Fentanyl-related deaths are increasing worldwide
More than 1000 fentanyl-related deaths occurred in Canada during 2009–2014.1 In the United States, an abrupt rise in opioid-related deaths has been attributed to increased fentanyl misuse, resulting in a health advisory from the US Centers for Disease Control and Prevention.2
There is a difference between pharmaceutical and nonpharmaceutical fentanyl
Pharmaceutical fentanyl may be extracted for misuse from transdermal patches. The fentanyl is then consumed via inhalation, intravenously or orally.3 Nonpharmaceutical fentanyl is synthesized as powder in illicit laboratories.1 This powder is cut with other drugs such as heroin and xylazine and pressed into tablets to mimic oxycodone1 (Figure 1).
The hallmark of fentanyl toxicity is respiratory depression
The triad of respiratory depression, miosis and altered level of consciousness represent key features of opioid toxicity and should alert physicians to the possibility of fentanyl poisoning.3
Naloxone is an opioid-antagonist that can reverse life-threatening fentanyl overdose
Naloxone can be delivered (in order of decreasing bioavailability) intravenously, intramuscularly, subcutaneously, endotracheally, intranasally or intralingually.3 Reversal of toxicity occurs one to eight minutes after administration.3,4 Recent Advanced Cardiovascular Life Support guidelines recommend empiric use of naloxone in treatment algorithms for respiratory depression or cardiac arrest.4 Up to six times the usual 0.4-mg dose of naloxone may be required because of the increased potency of fentanyl compared with other opioids and the unpredictable amount of fentanyl in each pill.3
Take-home naloxone (THN) kits are an effective, safe way to reduce fentanyl-related deaths
The kits consist of two doses of intramuscular naloxone, rescue-breathing masks and pamphlets on overdose management.5 Seven of the 13 provinces and territories have a dedicated THN program.6 Health Canada recently removed naloxone from the Prescription Drug List for emergency use for opioid overdose outside hospital settings, thereby broadening access.6 One study has shown that distribution of THN kits in British Columbia reversed 85 opioid overdoses in 20 months.5
Footnotes
Competing interests: None declared.
This article has been peer reviewed.