Fentanyl by Ian Mitchell

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Slide Notes

Ian Mitchell, MD, FRCP (Emergency Medicine)
Staff Physician, Royal Inland Hospital, Kamloops
Assistant Clinical Professor, UBC Department of Emergency Medicine
Site Scholar, Kamloops Family Medicine Residency Program

Did this person overdose or were they poisoned?

Fentanyl

Published on Sep 09, 2017

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PRESENTATION OUTLINE

Fentanyl

Ian Mitchell, MD, FRCP

Photo by peabodyproductions

haikudeck.com/p/dd21bec0b2/fentanyl

http://www.cbc.ca/news/canada/british-columbia/new-normal-overdose-fentanyl...

Untitled Slide

Emergency MD, R.I.H.
Scholar for Kamloops Family MD program
Coinvestigator in cannabis study
Assistant Professor UBC

Disclosures

No disclosures related to opiates or naloxone
Medical cannabis

I have no disclosures related to opiates or naloxone.

I do receive money related to medical cannabis as a prescriber, researcher and educator. To limit bias in the talk, I will not be discussing the use of medical cannabis.

More on MD bias & opiates: http://www.macleans.ca/politics/students-demand-boundaries-between-drug-fir...

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Nuts and Bolts

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Fentanyl Pharmacology

half life of 4 hours
dosage 50 mcg to 6000?

Counterfeit pills have been found with 6.9 mg fentanyl (2 mg likely lethal dose)

http://www.emcdda.europa.eu/publications/drug-profiles/fentanyl

http://jamanetwork.com/journals/jama/article-abstract/2528225

Photo by Nottingham Vet School

Which Fentanyl

carfentanil
remifentanil
3-methylfentanil
acrylfentanyl

https://www.opiate.com/wp-content/uploads/fentanyl.jpg

https://academic.oup.com/jat/article-abstract/4259785/Three-Cases-of-Fatal-...

Carfentanil

13 mg to sedate an elephant.
Used on Moscow theatre hostages.
No studies on humans.

Less apnea than fentanyl, maybe less toxic in lower doses.

http://www.ajemjournal.com/article/S0735-6757(17)30694-0/abstract

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Fentanyl Test Strips

http://www.cbc.ca/news/canada/british-columbia/health-officials-warn-of-lim...

https://www.straight.com/news/954966/promising-signs-fentanyl-test-strips-m...

https://www.vice.com/en_us/article/3kkea9/this-fentanyl-test-could-save-liv...

10.

Prolonged Action?

How long should people be observed after getting naloxone? Old rule was one hour, but that was for heroin. No one knows for fentanyl.

http://www.thepoisonreview.com/2016/11/22/treating-heroin-overdose-the-past...

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11.

Higher doses of naloxone

Unclear if carfentanil needs higher doses.

http://www.jwatch.org/fw110784/2015/10/27/cdc-multiple-naloxone-doses-may-b...

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12.

First Responder Safety

Fentanyl powder is not readily absorbed through the skin or lungs
Dealers are not succumbing to overdose.
Anecdotal reports are not convincing for opiate overdose symptoms
"Law enforcement may have experienced psychogenic effects"
http://www.acmt.net/_Library/Fentanyl_Position/Fentanyl_PPE_Emergency_Respo...

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13.

Pause

14.

Poisoning or Overdose?

There is more stigma attached to overdose than poisoning. But really what we are dealing with is a contaminated drug supply.

http://www.cbc.ca/beta/news/canada/british-columbia/overdose-fentanyl-1.426...

Alcohol has less stigma for overdose, often called alcohol poisoning or a hangover. During Prohibition, the US government caused mass poisoning by adding toxins to industrial alcohol.

Photo by Imagens Evangélicas

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