Opioids Fentanyl

[Pattypuffer]

Looking for advice for speeding up a fentanyl comedown. A little bit much might have been used. Just want to balance out the opioid effects

 

[Nicomorphinist]

Via which route of administration?

 

[Pattypuffer]

Update: my friend pulled through after all, they just had a hell of a time keeping it together till then. Their ROA was IV, which as far as I'm aware, there's not much help other than calling an ambulance. All advice still welcome and appreciated though, never know when it'll be needed.

 

[Nicomorphinist]

In that case I would try to arrange for having naloxone around next time. The way and relative rapidity with which fentanyl is metabolised and eliminated and IV fentanyl is absorbed and distributed means that there are not, to the best of my knowledge, anything like the lemon juice/Vitamin C methods for quickening methadone elimination. I do not think slapping the person or putting them in the shower is going to be as effective as it may be with other things, though if it was fentanyl by itself, keeping the person awake is a difficult and labour-intensive process which requires constant attention but it may only need to be done for 45-120 minutes depending on dose and other factors. I hope that no one thinks that an intra-cardiac injection of milk can do the trick. But medical attention is imperative, usually hospital/EMT, or if a trained and knowledgeable person is around and there is naloxone on hand, that may do it but close monitoring is essential.

The same would go for getting too much through the mucous membranes -- but if one likes fentanyl or sufentanil lozenges and lollypops, tape the lollypops to your hand so when you get enough for a hard nod it falls out of your mouth and does not overdose you. The Danish military I believe invented this for their medics to use on the battlefield and now lots of nations and organisations do it.

Fentanyl effervescent tablets -- start slow as one can always take more later not less.

For the Duragesic/Durogesic/Chronogesic using folks out there, one thing which you must watch out for applying too many, as if they are clinically effective for their labelled purpose, that means that the skin below the patch has developed a bolus of fentanyl or sufentanil which can create therapeutic or supratherapeutic plasma concentrations of fentanyl/sufentanil for up to 17 hours or more. Again, then it is naloxone time and if one patch is delivering too much, one can always put the bottom plastic piece that was removed to expose the adhesive on the adhesive side of the patch to expose a fraction of the surface area to reduce the fentanyl delivery rate and make the patch last longer -- just move the plastic and expose the covered and vice versa area later. Kick-starting them with a heating pad, well one has to do what they have to do in pain, but do like the lollypop medics and sit on an edge of a chair so you will fall down and drop the heating pad if you fall asleep/nod/pass out.

If one uses patches in a manner inconsistent with their labelling, have plenty of naloxone on hand.

 

[Speed King]

To anybody fucking around with opiate/opioid drugs that kill real fast, have a bunch of noloxone laying around . Narcan is your friend. You may have to shoot someone up a few times before they are good.

 

[Nicomorphinist]

Naloxone metabolises quickly so, for example, a morphine overdose probably needs two or three administrations, and monitoring vital signs is the way to know when; methadone could be four, five or more.

By the way, there have been reports of difficult-to-revive buprenorphine overdose cases over the years . . . it has to do with the strength of receptor binding and is thus correlated with potency. Nalodeine, the first antagonist invented in 1915, is the N-allyl derivative of codeine. So an analogue short on its heels, nalorphine, the morphine analogue, became the antagonist of choice for many years. Naloxone is the oxymorphone analogue of nalorphine. Many other opioids from levorphanol to hydromorphone to smack to nicomorphine also have their nalorphine analogues. Given that levorphanol has pieces of the morphine structure, it also has a nalorphine analogue by the name of levallorphan. And so on. Buprenorphine is a bridged oripavine derivative like etorphine. Perhaps it needs the specific etorphine antidote, diprenorphine, to assure that overdoses can be treated all of the time and not have the danger which can apparently crop up in some but not all cases. Diprenorphine is also the antidote for carfentanil, which of course is all over the place these days. It is not an allyl opioid antagonist but a 17-cyclopropylmethyl one, the strongest known at 100 times stronger than naloxone.

 

[Speed King]

So OP/anyone else, get a lot of naloxone. If you have money for dope, you have money for naloxone

 

[Nicomorphinist]

Do we have a chart of current information about naloxone availability under law and de facto considerations like pharmacy chain policy by state/province/city/country here some place?

 

[Nicomorphinist]

So OP/anyone else, get a lot of naloxone. If you have money for dope, you have money for naloxone

That there are people who carp about making naloxone more available just shows there are some corrupt and evil people out there. A lot of the same people crying crocodile tears about the "opioid crisis"

 

[BeachBum4u]

I will say that my pain doc required me to fill a prescription for Narcan, as I've been a pain patient for a long time. And to honest, with my tolerance pretty high from years of use and the fact that I never have more than a 4 week supply, I'm super low risk for OD'ing. Now if I really wanted to off myself, a 4 week supply might do the trick. Narcan would probably never come into play in such a scenario.

I guess my point is, if you're shooting drugs up, it's a necessity, period. Hell, many dope dealers keep it in their places of business. That actually should speak volumes, right?

 

[Nicomorphinist]

When I started getting injectable narcotics for subcutaneous and intramuscular injection like hydromorphone, morphine, nicomorphine, piritramide, and oxymorphone, I would get from four to 10 ampoules of naloxone, and in the early days nalorphine, in case I did not aspirate properly and had the needle in a vein or artery. Then multidose phials and a syringe driver when they approved intravenous administration for breakthrough pain. Sometimes it was on the prescription, later the chemist started including them.

The only time had to have someone draw naloxone into a syringe was when I somehow had some dextromoramide hit me too hard and I thought I may pass out.

There are also methadone maintenance patients who get ampoules of injectable methadone in some countries and I believe there may be a fraction of the number of methadone ampoules which they use as a guideline.

Also I would think anyone with kids in the house and high dose powerful narcotics even in tablet form should have some handy too because the kids just have to break open a bottle and eat tablets that look like candy once and it will be needed, like the child who ate one tablet of bezitramide and died after taking out of his mother's purse, leading to it being banned in the Netherlands.

 

[Pattypuffer]

Madness. Yeah its been 10+ years since I've had anything to do with iv and opiates and back then the its was all Rx's in my area. Hell, I never even came across heroin, and couldn't have found it if I tried ( I still remember being sick as a dog and trying to find ANYTHING). I think I remember narcan being a thing but if I'm correct they were only available in an emergency setting and the one time I'd heard of fentanyl it was a patch that never made it to me... So while I get what yall are saying, I'm a bit out of the loop when it comes to opiates these days and full disclosure, I need to catch up on last night's rest before I'll be able to fully comprehend the science behind it (it is much appreciated though)

To be clear and please correct any misunderstandings.... there are various medications available via RX in the U.S. that will combat an opiate o.d. some and those are actually intended for i.v. use by the patient? or is i.v. just the most efficient ROA and is necessary in that type of situation? What I miss, nicomorphinis??? A chart regarding availablity and legalities would be great and I'm a little surprised pain mgmt docs write scripts for both, then again I guess I really shouldn't be.

But yeah that was big reality check the other day, at least for me, he probably doesn't even realize how bad that could've been. I wouldn't have had a clue what to do. Hes been "camping out" and was refusing to call for legitimate help, the only thing I knew to do was bring plenty of drinks, something to eat and whatever vitamins I had on hand for stim recovery (CoQ10, magnesium, vitamin c, and alpha-lipolic acid). I'm sure all that didn't hurt, but I'm also not foolish enough to think it'd save the day in an emergency. (Although if there are any otcs that will help even as a preventative measure please lmk.) I will definitely try to stress the importance of him having naloxone (or whichever) on hand for next time and implementing a variety of harm reduction strategies, unfortunately I cant make him prioritize his own wellbeing any more now than I could ten years ago.

That being said everyone please stay safe and do everything you can to prevent finding yourself in a similar situation. I appreciate all the advice and feel free to post anything else that might be useful.