Colwell said on average about 10 to 15 people who've taken fentanyl are treated in the San Francisco General emergency room a day, sometimes more. And that's at just one hospital in the city.
The majority of people are found passed out and brought into the emergency room by emergency medical services. Most are very sleepy and unable to stay awake. Those who are on both fentanyl and methamphetamine can be very agitated and unable to stay still.
Naloxone (Narcan) is a medicine used treat a fentanyl overdose and prevent death, and when administered, patients actively vomit and sweat.
"Our most immediate threat right now is the opioid epidemic and the trauma we are seeing. We are seeing increases I haven’t seen in my career around dependency and overdoses, mostly involving fentanyl. We always had problems with opioids, specifically heroin, but fentanyl has changed the whole landscape of drugs."
Fentanyl is a powerful synthetic opioid that's 50 to 100 times more powerful than morphine. Like all opioids, it's a respiratory depressant and can impact the user's ability to breathe.
It was initially created in the 1960s to manage pain after surgery, and its clinical use expanded in the 1990s with the introduction of the extended release patch for chronic pain, typically advanced cancer pain.
"I give fentanyl in the ER every day for people in trauma," said Colwell. "It’s very quick. Morphine reaches peak effect is 20 minutes. Fentanyl is immediate."
More recently, fentanyl is being illicitly made in labs and usually either sold under its own name as powders or tablets or mixed with a wide range of drugs, such as heroin, cocaine, methamphetamine and MDMA. It's also made into counterfeit pills that look like other prescription opioids.
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