12 March 2007
States of Jersey Health and Social Services
Author: Dr Susan Turnbull, Deputy Medical Officer of Health
1st March 2007
NEWS RELEASE
Fentanyl deaths – public health alert issued to Jersey doctors and pharmacists
A public health alert, including new guidance for Jersey doctors and pharmacists, has been issued by Health and Social Services, following the deaths of up to five people here who are believed to have misused the pain-killing medicine fentanyl (brand name Durogesic). At the request of the Deputy Viscount, Dr Susan Turnbull (Deputy Medical Officer of Health) and Paul McCabe (Chief Pharmacist) have completed an enquiry into the use and abuse of this prescription medicine in the island.
Fentanyl has an important place in the management of chronic, severe pain which has been poorly controlled by less potent pain-killing drugs. An example would be management of severe pain associated with some cancers, and as part of terminal care. But the drug is very potent, about 200 times stronger than morphine, and so must be used exactly as prescribed to avoid the danger of accidental overdose.
Most of the Jersey fentanyl-related deaths appear to have been associated with injecting a fentanyl solution, using vinegar to extract the active drug from patches. As well as being potentially lethal, injecting extracted fentanyl can cause abscesses and thrombosis.
Fentanyl patches are believed to sell on the ‘black market’ here for £40 -80 per patch – the price varying by strength of the patch, and the current availability of ‘street’ heroin. The high ‘street’ price of heroin in Jersey seems to have led to a growing demand for prescribed fentanyl as an alternative. We are aware of disturbing cases where patients in genuine need of fentanyl have had their patches stolen, or have experienced harassment.
Twice as much fentanyl was prescribed in Jersey in 2005 compared with 2002. Growing awareness of problems of abuse of fentanyl, as an alternative to ‘street’ heroin – less available and relatively more expensive in Jersey than in the UK – has led already to a number of measures to help address the problem. These measures have included communications to GPs from Social Security’s Prescribing Adviser, and from the Alcohol and Drug Service, as well as limiting the type of fentanyl patch which can be prescribed here to a formulation (‘matrix’) from which it is more difficult to extract fentanyl to abuse. The Misuse of Drugs Advisory Committee has recommended a change in the law to require notification of fentanyl addiction to the Medical Officer of Health, and to prevent prescription of fentanyl to people with a history of drug addiction – unless there is demonstrable physical disease. This change is expected to come into force shortly.
Following the most recent death, the Alcohol and Drug Service published an alert (Note: see JEP ? 9 February – press release 8/2/07 “Dangers of injecting fentanyl”) aimed at those who may abuse fentanyl, warning that it can cause sudden death.
The main aim of the new guidance on fentanyl prescribing in Jersey is to raise awareness of the cluster of recent deaths, and to urge all those who prescribe or dispense to recognise their crucial role in helping reduce the amount of fentanyl in circulation while maintaining its availability for safe use by people who genuinely need strong pain relief.
Dr Susan Turnbull, Deputy Medical Officer of Health, said,
“My enquiries suggest this is a problem in
Jersey which is not well recognised elsewhere – that is why we need a
Jersey solution. Five young men have died tragically. The escalating death rate in recent months is alarming. It seems that legitimately prescribed fentanyl may have been supplying a lucrative
Jersey ‘black market’.
All doctors who prescribe in
Jersey
have a very important role to play in ensuring that fentanyl patches are prescribed only for people in genuine need. Above all, we need to preserve availability of fentanyl for that genuine need when it arises – it is an effective treatment for the relatively small number of people for whom other very strong pain killing drugs are not effective enough, and for people unable to swallow – perhaps because of throat cancer. These are people who may otherwise have their lives ruined by, or die in poorly controlled pain.
People who need treatment for drug addiction need to be referred to the Alcohol and Drug Service (Tel 716000). GPs should not attempt to treat addiction unless they are suitably trained and experienced. Fentanyl patches have no place in the management or maintenance of addiction ”
ENDS…..
NOTES FOR EDITORS
Contacts:
Dr Susan Turnbull
Deputy Medical Officer of Health
Le Bas Centre
s.turnbull@health.gov.je 01534 623746
Mr Paul McCabe
Chief Pharmacist
Jersey General Hospital
p.mccabe@health.gov.je 01534 622314
gov.je