Fentanyl Dependence Caused by the Non-Medical Use: A Case Report

Another lesson from the earthquake: Transdermal fentanyl dependence in two child victims

Thousands died in the Kahramanmaraş-centered earthquake in February 2023, and even more were injured. Some were administered transdermal fentanyl patches (TFPs) due to severe pain. Two pediatric patients, both severely injured victims of the earthquake, developed dependence on TFPs and experienced difficulties during the cessation of fentanyl treatment. The first child was discharged while still being administered fentanyl after four months. In the second case, TFPs could be ceased after four months. This study aimed to emphasize that TFPs can lead to dependence in pediatric patients as well; hence, they should be used more carefully to avoid any potential dependency.

Oxygen vacancy-rich Fe2(MoO4)3 combined with MWCNTs for electrochemical sensors of fentanyl and its analogs

Hundreds of thousands of people dying from the abuse of fentanyl and its analogs. Hence, the development of an efficient and highly accurate detection method is extremely relevant and challenging. Therefore, we proposed the introduction of oxygen defects into Fe2(MoO4)3 nanoparticles for improving the catalyst performance and combining it with multi-walled carbon nanotubes (MWCNTs) for electrochemical detection of fentanyl and its analogs. Oxygen vacancy-rich Fe2(MoO4)3 (called r-Fe2(MoO4)3) nanoparticles were successfully synthesized and characterized in detail by scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive spectrometry (EDS), X-ray diffraction (XRD), Fourier transform infrared (FT-IR), Raman spectra, BET, X-ray photoelectron spectroscopy (XPS), and electron paramagnetic resonance (EPR) and investigated by comparison with oxygen vacancy-poor Fe2(MoO4)3 (called p-Fe2(MoO4)3). The obtained oxygen vacancy-rich Fe2(MoO4)3 was ultrasonically composited with MWCNTs for modification of glassy carbon electrodes (GCEs) used for the electrochemical detection of fentanyl and its analogs. The modified MWCNT-GCE showed ultrasensitivity to fentanyl, sufentanil, alfentanil, and acetylfentanyl with limits of detection (LOD) of 0.006 µmol·L-1, 0.008 µmol·L-1, 0.018 µmol·L-1, and 0.024 µmol·L-1, respectively, and could distinguish among the four drugs based on their peak voltages. Besides, the obtained r-Fe2(MoO4)3/MWCNT composite also exhibited high repeatability, selectivity, and stability. It showed satisfactory detection performance on real samples, with recoveries of 70.53 ~ 94.85% and 50.98 ~ 82.54% in serum and urine for the four drugs in a concentration range 0.2 ~ 1 µM, respectively. The experimental results confirm that the introduction of oxygen vacancies effectively improves the sensitivity of fentanyl electrochemical detection, and this work provides some inspiration for the development of catalytic materials for electrochemical sensors with higher sensitivity.

Systematic review on intentional non-medical fentanyl use among people who use drugs

Objectives

Fentanyl is a highly potent opioid and has, until recently, been considered an unwanted contaminant in the street drug supply among people who use drugs (PWUD). However, it has become a drug of choice for an increasing number of individuals. This systematic review evaluated intentional non-medical fentanyl use among PWUD, specifically by summarizing demographic variance, reasons for use, and resulting patterns of use.

Methods

The search strategy was developed with a combination of free text keywords and MeSH and non-MeSH keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO. Studies included were human studies with intentional use of non-medical fentanyl or analogues in individuals older than 13. Only peer-reviewed original articles available in English were included.

Results

The search resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. Out of 41 papers included, it was found that individuals who use fentanyl intentionally were more likely to be young, male, and White. They were also more likely to have experienced overdoses, and report injection drug use. There is evidence that fentanyl seeking behaviours are motivated by greater potency, delay of withdrawal, lower cost, and greater availability.

Conclusions

Among PWUD, individuals who intentionally use fentanyl have severe substance use patterns, precarious living situations, and extensive overdose history. In response to the increasing number of individuals who use fentanyl, alternative treatment approaches need to be developed for more effective management of withdrawal and opioid use disorder.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42021272111.

Fentanyl use disorder characterized by unprescribed use of transdermal patches: a case report

BACKGROUND

Fentanyl is a synthetic opioid with analgesic potency 75-100 times higher than that of morphine, and its analgesic effect is used for pain treatment, mostly in cancer patients. Using fentanyl patches may reduce misuse potential due to the transdermal route of administration, long-acting action, sustained release delivery property, and maintenance of steady-state serum concentration of the drug. Although there have been reports of transdermal fentanyl patches (TFPs) misuse via transmucosal, trans-nasal, intravenous, and oral routes of administration, fentanyl use disorder via the transdermal route is very rare.

CASE

In this case report, we present a patient with a history of substance use disorder who developed fentanyl use disorder via transdermal route after using unprescribed TFP in order to quit opium gum. The CARE guidance was followed in the preparation of this case report.

CONCLUSION

The risk of use disorder may be higher, especially in individuals with a history of substance use disorders. This risk should be taken into account when clinicians prescribe this medication.

Phenprobamate dependence: a case report

Phenprobamate (3-phenylpropylcarbamate) is a centrally acting muscle relaxant with mild sedative and anticonvulsant effects. Muscle relaxants can enhance and prolong the effect of narcotic drugs and enable to obtain same effect with a smaller amount of alcohol or illicit substance. Almost all of the centrally acting muscle relaxants have varying sedative effects on which their abuse potential mainly depends. Data related to abuse of carisoprodol, meprobamate, baclofen takes place in the literature. However, to our knowledge this is the first case report about abuse of and tolerance to phenprobamate. We aimed to attract attention to important points of prescribing drugs that have abuse potential like in our case who was using up to 16000 mg/day phenprobamate.