Pubdate: Fri, 23 Jun 2006
Source: Southeast Missourian (MO)
Copyright: 2006 Southeast Missourian
Contact:  http://www.semissourian.com/
Details: http://www.mapinc.org/media/1322
Author: Jennifer Freeze
Bookmark: http://www.mapinc.org/heroin.htm (Heroin)

THE PAIN OF FENTANYL

FARMINGTON, Mo. -- Justin Knox probably spent the last few minutes of 
his life struggling to breathe.

The fentanyl pain patch he chewed up March 11 released three days' 
worth of pain medication into his body in a matter of hours. The 
fentanyl -- 80 times more powerful than morphine -- shut down the 
22-year-old Farmington man's respiratory system.

It's been more than three months since Knox died, and his mother, 
Rose Marler, said it's difficult for her to understand her son's death.

"I just don't know where Justin got the idea to do something like 
this. If he was aware of what it can do, why would he do it?" Marler 
said about the fentanyl patch. "It's a new-generation drug, and most 
aren't living to tell about it."

Fentanyl is a synthetic opiate used to treat patients with severe or 
chronic pain, and a number of people have died abusing the 
prescription pain patch. The Food and Drug Administration reports at 
least seven people have died in Indiana and four in South Carolina 
since 2005. More than 100 deaths in Florida in 2004 were blamed on 
pain patch abuse.

About 8,000 emergency room visits were due to people misusing the 
fentanyl patch in 2004, according to figures from the Substance Abuse 
and Mental Health Services Administration, a division of the 
Department of Health and Human Services. Earlier this month, the 
department released a warning about the drug-related deaths to public 
health officials.

The increase in fentanyl abuse is a concern for local health and law 
enforcement officials, but they don't see the national trend 
occurring in Cape Girardeau County.

"Thank goodness we haven't had this problem here," said Coroner John 
Clifton. He said there have been no fatal fentanyl-related overdoses 
in the county.

About 3 percent of the patients at Gibson Recovery Center, a drug and 
alcohol rehabilitation center in Cape Girardeau, are addicted to 
opiates, including fentanyl. Despite that small percentage, assistant 
director Scott Doty said the number of people abusing pain 
medications has increased within the past few years.

"Opiates, including the pain medicines and heroin, are very difficult 
to get off of. It's like having a bad case of the flu for about three 
weeks, and the cravings are intense," Doty said.

Despite the addictiveness of the drug, local law enforcement 
officials said they haven't experienced many fentanyl-related cases. 
"I don't want to say it's never happened here, but it's not a 
reoccurring problem. We don't run into it much," said Cape Girardeau 
police spokesman Jason Selzer.

Lt. David James of the Cape Girardeau County Sheriff's Department 
said that a few years ago an inmate chewed up a used morphine patch, 
similar to the fentanyl patch, and was taken to the hospital for an 
accidental overdose.

A local recreational fentanyl user, who wished to remain anonymous, 
describes the drug's effect as "euphoric." Depending on the dosage 
amount, fentanyl patches sold on the street can cost from $15 to $100.

Marler said her son had been released from a drug rehabilitation 
center two weeks before he died. Knox had been abusing pain 
medication for almost six months before he sought treatment. "I knew 
he had some problems with pain medicine -- he knew that, too," she said.

The day Knox died, Marler said, he called her that afternoon when he 
got off work. "Everything seemed fine. He was just going to spend the 
night at his friend's house," she said.

Marler said that night, Knox and his friend purchased fentanyl 
patches from Potosi, Mo., resident Burl Washington. The next morning, 
Knox's friend found him dead. Washington has been charged with 
second-degree murder.

"It's been so hard without him here. I keep expecting him to walk in 
the door," Marler said about her son.

A week after Knox's death, another St. Francois County man was 
prescribed the patch legally and died after injecting himself with 
the gel that he scraped from it.

Prescription sales of the fentanyl pain patch reached the billions 
last year. More than 5.7 million prescriptions were filled in 2003 
for the brand name Duragesic patch, according to IMS Health, a 
consulting services for the pharmaceutical and health-care industries.

The Food and Drug Administration has an ongoing investigation into 
deaths and overdoses related to both Duragesic and generic fentanyl patches.

Dr. Harry George, a Cape Girardeau physician, said he prescribes 
fentanyl patches about three times a week.

"Doctors know when patients need the medication for pain. And we're 
aware of those people who come in wanting pain medication for 
recreational purposes," George said. "Some people think we're stupid."

George, in practice for more than two decades, has seen the abuse of 
fentanyl increase in the past few years.

Recently, a woman, who is now no longer George's patient, was 
prescribed the fentanyl patch. The woman's boyfriend took one of her 
patches, scraped off the gel and injected it into himself and the 
woman. Both ended up in the emergency room from an overdose.

"People abusing fentanyl are messing with fire. The risk is too great 
to use them for recreational purposes," George said. "They're going 
to end up in the funeral home."

Medicap Pharmacy pharmacist Ben Tally agrees.

"It's crazy to abuse them. I can't imagine wanting to because it's 
very dangerous," Tally said.

Marler can't understand why her son abused fentanyl, either. "If it 
had been a car accident, it would have been more understandable," she 
said. "But this was just an unnecessary death."

The Associated Press contributed to this report.
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MAP posted-by: Beth Wehrman