Sufentanil patch concerns

[Synack]

Am I the only one here concerned about OD issues with these when they come out? I mean, docs still rx the fent patches to post-op patients and kill them..these could be worse.. plus a junkie with a tolerance could OD much easier IMO on these... even if they're the matrix type.

I just think these might be too risky in settings that arn't tightly controlled...but who knows :)

thoughts?

[roxi*stardust]

I totally agree, I mean with all the ODs with Fentanyl patches that contain 3 days worth of medication. Now you are looking at a patch containing 7 days worth of a medication that is even stronger than Fentanyl. There must be a reason there aren't more concerns being voiced about this. How is oral, buccal, or sublingual absorption? Is it possible that Sufentanil isn't very effective via these ROAs? ILm going to see what I can find out. I'll post back any info I can find.

[Paregoric Kid]

if you take sufentanil you better know what you are doing. any doctor that is worth seeing will be able to prescribe the appropriate dose and junkies will use it the same as fentayl, some people will overdose from their own mistake, if you take drugs you take the fun and risks that go with it. fentanyl is strong, so what, it can be used safely medically and recreationally. people are always going to overdose we don't need a mob telling us what is best for ourselves. this new patch will be really valuable for pain relief and for recreational purposes.

[limitless_euphoria]

Yeah, as if it's not bad enough that all the ambulance chasers advertise on TV, "Have you been injured by THE PATCH... fentanyl is a very dangerous narcotic pain reliever that is responsible for thousands of deaths nationwide. If you've been killed or hurt by it, or a friend, neighbor, you pet or some guy you know on the internet has, or you think you might get hurt by one someday, call 1-800-SHEISTR for a free consult!"

I'd imagine the FDA is going to put anyone who tries to market this new patch through some fierce tests and examinations. I mean, on one hand--I hope CPers who are not helped by just regular fent might reap some benefit from the new patch--but still, I hope there aren't any more deaths because of it!

[chemboy7]

if you take sufentanil you better know what you are doing. any doctor that is worth seeing will be able to prescribe the appropriate dose and junkies will use it the same as fentayl, some people will overdose from their own mistake, if you take drugs you take the fun and risks that go with it. fentanyl is strong, so what, it can be used safely medically and recreationally. people are always going to overdose we don't need a mob telling us what is best for ourselves. this new patch will be really valuable for pain relief and for recreational purposes.

I agree, but still the overdose potential of these things is going to be many times that of other Opiate pharmaceuticals.

[Narkotikon]

I think the benefits will ultimately outweigh the risks. Yes, I do think it would be MUCH easier to OD on Sufentanil. I think Wiki said it's something like 5-6 times more potent as regular Fent. I know it's used a lot in heart surgeries. I do think there should be STRONG precautions set in place though. I mean, obviously, just like with Fent, this new patch should ONLY be for opiate-tolerant patients. Unfortunately, though, there will be diversion, and some people will die. I don't like it when anyone dies from an OD, but on some level I just think it could have been prevented.

What I mean is, is anyone dying from an OD okay? No. But, if you're going to do the shit, should you at least educate yourself with the basic knowledge to help you survive? Hell yes. Not that accidents still don't happen. I guess I"m just saying that while I feel pity for a kid / person who ODs on Fent or anything, I also feel like it's their fault. They should have known better. It's like people who pop pills without even knowing what the hell they are. That's so fucking stupid in my opinion. And there are even websites with pill search engines, or hell, call a pharmacy and pretend to be a parent who found pills in their kid's room. There's no reason to not do those things.

[roxi*stardust]

See I'm more concerned about what happens when a bunch of people do start dying from abusing it. Then you are going to have the FDA, DEA, lawyers, watchdog groups, and every other 3 letter government agency sticking their nose into the way doctors are prescribing it, for what they are prescribing it, and to who they are prescribing it. It's bullshit, I'm afraid it's just going to end up like Actiq or Fentora, with the FDA telling doctors to rx it only for cancer pain. This is potentially taking away a promising drug from a whole section of the population with chronic non-malignant pain that needs it.

[Narkotikon]

^^^^^^^ That's very true. I guess it's just the nature of the beast though. That will never change until the government gets it's nose out of the doctor - patient relationship. I really feel bad for CP patients. I would suck to have to jump through tons of hoops, and not even be gauranteed adequate care. Oh, you're pain level is a 9, here's some 800mg Ibuprofen. Hope it helps. Bullshit.

[Paregoric Kid]

its sufentanil, its a schedule II substance, the DEA is already on every doctors ass about prescribing practices involving CII meds. we need to change peoples mindset and abolish the CSA and the DEA (and the FDA while we're at it too) let the people and the doctors decide what medicines they want to take and assume the responsibilties of using them. there is too much pain in this world that is going untreated for no good reason and that is not right.

[chemboy7]

its sufentanil, its a schedule II substance, the DEA is already on every doctors ass about prescribing practices involving CII meds. we need to change peoples mindset and abolish the CSA and the DEA (and the FDA while we're at it too) let the people and the doctors decide what medicines they want to take and assume the responsibilties of using them. there is too much pain in this world that is going untreated for no good reason and that is not right.

I think we could all agree to that but what do you purpose to do about it? What could any of us do about it? Even in numbers we are weak against the beast. I think it was Robo who recently said on here that it is going to take someone with a great amount to lose that is willing to lose it for the cause, and with the American value system I think we are going to be fucked for atleast our lifetime.

[tgmu]

I think it will be a good thing to offer pain patients more choice, with this new schedule II seven-day sufentanil patch. However, some may prefer the current three-day fentanyl patches, since patches they can irritate the skin and fall off when left on for a long time. More choice though is good for everyone - if I could wear a patch that kept me pain-free for a week, without having any problems, this would be very convenient. Maybe sufentanil buccal lollies could become available too, for breakthrough pain.

[resorcinol]

I personally think it was a dumb idea to make it a seven day patch. Not only because of the obvious extreme amount of drug in each patch, but because of inconvenience. Once a day patches aren't a problem if they fall off too quickly. But you're fucked if this new 7 day patch falls off on day three.

[Princess]

Don't ya just love those commercials? I crack up every time I see them!

Yeah, as if it's not bad enough that all the ambulance chasers advertise on TV, "Have you been injured by THE PATCH... fentanyl is a very dangerous narcotic pain reliever that is responsible for thousands of deaths nationwide. If you've been killed or hurt by it, or a friend, neighbor, you pet or some guy you know on the internet has, or you think you might get hurt by one someday, call 1-800-SHEISTR for a free consult!"

That's my problem... I can't even wear mine for 3 days... I'll scratch myself raw.

I think it will be a good thing to offer pain patients more choice, with this new schedule II seven-day sufentanil patch. However, some may prefer the current three-day fentanyl patches, since patches they can irritate the skin and fall off when left on for a long time.

I agree. The ONLY reason I started abusing mine was because they irritated my skin after 2 days, I had so much gel left, I knew there would be a fun way to use it... I could see myself having too much fun with a 7 day patch, it would come off on day two & I'd be in trouble abusing the rest... I would refuse to have it prescribed to me. I want to continue living, for the time being.

I personally think it was a dumb idea to make it a seven day patch. Not only because of the obvious extreme amount of drug in each patch, but because of inconvenience. Once a day patches aren't a problem if they fall off too quickly. But you're fucked if this new 7 day patch falls off on day three.

[In2TheWoods]

I personally think it was a dumb idea to make it a seven day patch. Not only because of the obvious extreme amount of drug in each patch, but because of inconvenience. Once a day patches aren't a problem if they fall off too quickly. But you're fucked if this new 7 day patch falls off on day three.
This is exactly what I was thinking when I heard it is a 7 day patch. I'm a CPer and I use the fentanyl patch and I've often wished it was 48 hours instead of 72. Then, the times it falls off early aren't such a big deal. When you're Rx'd narcotic pain meds, you have to be so careful not to raise red flags. When patches fall off you run out early and that can look bad. I've had the same Dr for a few years and she trusts me but other Drs I've had the misfortune to deal with when she's away or in the ER will call the pharmacy and look for any times you've refilled too early. I tape mine on now so it's really rare that I need to get them early, but if they had to last 7 days....


Also Drs don't always take the time to learn about the med thoroughly before they Rx it. I was once told that all fent patches could be cut in half. I said, "but what about the ones with the gel?" The Dr said it didn't matter because the gel is absorbed into your skin and the time release was in the gel so you could just cut it open and squeeze all the gel onto your skin and it would work the same. If by "work the same" he meant potentially kill me. Thank God I had just started reading Opiophile and checked before rubbing all the fent gel on my back like suntan lotion. Anyway, my point is this would be a med with a lot of possibility to cause harm in the hands of uninformed Drs.


Or it could do a lot of good in the hands of suffering patients. Hmmm.
I do wish it wasn't 7 days in duration though.

[roxi*stardust]

I think it will be a good thing to offer pain patients more choice, with this new schedule II seven-day sufentanil patch. However, some may prefer the current three-day fentanyl patches, since patches they can irritate the skin and fall off when left on for a long time. More choice though is good for everyone - if I could wear a patch that kept me pain-free for a week, without having any problems, this would be very convenient. Maybe sufentanil buccal lollies could become available too, for breakthrough pain.
The patch itself is supposed to be 1/5th the size of a Fentanyl patch.
http://www.durect.com/wt/durect/page_name/pr_1098407155

[resorcinol]

Side note: Looks like they've got their NDA (new drug application) filed with the FDA for Remoxy. It doesn't have naloxone in it or anything along with the oxycodone, but it's got a new time release mechanism that I've heard is pretty much impossible to defeat (kinda like polistirex formulations of antitussitives) called SABER.

I sadly forsee oxycontin prescriptions becoming a thing of the past once this one hits the shelves.

[ndoftaworld]

Side note: Looks like they've got their NDA (new drug application) filed with the FDA for Remoxy. It doesn't have naloxone in it or anything along with the oxycodone, but it's got a new time release mechanism that I've heard is pretty much impossible to defeat (kinda like polistirex formulations of antitussitives) called SABER.

I sadly forsee oxycontin prescriptions becoming a thing of the past once this one hits the shelves.

Hopefully, SOMEONE will figure out a way to 'crack' the ER system of the new oxy's. Where there's a junkie will, there's a way...

And I AM curious about this sufentanil, especially after reading the link roxi posted. Up to 7 days pain relief w/ "reduced skin irritation and improved adhesion" Definitely interesting... :)

Nd

[smackem]

Side note: Looks like they've got their NDA (new drug application) filed with the FDA for Remoxy. It doesn't have naloxone in it or anything along with the oxycodone, but it's got a new time release mechanism that I've heard is pretty much impossible to defeat (kinda like polistirex formulations of antitussitives) called SABER.

I sadly forsee oxycontin prescriptions becoming a thing of the past once this one hits the shelves.



What do you mean? Doctors would be MORE likely to Rx them if they were safer.

[Indy]

Just so you guys know, having a really low equivalent dose isn't any more dangerous if the dose is already prepared and measured accurately. Or hell, if you dilute it, it's basically just as safe as a drug that has a higher equivalent dose.

BUT, the fact that it's 7 days of medication in patch, while it sounds DELICIOUS, DOES sound dangerous. It's not the fact that sufentanil has a lower equivalent dose, because that really means nothing in pharmaceuticals, its the fact that if anything goes wrong with the patch (or if you find a way to purposely take it all at once), you could die.

What do you mean? Doctors would be MORE likely to Rx them if they were safer.

He means doctors won't write for Oxycontin, they'll write for Remoxy.

personally i'm the type of guy who would prefer to actually leave the time release intact and just take more anyway.

[ndoftaworld]

personally i'm the type of guy who would prefer to actually leave the time release intact and just take more anyway.

I'd have to agree... of course, until day #2 when the effects are barely noticeable, and provide NO pain relief. I'm hoping the new patch (placebo effect or not) will actually provide measurable results. Might just need a titration on my current patches... but that ain't happenin' anytime soon :(

If it's offered, I'll take it. But I ain't risking a fall BACK down the opie-ladder for a new 'fun-sounding' fatal pain med :P

Nd

[resorcinol]

What do you mean? Doctors would be MORE likely to Rx them if they were safer.

That's exactly it though -- docs would perceive Remoxy as safer (both from an addiction and accidental time release breakage standpoint) and want to prescribe Remoxy instead of OxyContin.

Unlike OxyContin, where if a non-opiophile CP patient chews the pill not KNOWING that it breaks the time release (the could then easily OD), Remoxy, even if the gelcap is crushed and chewed up, retains its time release. In addition, it would deter rush-seeking opiophiles, or IV-method opiophiles.

It's not a total disaster though. It's not like it contains naloxone or naltrexone that is released if crushed or anything. It's just oxycodone with a more fortified time release mechanism (ion-exchange method, like Pennkinetic [polistirex]).

Taking more than you would of IR oxycodone to compensate would get you high, and you'd get a longer high too.

[hovadagod]

7 fuckin' days!? insane..

[Thebane]

Couldn't you always just let the remoxy sit in water for 12 hours then drink it? Or if not water some solution that has the right pH? I mean it would suck for convenience, especially if you bought pills everyday rather than get a monthly script, but it wouldn't prevent you from getting all the oxy at once if you wait 12-24 hrs. would it?

Edit: Post 666. Time to celebrate.

Edit2: Oh, I'm guessing it's a bitch to prep for IV, forgot about that. You'd have to evap a lot of water down.

[resorcinol]

Couldn't you always just let the remoxy sit in water for 12 hours then drink it? Or if not water some solution that has the right pH? I mean it would suck for convenience, especially if you bought pills everyday rather than get a monthly script, but it wouldn't prevent you from getting all the oxy at once if you wait 12-24 hrs. would it?

Edit: Post 666. Time to celebrate.

Edit2: Oh, I'm guessing it's a bitch to prep for IV, forgot about that. You'd have to evap a lot of water down.

If you wanted to make it IR, yes I'd imagine something like that would work, with a few tweaks.

Make the water acidic. Citric acid would be fine. In addition, keep it on a hotplate, in a beaker, with the temp set maybe 10 to 15 degrees F above the human body's temp (which is 98.6 F or 37 C ... so set the hotplate to about 109 F or 43 C).

There would be no need to squeeze the liquid out of the gelcaps; the gelcaps will dissolve on their own and not interfere with the process.

Leave your desired amount of Remoxy on the hotplate for 12 hours.

I'm pretty confident that this process would make the Remoxy IR. However, you could NOT shoot this up! Nor snort it, as the liquid in the gelcap and the gelcap material will make it a viscous mess -- not snort-able.

This making Remoxy IR process only applies if you really really want your oral oxycodone to be IR OR if you're willing to plug it (up the ass, for those unfamiliar with the term, with a needle-less syringe). Plugging it would give a feeling equivalent to if not better than snorting most likely, so get over the stupid homophobic I'm-scared-of-my-own-asshole attitudes and plunge that oxycodone laden liquid up your ass with a needle-less syringe!!! Lie down for a half hour after squirting it up your ass so it doesn't leak out (that would SUCK... wasting drugs is sad).

*The get over homophobia and being afraid of your own asshole comment was not directed at anyone in particular -- just wanted to clarify that.


NOTE!
This process to break the time release in the soon-to-come to pharmacies Remoxy product would almost certainly also defeat the TIMERx in Opana ER. You could get pluggable IR oxymorphone this way! Careful though.... oxymorphine is POTENT when plugged. Oral has an absolutely abysmal bioavailability of 10% (seriously the lowest I've seen among the common opioids) and snorted/insuffulated is only marginally better at 30%. Plugged, oxymorphone has a MUCH higher bioavailability ... I can't find a number but I'd guess it's probably around 80%. So, be careful, oxymorphone reveals its true potency when used by parenteral routes that have good bioavailability. Oxymorphone supposedly has one of the BEST rushes of all opioids when shot up (oxymorphone, ketobemidone, and dipipanone are the ones that I always hear have a rush that is better than heroin and even better than hydromorphone) -- so I bet when plugged it could actually give a decent rush since it has such a strong propensity to cause a rush.

[DCBA]

I agree, but still the overdose potential of these things is going to be many times that of other Opiate pharmaceuticals.

Not if used acording to the proper dose..
If one is talking about OD potential lets see paracetamol, its OTC and a small box of 20 pills will kill most people.
So, your not talking about overdose potential but ABUSE potential, at least thats what i think..

[Indy]

The fact that sufentanil is so potent on a mg/microgram basis means nothing because it's ALWAYS going to be measured out properly. What DOES matter is the 7 days worth of medication in one patch.

One of the many beauties of opiates is that most of them have water soluble forms, and if you can dissolve something in water, you can dilute 10 micrograms just as easily as you can dilute 10 grams.

[resorcinol]

The fact that sufentanil is so potent on a mg/microgram basis means nothing because it's ALWAYS going to be measured out properly. What DOES matter is the 7 days worth of medication in one patch.

One of the many beauties of opiates is that most of them have water soluble forms, and if you can dissolve something in water, you can dilute 10 micrograms just as easily as you can dilute 10 grams.

Very true. That's exactly why I'd try carfentanil or etorphine in a heartbeat. I've got a good scale for weighing chemicals that goes out to X.XX g. I'd just measure out say 0.1 to 1 g of the HCl salt, dilute in a known amount of water and ensure that everything dissolves totally and shake the hell out of the solution to ensure total and even dissolution, and do the math. Then I'd measure out the dose needed based on the concentration of the solution in water and use it sublingually. In the case of Wildnil where the total dose is already measured, I wouldn't even need to use the scale. Just dilute the Wildnil in a large amount of water of known volume and calculate the concentration of carfentanil per mL. 0.08 mg carfentanil is equianalgesic to 80 mg morphine, so I'd make the solution have 0.08 mg carfentanil per 5 mL water. Then I'd cautiously dose 1 mL of the solution every half hour sublingually until I found the right dose --- I'd probably need just 1 or 2 mL of such a solution with my current low-ish tolerance. It's only more dangerous to use these super potent opioids vs the more common weaker ones if one doses without properly measuring a dose (that's just asking for death by OD).

The concern with TransdurSufentail patches is gonna be ignorant high school kids (and some ignorant adult druggies also no doubt ... I'm trying not to be ageist ... there are plenty of careless adult drug users also who just take things assuming that "that tiny thing could never have enough to OD me" ... just not understanding the incredible potency of sufentanil and the 7 days worth of high CP necessary doses in it the patch) who see the tiny TransdurSufentanil patch and think it's OK to stick and entire patch in their mouth (even WEARING a whole one would be extremely dangerous for an opioid naive person, just like with fentanyl transdermal system). I'm quite sure we'll see overdose deaths when this product comes out and the pissed off greiving parents / family members trying to sue Durect / ENDO because of the OD death. It pisses me off because people who OD for such reasons OD'd because they were using drugs with incredible negligent attitudes towards safety. IDK when it became "cool" to just take something without knowing how much drug is in the goddamn thing. This is even a problem with OC .... people who know little to nothing about opioids and pharmaceutical opioids and take a whole 80 mg OxyContin when they're opioid naive for example --- that at the least would make an opioid naive person violently ill, and at the worst result in OD, the latter being more likely if it was chewed / crushed but possible even with time release intact. All it would take is a google search to figure out that an OC 80 has the same amount of oxycodone as 16 5/325 Percocets, yet so many folks thing "it's just a little pill" and don't realize how much potency can be packed into a single pill / patch / whatever. I have to say I don't feel all that sorry for these people. Using drugs safely requires taking safety measures that aren't all that difficult ... like a GOOGLE search followed by a sift through the results for reputable sources... or even a visit to Opiophile to ask exactly how much opioid is in X preparation. I understand that families suffer horrible grief in such situations, but they misdirect the anger tremendously. Perhaps if kids were taught HR instead of "just say no" they'd have a better grasp of responsible drugs use (and I strongly believe that teaching HR while recommending that no drug use is the best way to go ... but not PREACHING it via scare tactics and propaganda ... would actually be more effective in curtailing teenage drug use than "just say no" propaganda programs like DARE).

That's the concern with TransdurSufentanil... Duragesic redux with OD deaths but probably even more cases due to each patch being 1)smaller so even more deceiving 2)having 7 days worth of opioid vs 3 days, more than 2 times more opioid

The other concern is the one that effects CP patients ... the idiocy innate in creating a 7 day patch for even totally therapeutic-only never-get-high folks. It's especially stupid when it's so difficult to fill a CII Rx early no matter how legitimite and believable the reason is (I'm thinking of patches coming unstuck, here). The manufacturers of transdermal patches even admit that this is a problem, but try getting a pharmacist or doc to actually believe that you're having a sticking issue -- in this drug war fervor they're gonna think "junkie using shit up too fast" way before they even contemplate beleiving you about patches falling off even though it's one of the most legit problems related to running out early out there. With a 7 day patch, you get FOUR patches per month! Loosing one due to fall-off on day 3 would be a DISASTER. I think any CP patient who is aware / is made aware of the fact that patches fall off sometimes (even with tegaderm if one sweats a lot especially in summer ... and forget things like swimming) would NOT go on TransdurSufentanil unless they had such severe pain that even Duragesic won't cut it (like cancer .... it would be especially appropriate for the elderly in hospice care that have severe pain from terminal cancer ... at least in this situation if one falls of the medical professional taking care of ya through hospice can vouch for you that one fell off, giving you credibility). This SHOULD have been a change-daily q24 hr patch as should Duragesic and all transdermal patches. EMSAM and Daytrana's manufacturers have the right idea. 30 patches a month, enough in each patch for a day, change every day. Putting a new patch on once a day isn't inconvenient, but a 7 day patch falling off way early causing a refilling nightmare and leading to accusations of one being a junky by supposedly compassionate medical professionals IS inconvenient... it's inconvenient as fuck!

I say it's a HUGE blunder on the part of Durect and Endo for making this q7 days. Idiotic for so many reasons.

Please, some pharma company out there (Purdue, are you listening? It wouldn't surprise me if some of their workers check this board out sometimes. If so ... PLEASE READ THIS. Make a q24 hour patch containing 14-cinnamoxy-hydrocodone (matrix style like Mylan duragesic but improve the design to make it work for more folks). CP patients everywhere will thank you).