IV'ing Fentanyl gel into a picc line

[Cee Hawkins]

I know someone who currently has a picc line in his arm. He has the idea of removing the gel from his Fentanyl transdermal patch and IV'ing it through his picc line. He says he's only going to mix a pin drop of the stuff with some sterile 0.9% Sodium Chloride(Saline) and inject. I know he has a monstrous opiate tolerance, like 150mg. Oxycodone a dose or 80+ mg. of Itranasal Oxymorphone a dose and would redose with either a few times per day. Even with his big tolerance is this a death wish? If he's going to be stubborn and do it no matter what is there a safer way? Does the gel need to be filtered? Are there any additives in the gel that are poisonous and would be ridiculous to dump straight into your heart via the picc line? PLEASE HELP, AS I THINK HE HAS HIS MIND SET ON DOING THIS TONIGHT.

 

[tricomb]

Do not inject fentanyl gel, or ANY gel for that matter. It's not even so much a matter of tolerance (even though that's a major concern) but the fact that it could cause serious complications due to it being a gel.

It's a death wish, do not tamper with a fentanyl transdermal delivery system under ANY circumstances.

 

[Swimmingdancer]

Yes there are ingredients in the gel that would be seriously dangerous to inject! Especially into a PICC line that goes straight to the heart. Do everything possible to convince him that this is an extremely unsafe idea. If he needs more convincing, we can post some more details about why this is so harmful.

 

[oldkaw]

Capillaries in the eyes, lungs, kidneys and other vital organs would be clogged and compromised. O2 would be unavailable to tissue down stream from the damage and would starve. Organ transplants, even if one can afford them, are unavailable to those who's condition is a result of drug abuse, or in this case a ridiculously bad idea combined with drug abuse.

 

[Swimmingdancer]

Organ transplants, even if one can afford them, are unavailable to those who's condition is a result of drug abuse, or in this case a ridiculously bad idea combined with drug abuse.

Clearly you must be talking about in the US. But even in the US, is that actually true? I know organ transplants can be denied in the US because of current continuing illicit drug use, but can they actually be denied because of past drug use or because one's injuries were caused by drug use? I really don't think there is any rule that you can't be considered for a transplant if your injury to the organ was self-inflicted. But people do have to demonstrate a commitment to discontinue their drug use before they can actually receive a transplant (to show that they will take care of their new organ).

Either way, an available transplant is definitely not guaranteed for anyone, and knowingly putting yourself in a position where you might end up needing one is a terrible idea.

 

[alkap555]

Organ transplants, even if one can afford them, are unavailable to those who's condition is a result of drug abuse, or in this case a ridiculously bad idea combined with drug abuse.

This is not true. There are, of course, ethical considerations that go into determining suitable organ transplant recipients. But this does not preclude someone from receiving a life-saving transplant, even if the original organ damage was caused by drug abuse. Literally thousands of alcoholics have received liver transplants for end-stage cirrhosis.

From a Scientific American article:

Former Substance Abusers Rarely Relapse After Organ Transplantation
Substance abuse can lead to serious organ diseases for which transplantation is increasingly considered an acceptable treatment...

http://www.sciencedaily.com/releases/2008/02/080204111816.htm

Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs.
For patients receiving liver or other organ transplants for diseases associated with substance use, risk for relapse posttransplantation is a prominent clinical concern...The analysis included 54 studies (50 liver, 3 kidney, and 1 heart). Average alcohol relapse rates (examined only in liver studies) were 5.6 cases per 100 patients per year (PPY) for relapse to any alcohol use and 2.5 cases per 100 PPY for relapse with heavy alcohol use. Illicit drug relapse averaged 3.7 cases per 100 PPY, with a significantly lower rate in liver vs. other recipients (1.9 vs. 6.1 cases). Average rates in other areas (tobacco use, immunosuppressant and clinic appointment nonadherence) were 2 to 10 cases per 100 PPY.

http://www.ncbi.nlm.nih.gov/pubmed/18236389

While an addict can get a transplant for drug-induced organ damage, they must currently be abstinent and/or in treatment (policy varies by institution), and would definitely be ranked below another transplant candidate who did not cause organ damage via substance abuse.

IVing fentanyl gel is incredibly stupid, however, but if he is dead-set on doing it, then OBVIOUSLY filter it! Why would you even need to ask that?! To minimize chances of loss of limb or life, filter it through a 0.22 um wheel filter to try and remove as much polymeric goo as possible, and dilute it! The more dilute the better. You do not want any gel-globules floating around your vascular compartment---the embolic debris may occlude arterioles and capillaries, leading to tissue necrosis and possibly amputation if they make it through the lungs and into the arterial circulation. A more likely scenario is the debris settles in the alveolar capillary beds impeding oxygen exchange and possibly causing emphysema and/or pulmonary fibrosis.

Here is a video of the damage caused by IV administration of a drug called Koaxil (tianeptine) in Eastern Europe. Warning Very Graphic:
http://www.youtube.com/watch?v=EZGkO2xYcEU

 

[nAON]

This is a terrible idea for many reasons. For a start, he doesn't know how much he's actually going to be dosing, a 'pin drop' could be anything. Secondly, for the reasons above, the gel itself is either gonna clob up the IV line, or it's going to enter his body and start clogging up arteries, which is gonna lead to all sorts of problems, including but not limited to him losing a couple fingers and orgain failure.

 

[Mr.Scagnattie]

Wow. Saw the thread title and had to just come in and say what a horrible idea this is... the terms "gel" and "IV" should never be in the same sentence unless theres a big "DON'T DO IT" somewhere.

 

[Coraline]

Show him this thread and try to reason with him. It can kill him or cause severe harm from either over dose, complications from the gel, or infection. This is really bad news. I hope he does not do this.

 

[SteeleyJ]

Please steer him away from this idea. fentanyl gel is notorious for accidental overdose. We have had many a BLer die from this. RIP

 

[jdpaul88]

Wikipedia says fentanyl causes more deaths nationwide than traffic accidents

 

[oldkaw]

You are right. Self destructive behavior will not cause someone to be automatically rejected. It will cause much lower odds. It is a multi stage process in the US, the first being one has to have a doctor who will refer them as a candidate they professionally believe represent a good risk. This stage is subjective and laden with inequities. If a physician must choose between Charlie Sheen or a healthy father of four who was involved in an accident, and who didn't contribute any liability in the accident, all other facts equal, one would have to be really naive to think it would not influence the decision. Im just saying when society looks at the person with self destructive behavior, and then looks at the boy scout, the boy scout usually will win. Exceptions abound, as this is extremely subjective.