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Julie Latimer DANA NSW Drug & Alcohol Nurses Forum September 2014 MSIC provides: A practical and compassionate response to drug injecting Supervision of injecting episodes that might otherwise occur in less safe circumstances such as public places or alone A safer environment where immediate medical assistance is available if required Access to health & social welfare services for a marginalised & difficult to reach population Powerful synthetic opioid analgesic 100 times more potent than Morphine Highly lipid soluble = rapid onset Transdermal patch Prescription of fentanyl patches in Australia has increased dramatically since 2006 First recorded use at MSIC Sept 2012 Higher incidence of overdose compared to other opioids Increase in use now that new formulation of Oxycontin (OP) available High incidence of overdose due to potency Fatalities internationally & nationally Misinformation around dosage Complicated preparation process Tolerance rapidly increases with regular use Have you used Fentanyl before? Do you know the Oxycontin equivalent of the patch you have? How do you prepare it for injection? How many 80mg Oxycontin tabs do you usually use? Have you ever overdosed after using Fentanyl? Discussion with clients regarding dose and knowledge base Increased chance of overdose – may happen quickly Close observations – 1st 20 mins are important Clients report effects are not always pleasant Patch strength Fentanyl content Approximate Morphine equivalent Approximate Oxycontin equivalent 100mcg per hour 16.8mg 1680mg (16.8 x 100mg Morph) 1120mg (14 x 80mg Oxy) 75mcg per hour 12.6mg 1260mg (12.6 x 100mg Morph) 840mg (10.5 x 80mg Oxy) 50mcg per hour 8.4mg 840mg (8.4 x 100mg Morph) 560mg (7 x 80mg Oxy) 25mcg per hour 4.2mg 420mg (4.2 x 100mg Morph) 280mg (3.5 x 80mg Oxy) 12mcg per hour 2.1mg 210mg (2.1 x 100mg Morph) 140mg (1.75 x 80mg Oxy) Fentanyl is 100 times more potent than Morphine Risk of overdose is much higher 1cm square of any strength patch will have the same amount of Fentanyl on it Find out what the client knows about Fentanyl