In Mexico, the debate on the use of fentanyl as one of the most dangerous drugs due to its addiction and effects has increased.
President Andrés Manuel López Obrador has addressed the issue on various occasions in his customary morning conference. In recent days, he raised the need to analyze alternatives that replace fentanyl for medical purposes with other sedatives, which, according to the president, would allow its importation into the country to be prohibited.
This immediately alerted the medical community, which, through a statement signed by 60 medical federations, associations and colleges of all specialties, indicated that it would be a backward measure:
“We totally and absolutely reject the elimination of fentanyl from daily clinical practice, since this drug is used in 95% of surgeries in Mexico and throughout the world in order to avoid or suppress pain.”
Dr. Enrique Hernández Cortez, president of the Mexican Federation of Colleges of Anesthesiology, explains that in the country fentanyl is used regularly by anesthesiologists, intensivists, who keep patients pain-free and intubated, algologists (in charge of the study and pain treatment), for serious diseases such as cancer with metastases or neurological disorders, in addition to neonatologists.
“There are around seven groups of specialist doctors who work with fentanyl every day (…) leaving an entire population without the drug is going back many years in the history of pain treatment,” he points out.
A safe drug under control
Fentanyl has several formulations and is on the World Health Organization’s Model List of Essential Medicines. It belongs to the class of narcotic (opioid) pain relievers and works by changing the way the brain and nervous system respond to pain. It is considered a safe drug when consumed for a short period and according to medical recommendations.
Dr. Hernández emphasizes that until today there is no other drug as effective as fentanyl. Even having the resource of morphine, fentanyl is 100 times superior, capable of suppressing the most serious pain that human beings can suffer and also with an accessible cost to be used in the public and private sectors.
He explains that until now in the world there are other types of fentanyl, similar, but that do not have the same properties (such as sufentanil), that is, they are drugs that are administered and destroyed very quickly, so they must be administered continuously. , connected to a vein so that they have adequate levels and concentrations in the blood. This is commonly used during surgical procedures, “but until today there is no equivalent to fentanyl with these properties and that allows it to be diversified for various purposes,” he clarifies.
Medical use vs. illegal
The most recent cases of fentanyl-related overdoses are linked to the illicitly manufactured fentanyl, which is distributed in illegal drug markets for its heroin-like effect.
The specialist is blunt: “it is a totally different market”. He shares that medical fentanyl is approximately 60 years old when it reached the clinical practice of anesthesiologists. In Mexico it has been used approximately since the 1990s and “that totally changed the procedure for administering anesthesia, it changed the way of working.”
He adds that this opioid is strictly regulated and controlled by the Ministry of Health through the Federal Commission for the Protection against Sanitary Risks (Cofepris) and it is very important to point out that the drug used in medicine has no point of comparison with which is consumed illegally. The latter is manufactured in completely clandestine sites and in a very primitive way. It is an “apocryphal fentanyl” that is combined with a series of substances (cocaine, methamphetamine or heroin) that make it extremely dangerous and addictive, since it causes a more powerful and immediate effect, at a lower cost.
For its part, fentanyl for medical use is a synthetic drug, that is, it is manufactured in a laboratory under strictly controlled conditions. He even points out that 2% of doctors with a professional license have an exclusive recipe book controlled by the Ministry of Health through barcodes. “It is a pure drug that is also used by highly knowledgeable specialists in the subject, which makes it diametrically different from the illegal one.”
When questioning whether fentanyl for medical use could become addictive, the specialist explains that it could be probable, because drug dependence is a hidden disease, but in general the data on dependence are extremely low. “If we talk about 100 people, for illegal versus legal fentanyl, we could talk about 0.5 (addiction cases). We did not reach significant levels, although this does not mean that we are exempt from drug dependence and that deaths can occur,” he specifies.
