Illicit Fentayl vs. Prescription Fentanyl - know the difference
SOURCE: Click Here below
https://www.acsh.org/news/2018/07/02/fe ... logy-13141
By Josh Bloom — July 2, 2018
Let's Keep Our Terms Straight. Source: Dictionary.com
It's more than a bit ironic that nine months after I wrote about how the Kolodny Klan was using misleading words (and numbers) to promote their version of the fake opioid crisis (See The Opioid Epidemic In 6 Charts Designed To Deceive You) that some of the pain patients who are fighting back are doing the same things, albeit, unintentionally. Let's fix this.
ORGANIC CHEMISTRY NOMENCLATURE IS MADNESS
For most people, chemistry is difficult enough, but when you toss in nomenclature, logic becomes illogical. There are multiple ways to name almost all chemicals. It is not rare to see a dozen different names for the same compound, some of which make sense and others are bewildering. As in Figure 1.
Figure 1. 10 different names for rubbing alcohol - all correct (1) (See Putrescine And Cadaverine: Two Chemicals That Earned Their Names )
So it should not be the least bit surprising that the terminology of the "fentanyl epidemic" (2) is being mangled. Let's unmangle it.
FENTANYL IS FENTANYL
Fentanyl is a single chemical with a unique molecular structure. It has a bazillion different names but they all refer to the structure below.
So, no matter how its made or where it comes from, fentanyl is fentanyl. But, it's not quite that simple.
FORMULATION MAKES A BIG DIFFERENCE
The properties of a drug can be drastically altered by how that drug is formulated. The simplest example is immediate-release vs. extended-release. The terms are self-explanatory. Extended-release drugs often have advantages over their immediate-release versions (3).
Pharmaceutical (legal) fentanyl comes in a variety of forms, some are immediate-release and others are extended-release (4). Some examples:
Durogesic aka Duragesic (patch, extended-release)
Actiq (lozenge, immediate-release)
Abstral (sublingual, immediate-release)
Effentora (buccal, immediate) (5)
Instanyl (nasal spray, immediate-release)
WHY THE NAME CONFUSION? FENTANYL VS. ILLICIT FENTANYL
I don't really know. It is quite possible that the confusion was intentionally created by the CDC, just like it did by lumping all opioids together, giving the impression that pills were killing 64,000 people per year, even though this is undeniably false. But this one is really simple. Here are the correct definitions for the two terms that are creating confusion at this time.
Pharmaceutical vs. Illicit Fentanyl
- Pharmaceutical fentanyl is made legally by drug companies using FDA standards that apply to all other prescription drugs- safety, purity, potency, dose, etc. Pharmaceutical fentanyl is not a significant contributor to the number of OD death. Illicit fentanyl, mostly from Chinese labs, is. But it is the exact same drug (6) as that found in pharmaceutical fentanyl but in a different form. Illicit fentanyl is a white powder contaminated with god-knows-what. It is immediate-release and this is why it is killing people. A lethal dose is 1-2 mg, so even a small weighing or mixing error can lead to a fatal overdose.
MORE CONFUSION - FENTANYL VS. FENTANYL ANALOGS
As if unknown doses of street fentanyl aren't bad enough, it isn't only fentanyl that is killing people. Fentanyl analogs (7) are far more dangerous because there are about a dozen of them circulating around the US and most of these are far worse than fentanyl itself. These are different drugs. They are not fentanyl. (See: If You Think Fentanyl Is Bad... )
https://www.acsh.org/news/2017/01/17/if ... -bad-10663
Fentanyl and three analogs. All three are far more potent than fentanyl.
So, it is incorrect to call carfentanil fentanyl. Carfentanil is a drug which is a member of the fentanyl family but it is not fentanyl. It is structurally different and much more dangerous. Do not equate illicit fentanyl analogs with fentanyl. This is inaccurate.
So, let's keep our terms straight, especially since the CDC and other zealots do not. There are already plenty of screw-ups running around. Don't become one of them.
(1) It gets even worse. Ethanol, which is also called rubbing alcohol, has about 10 names of its own.
(2) As I have written many times in the past the term "opioid epidemic" is contrived and misleading. There is no opioid epidemic. What we are going through is a "fentanyl epidemic."
(3) But not always. Extended-release drugs give steady blood levels, which is usually beneficial. But if you have had painful oral surgery and the Novocaine is starting to wear off you're going to want Percocet, not Oxycontin, even though they contain the same drug oxycodone.
(4) An intravenous combination of fentanyl, propofol and a benzodiazepine is used for induction and maintenance of general anesthesia.
(5) Buccal means putting the drug between your cheek and gums. It is similar to sublingual (under the tongue).
(6) It may be the same drug but it will not have the same purity. In fact, the profiles of impurities can be used to determine where the illegal drug came from. (See: Fentanyl Sleuthing Gives Hints About Where It's Made - Sometimes)
(7) Analogs are close chemical cousins, but they are always different in chemical structure and properties. Sometimes even minor changes in structure can make an enormous difference in potency. Sometimes it is inconsequential.
By Josh Bloom
Dr. Josh Bloom, the Director of Chemical and Pharmaceutical Science, comes from the world of drug discovery, where he did research for more than 20 years. The field of drug discovery involves chemistry, biochemistry, toxicology, and pharmacology - skills that he has used to write on a wide variety of topics since he joined ACSH in 2010. One of the topics he has tackled is the so-called "opioid crisis." He is now recognized as an expert in this area and was the first journalist to write a nationally published opinion piece about the unintended consequences of a governmental crackdown on prescription pain medications (New York Post, 2013). Since that time he has published more than 20 op-eds in regional and national newspapers on different aspects of the crisis. In that same year, he testified at an FDA hearing, where he noted that fentanyl was the real danger, something that would be proven years later. At that time almost no one had heard of the drug.
He was also the first writer (2016) to study, dissect and ultimately debunk the manipulated statistics used by the CDC to justify its recommendations for opioid prescribing, which have resulted in Draconian requirements for prescribing pain medications as well as government-mandated, involuntary tapering of patients receiving opioid treatment, both of which have caused great harm and needless suffering to chronic pain patients. His 2016 article, "Six Charts Designed to Confuse You," is the seminal work on CDC deception and has been adopted by patient advocacy groups and individuals and has been sent to governors and state legislatures.
Dr. Bloom earned his Ph.D. in organic chemistry from the University of Virginia, followed by postdoctoral training at the University of Pennsylvania. His career in drug discovery research began at Lederle Laboratories, which was acquired by Wyeth in 1994, which itself was acquired by Pfizer in 2009. During this time he participated in research in a number of therapeutic areas, including diabetes and obesity, antibiotics, HIV/AIDS, hepatitis C, and oncology. His group discovered the novel antibiotic Tygacil®, which was approved by the FDA for use against resistant bacterial infections in 2005. He is the author of 25 patents, and 35 academic papers, including a chapter on new therapies for hepatitis C in Burger’s Medicinal Chemistry, Drug Discovery and Development, 7th Edition (Wiley, 2010), and has given numerous invited lectures about how the pharmaceutical industry really works.
Dr. Bloom joined the American Council on Science and Health in 2010 as ACSH’s Director of Chemical and Pharmaceutical Sciences, and has since published more than 60 op-eds in numerous periodicals, including The Wall Street Journal, Forbes, New Scientist, The New York Post, National Review Online, The Boston Herald, and The Chicago Tribune, and given numerous radio and television interview on topics related to drugs and chemicals. In 2014, Dr. Bloom was invited to become a featured writer for the site Science 2.0, where he wrote more 75 pieces on a broad range of topics.
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