Sufentanil Addiction

Sufentanil Addiction

Sufentanil Addiction

Sufentanil AddictionEvery so often a nurse anesthesiologist or a physician anesthesiologist is found dead in a hospital setting, usually in a bathroom or some other locked room. Nearby will be syringes filled with sufentanil. The person’s colleagues are often completely shocked by the incident because the deceased was a model of professionalism, often one who volunteered for extra calls.

There are many reasons why people involved in anesthesiology become addicted to the drugs they use. They have easy access to powerful narcotics, and a dangerous drug like sufentanil is just part of their everyday reality. They experiment with it because they are familiar with how calm and relaxed their patients become under its influence. Once addicted, they develop elaborate denial systems about why they can handle drugs when ordinary people cannot.

Dr. Elizabeth Khuri, an addiction specialist at New York Hospital-Cornell Medical Center, has treated many addicted healthcare professionals. She puts it this way, “It’s a kind of hubris — thinking that you can handle it, that you know everything.” The lucky ones enter treatment programs and recover. One in five are not so lucky – the 20% who die of sufentanil overdoses.

What is Sufentanil?

Sufentanil is one of the most powerful narcotic painkillers made. Scientists at Janssen Pharmaceutica first synthesized Sufentanil as an analogue similar to fentanyl. Fentanyl is about 80 times stronger than pure morphine, and sufentanil is five to ten times stronger than Fentanyl.[i] It comes as a white crystalline powder.

The chemical name for Sufentanil is N-[4-(methoxymethyl)-1-(2-thiophen-2-ylethyl)-4-piperidyl]-N-phenylpropanamide.

Legally, the United States government classifies sufentanil as a Schedule II Controlled Substance, which means it has the highest potential for addiction, but can be used medically under a doctor’s supervision. The penalties for possessing and dealing in sufentanil are the most severe among all the drug laws.[ii]

What are the Medical Uses of Sufentanil?

Sufentanil is an anesthesia that produces immediate sleep. In one study of 60 patients undergoing surgical procedures, sufentanil and its cousin-drug fentanyl were found to be more effective anesthesia than either morphine or meperidine because they caused fewer complications and were less likely to cause respiratory depression.[iii] Sufentanil has the advantages of producing no active metabolites and distributing rapidly throughout the body. It also has a high therapeutic index, which means you have to take a large amount in order to achieve a fatal overdose.[iv]

Millions of women experience sufentanil when they give birth because sufentanil is the main ingredient in “epidurals,” the analgesic injections into the spinal cord. Pain relief begins within ten minutes and lasts approximately 1.7 hours.

Studies have shown that sufentanil can provide complete pain relief in 80% to 90% of patients during childbirth.  Sufentanil does not affect a baby’s APGAR scores, the test for health and alertness given to newborns immediately after birth.[v]

Only a trained anesthesiologist can administer sufentanil intravenously during surgical operations. The beginning dose is usually stronger than the maintenance dose, but it requires expertise to keep the patient comfortable. The amounts used during an operation depends on the person’s body weight, physical status, type of illness the person has, other drugs the person may be taking, and the type of surgery being attempted. Elderly and debilitated patients need special monitoring.[vi]

Emergency medical personnel administer sufentanil as a pill that dissolves in the mouth to trauma victims in battlefield and disaster settings.[vii]

Sufentanil also comes as an intravenous drip system that patients can administer themselves. They can allow themselves to regulate their pain relief by directing the flow of their IV systems.[viii]

What Drugs Interact With Sufentanil?

Sufentanil interacts with calcium channel blockers, beta blockers, and neuromuscular blocking agents.  It is usually not taken with central nervous system depressants, such as other narcotics, barbiturates, opiate painkillers, sleeping pills, tranquilizers, muscle relaxants, and benzodiazepines because of the danger of overdose.[ix]  People who are taking sufentanil for nonmedical reasons are very likely to overdose and die if they combine it with alcohol, illegal narcotics such as heroin, or any other prescription pain killer.

What Are the Side Effects of Sufentanil?

Typical side effects of sufentanil are upset stomach, confusion, vomiting, drowsiness, itching, and constipation. Serious side effects might be difficulty breathing, hallucinations, and seizures. Some patients go into such a deep sleep that they cannot be easily aroused.[x]

What are the Risks of Taking Sufentanil?

Sufentanil is considered so dangerous drug that it is usually only used in a hospital or nursing home settings under a doctor’s supervision. It is highly addictive – in fact, scientists have found that laboratory animals will self-administer sufentanil if allowed to do so.  Sufentanil addictions are similar to morphine and heroin addictions, and among the most difficult to defeat. Narcotics addicts experience drug cravings long after they withdraw from their drugs physically, and they have very high relapse rates.

Some people have adverse reactions to sufentanil that may include respiratory depression, muscle rigidity in the trunk of their bodies, fast heartbeat, hypertension, hypotension, sleepiness, irregular heartbeat, cardiac arrest, and apnea.[xi]  Muscle rigidity usually occurs in the neck and extremities, sometimes after surgery. The seriousness of the condition is related to the amount of sufentanil used.[xii] All these adverse reactions can be treated.

Many people get infections at the place where sufentanil was administered intravenously. Signs of such an infection are tenderness, warmness, drainage, redness, swelling, irritable to touch, and pain. These infections sometimes require treatment with antibiotics.[xiii]

If a medical professional attempting an epidural unintentionally injects sufentanil into a blood vessel instead of the spinal cord, the result can be a serious overdose.[xiv]

Some people are allergic to narcotics, and they enter a life-threatening syndrome called anaphylaxis when they take sufentanil, a syndrome that affects the whole body. Symptoms are difficulty breathing, swelling of the tongue and mouth area, abnormal heartbeat, anxiety, wheezing, closing down of the throat, hives, rashes, and rapid pulse.[xv]

No studies have determined whether sufentanil causes cancer.[xvi]

Who Should Not Take Sufentanil?

People with head injuries and problems with their respiration, kidneys or liver should not take sufentanil. Sufentanil is mostly used under medically supervised situations such as during surgeries or severe cancer pain. Often these patients are in nursing homes, hospitals or hospices where special equipment is available if they should develop problems, especially respiratory depression. Patients who have prior histories of drug addiction or alcoholism usually are not prescribed sufentanil except under controlled situations or if they are terminally ill. Sufentanil is such a potent narcotic that it should never be abused in a recreational way because of the danger of overdose.

Does Sufentanil Show Up in Urine Tests?

Sufentanil will show up in drug tests at work or school because they screen for narcotics. The half-life of sufentanil is 164 minutes, and 80% is excreted within 24 hours.  Nevertheless, sufentanil usually shows up for three to five days after using it, and in that way, it is similar to its cousin, fentanyl.

What is a Sufentanil Overdose?

As sufentanil addicts build up tolerance to the effect of the drug, they are likely to keep taking more, until one day they take too much and overdose.[xvii] The number of Americans dying of overdoses from prescription painkillers like sufentanil has increased by 300% since 1990, adding up to about 6500 fatalities a year, and the rate is continuing to increase every year.[xviii]

The most common symptom of a sufentanil overdose is severe slowing down of the rate of breathing to the point where it stops. Most people are not found until it is too late. Early symptoms can be slurred speech, disorientation, lack of coordination, confusion, inability to think clearly, slow heartbeat, slow rate of speech, seizures, muscle spasms, pinpoint pupils, and bluish skin.[xix]

At an emergency medical facility, doctors can administer oxygen and various medications to revive a person overdosing on sufentanil, as well as dispense neuromuscular blocking agents to counteract muscle rigidity.[xx]

What is Sufentanil Withdrawal?

Sufentanil withdrawal is a series of unpleasant symptoms that occur when someone addicted to this drug tries to stop using it. If the person is physically dependent on the drug but not addicted, withdrawal will be simpler.

The physical symptoms of withdrawal can be nausea, vomiting, diarrhea, aches, fever, runny nose, sneezing, nervousness, irritability, shivering, and abdominal cramps.[xxi] The severity and length of a withdrawal syndrome depends upon individual factors such as the person’s general health, how long the drug was used, in what amounts, and so forth. It is similar to morphine and fentanyl withdrawal, and can be treated with various antidotes and other medications to ease symptoms.

What is Sufentanil Addiction?

Since powerful narcotics like sufentanil are classified as Schedule II Controlled Substances, they are highly regulated and hard for the average person to obtain. Someone as wealthy as pop star Michael Jackson was able to hire a personal doctor to prescribe powerful anesthesia for his personal use, but the average addict would have trouble obtaining sufentanil or fentanyl without diverting it from cancer patients. They are highly regulated – in fact, these pills are usually carefully counted and then discarded after someone dies.

In hospital settings, the only people who have ready access to sufentanil are doctors specializing in anesthesiology. Unfortunately, as one study concluded, “Addiction remains a major problem in the anesthesia workplace, with outcomes unchanged for years.”[xxii] Sufentanil and other such addictions are most common in the first five years after medical school, particularly among resident physicians. One survey of resident anesthesiology programs found that 80% had residents impaired by drug abuse, and 19% had one or more drug-related deaths.[xxiii] [xxiv] Studies of doctors in all specialties usually conclude that their addiction rates are equal to that of the general population, but anesthesiologists are in particular danger because the majority of addicts use sufentanil or fentanyl, and because between ten and 20% of fentanyl and sufentanil die of overdose.[xxv]

Physicians who are addicted to narcotics are extremely intelligent and high functioning, and they create elaborate denial systems about their problems.[xxvi] They can be ingenious and creative about defeating the sophisticated security systems protecting Schedule II drugs. They buy artificial penises and “clean” urine from the Internet to defeat drug-screening tests, and they know how to use certain herbs or medications for the same purpose. They get their drugs from discarded syringes, and some are even desperate enough to steal doses from patients.  For these reasons, it usually takes one to five years for a physician/addict to be discovered.[xxvii]

Why are so many physicians and nurse anesthesiologists addicted to fentanyl and sufentanil? Various experts list the following reasons: proximity to drugs, ease of diversion, and high stress jobs. Others list genetic susceptibility to drug abuse, risk-taking personality factors, casual attitude toward drug use, and psychiatric comorbidities, such as depression and bipolar disorder. One study found that six percent of physicians in treatment had psychiatric comorbidities and may have been using drugs to self-medicate.[xxviii] Some experts believe that exposure to drugs in their workplaces through breathing in certain fumes or having trace amounts on their bodies could make physicians more susceptible to drug addictions.[xxix]

What Treatments are Available for Sufentanil Addictions?

The vast majority of sufentanil addicts are nurse anesthesiologists or physician anesthesiologists. The best results in terms of recovery rates are achieved by those who enter a residential treatment center. Treatment begins with a medically-supervised physical detoxification from sufentanil. Once that is completed, the person can move into the center and take part in self-help groups, individual psychotherapy, classes on addiction, recreational activities, classes in stress reduction, physical fitness pursuits, and other therapies such as art, music, drama, journaling, and so forth. Many can use naloxone to reduce their cravings for narcotics. Family therapy is usually a necessary component of treatment. One researcher suggested that a treatment program for physicians should include simulations to desensitize them to workplace “triggers.” In other words, they need to practice being around drugs without using them.

A controversy exists as to whether physician/addicts should be treated in separate programs. Some experts contend that isolating them makes them more grandiose and treatment more difficult.[xxx] Others say that physicians do better with their own peer group, because they feel less despair about what happened to them. Many point out confidentiality issues, such as when a physician joins a local group like Narcotics Anonymous and must stand up and publicly declare himself to be an addict.

Once they leave their residential treatment centers, physician drug recovery programs usually include remaining abstinent from drugs for at least a year, having appointments within addiction specialists at least once a week, attending 12-step programs, and undergoing random drug testing. Many hospitals do not allow recovering addicts to have narcotic privileges when they first return to work, but rather introduce these privileges back on an incremental basis.  Sometimes it is disastrous for a former addict to return to the pressure of full-time work, and some anesthesiologists in recovery have to be redirected into different medical specialties. One study found that redirected physicians had better long-term outcomes.[xxxi] About 40% of anesthesiologists relapse back into drug use, and relapse rates are highest for those who continue to have access to powerful narcotics.

Physicians tend to be treated differently when it comes to drug abuse.  For example, only Cleveland Clinic and Massachusetts General Hospital were routinely screening doctors for drug abuse in 2009.[xxxii] A doctor with a drug addiction has some legal rights under the Americans with Disabilities Act in that it is up to the employer to prove the doctor is unable to work. Once a doctor’s addiction is discovered, the state licensing board will usually “suggest” that he or she enters treatment under the Impaired Physician Program or else it will pull his or her license.[xxxiii]

How can I tell if I am addicted to Sufentanil?

If you suspect that someone you know is addicted to sufentanil, you may look for the following signs: withdrawal from friends and family, mood swings, anger, irritability, hostility, weight loss, and pale skin. They may refuse lunch and coffee breaks and spend more time in the bathroom, again to administer drugs to themselves.  Doctors or nurse anesthesiologists with addictions usually spend more time at work and sign up for extra calls in order to be close to their drug supplies. They may become more attentive at work in order to maintain their positions (and drug supplies). Some experts note that the other parts of their lives — such as finances and family relationships– tend to fall apart before their professional work does.

If you can answer yes to any of the following questions, it may be time to enter a drug treatment program for sufentanil.

  • Are you injecting yourself with sufentanil?
  • Are you using sufentanil without a prescription?
  • Do you develop withdrawal symptoms when you stop using sufentanil?
  • Are you afraid that you might overdose one day because of your sufentanil habit?
  • Do you believe you are spending too much time and energy on sufentanil?
  • Have you tried to quit using drugs unsuccessfully on your own?
  • Do you find it impossible to go more than a few days without using drugs?
  • Are you afraid that someone will find out about your sufentanil abuse?

 


[i] “Drug Fact Sheets: Fentanyl,” The United States Drug Enforcement Agency, see http://www.justice.gov/dea/druginfo/concern_fentanyl.shtml

[ii] “Schedule of Controlled Substances,” The United States Department of Justice, the drug enforcement agency, seehttp://www.deadiversion.usdoj.gov/schedules/

[iii] Flacke, Joan et al. Comparison of Morphine, Meperidine, Fentanyl and Sufentanil in Balanced Anesthesia: A Double-Blind Study. ANESTH ANALG 1985; 64:897-910

[iv] “Sufentanil,” Acel RX, Manufacturer’s Website, see http://www.acelrx.com/technology/sufentanil.html

[v]Sufentanil,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/pro/sufentanil.html

[vi] Ibid.

[vii] “Sufentanil,” Acel RX, Manufacturer’s Website, see http://www.acelrx.com/technology/sufentanil.html

[viii] “Sufentanil Injection,” The United States Library of Medicine, Medline, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684066.html

[ix] “Sufentanil Citrate,” The RX List, The Internet Drug Connection, see http://www.rxlist.com/sufenta-drug.htm

[x] “Sufentanil Injection,” The United States Library of Medicine, Medline, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684066.html

[xi] Sufentanil,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/pro/sufentanil.html

[xii] “Sufentanil Citrate,” The RX List, The Internet Drug Connection, see http://www.rxlist.com/sufenta-drug.htm

[xiii] “Sufentanil Injection,” The United States Library of Medicine, Medline, see http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684066.html

[xiv] Sufentanil,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/pro/sufentanil.html

[xv] “Anaphylaxis,” The United States National Library of medicine, Medline, see http://www.nlm.nih.gov/medlineplus/ency/article/000844.htm

[xvi] Sufentanil,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/pro/sufentanil.html

[xvii] Kennedy, Randy. “Death Highlights Drug’s Lethal Allure to Doctors,” The New York Times, November 11, 1995.

[xviii]“Prescription Painkiller Overdoses,” Statistics from the Center for Disease Control,  see http://www.cdc.gov/vitalsigns/PrescriptionPainkillerOverdoses/

[xix] “Opioid Overdoses,” United States Department of Justice, The Drug Enforcement Agency,  see http://www.justice.gov/dea/druginfo/drug_data_sheets/Narcotics.pdf

[xx] Sufentanil,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/pro/sufentanil.html

[xxi] “Sufentanil Interactions,” Drugs.com, Official Information from the United States Food and Drug Administration, see http://www.drugs.com/drug-interactions/narcan-with-sufentanil-1682-1044-2119-0.html

[xxii] Bryson, Ethan MD, and Jeffrey H. Silverstein, MD. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 November; 109(5): 905–917.

[xxiii] Ibid.

[xxiv] Wright EL, McGuiness T, Moneyham LD, Schumacher JE, Zwerling A, Stullenbarger NE. Opioid abuse among nurse anesthetists and anesthesiologists. Journal of the American Association of Nurse Anesthetists 2012 Apr; 80(2):120-8.

[xxv] Slack, Charles. “To Catch an Addict,” Proto (Massachusetts General Hospital Magazine), Spring 2009.

[xxvi] Bryson, Ethan MD, and Jeffrey H. Silverstein, MD. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 November; 109(5): 905–917.

[xxvii] Wright EL, McGuiness T, Moneyham LD, Schumacher JE, Zwerling A, Stullenbarger NE. Opioid abuse among nurse anesthetists and anesthesiologists. Journal of the American Association of Nurse Anesthetists 2012 Apr; 80(2):120-8.

[xxviii] Bryson, Ethan MD, and Jeffrey H. Silverstein, MD. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 November; 109(5): 905–917.

[xxix] Ibid.

[xxx] Ibid.

[xxxi] Bryson, Ethan MD, and Jeffrey H. Silverstein, MD. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 November; 109(5): 905–917.

[xxxii] Slack, Charles. “To Catch an Addict,” Proto (Massachusetts General Hospital Magazine), Spring 2009.

[xxxiii] Bryson, Ethan MD, and Jeffrey H. Silverstein, MD. Addiction and Substance Abuse in Anesthesiology. Anesthesiology. 2008 November; 109(5): 905–917.

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