (to use a small pun). For neurological conditions, not so much. Fentanyl suckers (“Actiq” lollipops) are marketed for neurological problems such as headaches. In my experience all Actiq did for my migraines was make me not-care about them. They didn’t take away much pain—they just made me not-care about it.

And for addiction, they’re hell. There’s almost nothing harder to get free of than fentanyl. You want to up your tolerance, you’re in for some serious debt when you pay the piper, take it from me.

Fentanyl was my ball-and-chain for three years, until I hired a detox physician to help me get free. And two years ago this week I woke up free of fentanyl. I was on Suboxone for two more months—which is another story for another day soon—but I was free of fentanyl. Thank god.

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  • That Guy

    Hey, I respect your output on the situation. Hopefully more kids will read this. I took a stab at “fent” so to speak, when I was dablin in Oxy Contin. I was working for a company as a 3rd party rep for Fios a nationwide service provided by verizon. I had some peer pressure and bad influences, well influencing me. I did one half of the patch that has the alluminum like cover and you rub the gel off and chew on it. I was so high and not ready for it I actually fell asleep for like 3 minutes standing up(we were a small desk like kiosk location inside a wholesale club) my employee was on the other half and she was doing the same. Shit was nuts. I want to never be in a position like that again I felt like a occasional like to sniff a pill kind of guy zapped and turned right into a junky “nodding off” and I am thankful now that I read your post that I could of died from the “nod” cuz man I was literally out for like 3 minutes my employee told me so and i watcher her do the same.

    Im glad it was a one time thing because the high was so intense, but yet so enjoyable I see where the addiction can lie within that pharmacuetial. Reach out and tell the world opiods are not to be fucked with unless you are perscribed by a LEGAL doctor.

    To all you kids that think it is cool this shit can ruin your life and not just “fent but all pills and forms of opiods. My mother has smoked crack for 11 years and has been clean for 2 years next month. She even told me that nothing was better than popping pills even her addiction to crack couldnt beat the high she shamefully told me. dont say “COOL” no its not cool no drugs are cool I think its a profound and discrete way for certain governments to control the people and i am starting to believe it risk for addiction is just now starting to be told in every doctors office since the label our poor youth has gained. Generation RX.

  • southsam7

    I have severe back pain and I’m out of my lortabs. Can I take one 25 microgram patch transdermally safely? I’m 45 and weigh 200 lbs. I have no interest in getting off on this TEMPORARY fix to my pain. I won’t have my Rx for lortab until Monday and January I’m quitting my job which is causing the back pain. I have taken NSAIDS and Tylenol until my stomach is pre-ulcerative.

    Asked another way, is the risk of fatality from taking one 25 microgram patch as directed (transdermal) relatively low? Please help!

  • http://guineveregetssober.com/ Guinevere

    However much I’d like to help, I cannot give medical advice—this site is not a replacement for talking with a qualified practitioner.

    I would ask how you came to be in possession of fentanyl if it’s not prescribed for you. If it’s prescribed, then surely you have a doctor’s instructions about how to take it? I would also ask how you came to run out of Lortab if you’re taking it as prescribed.

  • Catherine

    Nasty, horrible stuff to take for recreational reasons. I once slapped one on, in the midst of my terrible addictions ( I am clean and sober now) and woke up a day later. My 3 year old son had been alone with me. Yuck. Leave it alone. Get help if you are messing around with it. My humble opinion.

  • Ali

    You are an amazing person. You took a terrible situation and turned it into a way to help people–into a positive direction for your life. If even one person is directed to this site and thinks twice about starting down a path of addiction (or decides to start down a path of recovery) as a result, you are a miracle for him or her. Thank you for sharing your experiences.

  • cbd2006

    I was on fentanyl patches for from 2005-2007 It got to where it didn’t help with the pain anymore. I was on the patches bc of recurrent meningitis. I decided that it wasn’t worth it anymore. The pain was still bad and the price was horrible. I told my doctor that I needed help to come off of them. She refused to help. The most she did was write 5 Ativan. She didn’t warn me of anything. That had to have been the most horrible experience in my life. I had every withdrawal symptom you could think of. The restless legs, lethargy, insomnia and even worse pain. But I got through it. I am so angry that my doctor never told me that I could die from this. This drug is so so dangerous and I don’t think people have a clue of how bad it can be. I admire anyone that can come off this drug!!!

  • Katharine Spann

    Fentanyl is for people with long term chronic pain only. I was on 75 mc gm patches for over a year, but was so allergic to the adhesive that I have been put on OxyContin instead.
    What makes me angry is that I was only in my 30′s when I became bedridden with 5 small children who depended on me. The pain was so bad that I begged everyone to help me take my life. Meds like Fentanyl and OxyContin help to give me some relief. I am still unable to get out of bed. However, due to the misuse of these drugs, the AMA and the State Pharmacology Board has made it almost impossible for me to get me meds. At least once every 2 months I have to go 5-8 days with no pain relief because of laws which require me, a bedridden patient, to GO VISIT a special State sanctioned Doctor every 60 days in order to get my medicine.
    Thanks a lot to you folks who have misused the only thing on this planet that makes life worth living for me.

  • JXW MD, FAAPM

    Very good point, Guinevere — by NO means should anyone self-medicate themselves with Fentanyl/Duragesic patches — you can DIE. I’ve read unsettling statistics based on COD statistics from ME (coroner) reports of fatalities where the only substance present in the toxicology report is Fentanyl.
    Young kids and adults are almost half of those that have died. Its so sad.

    As for southsam7′s question: I’m going to assume, purely for the sake of discussion, that you ran out of your Lortab early because you took more of your pain medication than prescribed; And I’m going to make the assumption that you took more because your pain was “so severe” that you had no other choice than to dose early, leaving you short for the month. (Just so its said, I’m not likely to convince many readers here of any of these assumptions — I find them hard to believe myself — but I digress).

    Back to my point. DON’T APPLY THAT PATCH IT IF YOU VALUE YOUR LIFE. There’s a very very high chance that you will kill yourself. That patch is at minimum THREE TO TEN TIMES more potent than what you are currently taking.

    I’ll say it again in a different way: Based on the information you’ve volunteered as to the medication that you claim you have been prescribed (you said Lortab, didn’t say what strength or qty per day), just “Trying” a Fentanyl TD 25mcg/hr patch will probably killing you in short order.

    I’m not going to tell you what dosage you could start at, because my doing so could constitute the rendering of medical advice (you already have a doctor for that, right?). But I will say that they don’t make a Fentanyl patch with a low enough dose that would be safe to use — no matter how high of a dose or how many Lortab you are taking a day (based on the maximum dosage per FDA guidelines — if you go over 8 Lortab 10/500s a day, you might as well kiss your liver goodbye.)

    And YES, I am absolutely saying this to scare you.

    The truth speaks for itself. What I’m telling you is based on a calculation using an equianalgesic conversion with a 30% factor for incomplete cross-tolerance, a factor that varies wildly between 30-50% depending on many factors including the patients age, pharmacokinetics (level of kidney/liver function), comorbid conditions, BMI (body mass index), other medications you are taking (including OTC) — just to name a few.

    And don’t think that if you stick one of these patches on and start feeling sick or lightheaded, you can just rip the patch off your body and everything will be just fine. Your skin will continue to release Fentanyl in your blood stream for 12 to 18 hours after the patch has been removed from the skin.
    If you have unfortunately applied a fentanyl patch while not under the care of a doctor, call 911 immediately and tell the dispatcher EXACTLY what you took. We can’t help you if we don’t know what you have taken and how much. Time is very important here because it is highly likely that the situation will become life threatening.

    One Final Point
    If you are actually seeing a physician whom is prescribing Lortab for your pain, he should DC (discharge) you immediately for two very important reasons:

    1. You illegally obtained a Schedule II controlled substance from someone else — that’s what we call “narcotic seeking behavior” (the DEA calls it a Felony). Learn that term, if you haven’t been labeled narcotic seeking, your days are certainly numbered.

    2. Because you ran out of you regular meds early, and called some friend/family member/drug dealer instead of calling your doctor. We have the means to help you provided you follow the rules.

    Pain management is a partnership between patient and physician.
    If it helps you to understand what I mean, its kind of like being married. If you “cheat”, you’re done. The only difference is that we physicians keep records, and are required to report narcotic seeking behavior in the patient’s record — and share that information under certain criteria.

    It’s like getting married, then she divorces you for cheating on her, with the only difference being that every woman you ever try to date again will know about your prior infidelity.

    Get it? Don’t mess with it. If you’re in pain, I hope your doctor can help you, but you need to be honest and listed to what he says. If you’re addicted, get help — its out there. You know you’re not happy.
    Life is for the living.
    Dr. JX, MD, FAAPM