Despite criticism and concerns, FDA approves a new opioid 10 times more powerful than fentanyl

a reply to: Cobaltic1978

Sure, but fentanyl not strong enough?


And, it will, of course, make it's way into the general public.

originally posted by: threeeyesopen
a reply to: dug88

The part that I find most interesting is that the Pentagon wanted it to be expedited. Why exactly would the military want such a powerful drug be produced ? Its a powerful painkiller, that in itself could be its own conspiracy.

Just thinking out loud. If a soldier is juiced on pain killers, hormones, energy boosters and stimulants as well as some anti psychotics and possibly some hallucinogens they might recklessly charge into battle. Sort of a chemed up attempt at a super soldier.

Although, in books and movies the soldier usually doses after injury or initial defeat so they can get up and fight again.

Maybe a think tank stop gap until autonomous machines are available.

a reply to: Bramble Iceshimmer

I think you have tank right, ever played a game where you tank? take as much punishment as possible lol.. I guess the more you don't feel the longer you go?

Yay just what we needed!

Funerals are so much fun!

I get to attend one today... 40 year old mother of 2.

originally posted by: dug88

originally posted by: toms54
a reply to: dug88

Maybe if the military has this drug we won't need to guard the opium crop against the Taliban in Afghanistan anymore.

Why else are we over there anyway? To keep out the Chinese? c'mon. This whole opiate epidemic began when we went over there. Just like the smuggling from the golden triangle during Vietnam. CIA claims they only sell to Russia and Kazakhstan.

Except where would the poppies come from needed to synthesize all the synthetic opiates? Oxycotin and percocets are still made from poppies at least. Though I think the poppies they use for Oxys come from Australia. They have special ones that only produce thebaine and not morphine or codeine.

Opium Poppies produce morphine, thebaine, codeine, papaverine, noscapine and oripavine among others naturally. These are where the opiate derivatives come from.

Medical grade opiates are typically produced from Tasmanian Poppies from, obviously, Tasmania. They don't buy raw poppy products from Afghanistan. There's a pretty strict import certification for bringing the stuff into the country and you can only get it from very specific producers, primarily Tasmania.

I work in a teaching hospital and can't understand why sublingual sufentanil is necessary.

It's apparently for "administration by healthcare professionals in hospitals, surgical centers, and emergency departments."

Link

But we already have and use IV sufentanil. It's used for surgical analgesia and anesthesia, not chronic or even severe acute pain. There was a fentanyl shortage last year and we still didn't use sufentanil for pain management outside of the operating rooms because of the risk of dosing errors and adverse effects.

You don't want to just pop 30 mcg of sufentanil under your tongue because something hurts. Of course there are scenarios where quick onset and potent analgesia is necessary, but there's no shortage of products already available for that (like, I don't know, fentanyl). The idea that we might start giving opioid-naive patients in cases of combat-related trauma sublingual sufentanil for pain management is absurdly misguided. If those are the patients we're worried about, let's push more ketamine instead. At least they won't stop breathing.

If this makes it to the streets (which it will, if it comes to hospitals), people will overdose and die. I don't think there's any way around that. Bringing this to market just seems completely irresponsible to me.

a reply to: Weagle

Working in a teaching hospital, you should understand that sometimes it’s quicker to drop one of these under the tongue than it is to find a suitable vein. It’s not nearly as necessary as the manufacturer claims but in a battlefield triage scenario, getting a suitable IV line while under fire isn’t what’s done. It’s all IM morphine currently. That’s been the standard for decades now. It’s painful, leads to potential infection site and doesn’t work very quickly. I totally understand the concerns, especially in an opiate naive patient. There are some of us however who have been on a pain management regiment for so long that our tolerance Is through the roof. People look at me like a straight up junkie if they find out the cocktail of meds I’m on just to hang minimum function throughout the day. I’m not saying I would advocate for this for breakthrough pain because it would quickly send my tolerance to such a level that there’s no coming back from. But damn, there are days where I wouldn’t refuse it either. Most patients, primarily opiate naive onse, suffer the respiratory effects that kill them. If I were to take too much do you know what it does? The exact opposite effect. It’s like taking speed and can cause hallucinations. Not sedation. Some of us served our country and the thanks we get is a lifetime of agony and misery. I don’t think sufentinyl is the answer but treating us like junkies who have to jump through hoops and take ransoms urine tests and pill counts is insulting and we should be allotted more options. As it is I fight with insurance every month because I’m exceeding “guidelines” of a maximum equianalgesic dose in comparison to a max of 100 mg of morphine per day. Decades on pain management for what I went through in Mogadishu and Bosnia and continued doing my job without complaint until I couldn’t fake it any longer and would put my unit at risk. Their lives were my responsibility and putting them in danger because of my stubborn adherence to the job was making me a liability and I had to face reality. Too many poor landings after walking out the back of a C-130a and getting pushed out of a second floor window and working through the pain thanks to adrenaline only take you so far so while this medication in civilian hands does make me nervous and you’re correct, if it’s in a hospital setting,
It will be stolen and diverted. In a combat setting where it’s a much faster ROA than trying to retrain medics to run an IV just isn’t realistic and this is a much better ROA in that situation. I can only think of limited uses in an ER setting where this is beneficial but the option should be avavailable. Especially for long term pain patience. Though mucosal absorbed liquid morphine may be adequate for many of those patience, having an additional option available isn’t the worst thing that could happen

a reply to: peter vlar

That's fair, and in a battlefield situation where there's not time to start an IV, I'd agree that pushing anything gets less practical. I'd argue that sufentanil still may not be the answer, because I'm guessing that most people in that situation don't have the tolerance for it. And, if you don't have time to start an IV, then dealing with respiratory arrest is probably also not practical. Why not intranasal fentanyl or ketamine for those injuries? (There may be a good reason, I have no experience being there so I just don't know. There are a few things we would do in the hospital setting to control pain even without IV access before we'd use IM morphine, so I'm just curious.)

I appreciate that there are patients with real pain, and I'm firmly against the idea that anyone asking for pain medication is a junkie. Of course I believe in sickle cell pain, and cancer pain, and chronic pain from injuries - to name a few. So I apologize if you thought I was saying that no one should need or use high dose narcotics. The hoops that both patients and providers have to jump through are cumbersome, and there is much scrutiny on both sides when doses get that high.

Also, thank you for your service.

The new push is for multimodal pain control, which I admit I'm skeptical of in patients with pain like yours. Some patients just require opioids, and I see no way to ever get completely around that. The problem is with the overuse, misuse, and diversion. Many patients need regimens of scheduled and PRN narcotics, but not everyone with a broken finger needs oxycodone for 6 weeks. And of course, the more of it that's available, the more of it that gets into the wrong hands. While certainly not everyone is drug seeking and abusing, many people are. We see plenty of people overdose on their own narcotics, black market narcotics, their grandparents' narcotics, their pets' narcotics, and more. We have patients who try to chew up fentanyl patches to get high, patients who can't be discharged on long-term antibiotics for fear that they will inject opioids into their central lines, patients who cause severe injuries to themselves to justify the need for narcotics. It's a struggle for everyone, and there is no simple answer.

My issue isn't with narcotics, I just have trouble understanding why this particular one is necessary. We have long-acting oral narcotics, short-acting oral narcotics, sublingual narcotics, IV narcotics, IM narcotics, narcotic patches, intranasal narcotics, ON-Q pumps, ketamine infusions, and a whole host of multimodal options to add to all of that. I don't see what role sublingual sufentanil is filling that isn't already covered, except offering a much higher dose in a much smaller package. The risks seem to outweigh the benefits, and I would guess that the people who would/will suffer will outnumber those who benefit. No one's going to surgery without IV access in a hospital, I doubt EMS would assume the risk of administering 30mcg of oral sufentail pre-hospital, and I don't see this being used in the emergency department. It appears that they are planning to slap a warning on it restricting it to supervised inpatient use, so inpatient treatment of refractory pain is about all I can come up with.

But hey, nobody asked me so the FDA will do what it's going to do. It'll be interesting for sure to see how it's used if it makes it to market. It would shock me if it even makes it to most hospital's formularies, so the whole exercise may be mostly meaningless.