Fentanyl is a powerful drug that’s used in a variety of medical settings for the treatment of moderate to severe pain. Unfortunately, it’s also a driving force behind a surge of opioid overdose deaths within the past several years.
Fentanyl, like other opioids, is an effective medication with extremely dangerous potential. Today, the drug can be administered via injections, transdermal patches, and even in a submucosal lozenge which some people call a fentanyl lollipop.
How effective are these lollipops, and why are they used? Is this form of the drug a dangerous risk that can be mistaken for candy or do the benefits outweigh the risks?
Learn more about fentanyl, and this offbeat means of administration.
Fentanyl is a synthetic opioid that’s used to treat moderate to severe pain in a variety of settings. Its primarily used in hospitals where it’s administered via transdermal patches or in epidurals. It’s a fast-acting opioid that’s useful in situations where the pain is severe and comes on suddenly.
It’s an effective treatment for labor pains because of its ability to become active sooner than other opioid options. Labor can come on suddenly, and other opioids may take a bit longer to become completely effective.
Fentanyl is also administered in lozenge form through lollipops called fentanyl citrate and sold under the name Actiq. These lollipops are primarily used in combat settings, where military members need quick pain relief to treat injuries or for emergency medical procedures.
Fentanyl lollipops were controversial when they were first introduced because of the fear that they might fall into the wrong hands. However, fast-acting pain relief that can be administered in a way that is easy to access out in the field and in hospital settings is a significant advantage.
Still, the worry that fentanyl could be abused is warranted. In the current opioid epidemic, fentanyl is a major cause of the sudden spike in overdose deaths in the past few years.
Fentanyl is about 50 to 100 times more powerful than morphine and 10 to 50 times more potent than heroin. It’s often mixed into heroin and other drugs like cocaine in order to improve perceived quality.
Heroin is often adulterated as it makes it’s way from suppliers to the average users. Drug dealers will mix in inert substances to stretch their profits. But at a certain point, users can tell the difference between heavily diluted heroin and purer products. In order to make heroin seem pure, fentanyl is added to it.
Fentanyl is cheaper to make and easier to transport. Because it’s so potent, smaller amounts can be shipped in packages that are difficult to detect. When fentanyl is mixed into other drugs, users may take a high dose, thinking they are just using normal heroin. Fatal fentanyl overdoses often occur without the user ever knowing what was in their supply of heroin.
Like heroin, fentanyl is extremely addictive. If abuse doesn’t kill you, the potent drug can quickly lead to dependence and addiction.
Fentanyl is a fast-acting opioid that can work immediately when injected. In lozenge form, it works within five to ten minutes. The lollipop takes about 15 minutes to consume, and pain relief should occur within that time frame. It can take 15 to 20 minutes for a patient to start feeling the effects of a morphine injection. That means that fentanyl lollipops can work faster while being less invasive and easier to administer than an injection.
In combat medicine, versatility and flexibility are essential. Other common battlefield pain relievers like morphine are required to be injected into a muscle. That means safe administration would require sterilization, and whoever is administering the medication needs to take care not to inject it into a vein or just beneath the skin. At the same time, a lollipop can be administered on the move, simply and effectively.
Active military personnel isn’t the only people who use fentanyl lollipops. The U.S. Food and Drug Administration (FDA) has also approved this version of the drug for use in treating cancer pain. Cancer pain can come and go or be near-constant. During hospital treatment or in advanced stages, this may require an IV. However, during the day to day treatment of cancer pain, doctors can prescribe pills that may take a long time to activate, or they can use fentanyl lollipops that work within minutes. This also avoids the need for an IV or frequent injections.
Fentanyl lollipops are also easy to stop using once the pain has subsided. With an injection or a pill, a doctor decides on the proper dose and prescribes the medication. If the dose was too small, you might not get relief. If the dose was too high, you might feel intoxicated. The lollipop slowly delivers the medication as it’s consumed. Once you feel pain relief, you can just take the lollipop out. Other medications have to run their course in your body.
One of the main drawbacks of the fentanyl lollipop is the fact that fentanyl itself is highly addictive. Regular prescribed use is less likely to turn into a substance use problem, but if you use it too frequently or for too long, you may become dependent or addicted to the drug.
Fentanyl attaches to opioid receptors and mimics your own endorphins. Research shows that opioids like fentanyl also affects dopamine, a brain chemical that’s closely tied to reward and motivation.
Both endorphins and dopamine are linked to the reward center of the brain and can play a role in forming addictions. The reward center of the brain is designed to pick up on activities that cause a release of “feel-good chemicals” like endorphins and morphine.
Powerful opioids like fentanyl tell the reward center that the drug is a powerful option when you are feeling pain. Once the reward center starts to confuse fentanyl use with other life-sustaining activities, it’s designed to encourage; it may cause powerful compulsions to use.
Fentanyl lollipops are easy to use, and they act quickly. That’s what makes them such an effective pain-relief option, but it’s also what makes them dangerous in the wrong hands. Recreational drugs tend to be ones that act quickly. If you are looking for entertainment and a euphoric high, you may not want to wait around for 30 minutes or an hour for a drug to start working.
Fentanyl lollipops are highly regulated, and they aren’t prescribed for people to take home in the way that other opioids like oxycontin are. It’s generally administered in controlled settings. However, this fast-acting and potent opioid should always be used with strict care.
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National Institute on Drug Abuse. (2007, January). 4: Opiates binding to opiate receptors in the nucleus accumbens: increased dopamine release. from https://www.drugabuse.gov/publications/teaching-packets/neurobiology-drug-addiction/section-iii-action-heroin-morphine/4-opiates-binding-to-opiate-rece
Nolan, M. L., Shamasunder, S., Colon-Berezin, C., Kunins, H. V., & Paone, D. (2019, February). Increased Presence of Fentanyl in Cocaine-Involved Fatal Overdoses: Implications for Prevention. from https://www.ncbi.nlm.nih.gov/pubmed/30635841