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Efeitos adversos do fentanilo como droga de abuso
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Abstract(s)
O fentanilo é um analgésico opioide sintético, de elevada potência, rápido início e curta duração de ação. Desde a sua primeira síntese em 1960, diversos análogos foram desenvolvidos, com propriedades farmacológicas específicas. Este medicamento apresenta um elevado valor clínico, com múltiplas indicações terapêuticas, como adjuvante em diversas técnicas de anestesia e tratamento da dor crónica oncológica e não
oncológica. Contudo, apresenta um grande potencial para utilização como droga de abuso, uma vez que induz a sensação de recompensa, a dependência física e ainda a adição. Atualmente, o fentanilo é responsável por um grande número de mortes por sobredosagem, devido à sua elevada potência, sendo que estes números têm vindo a aumentar substancialmente todos os anos. As sobredosagens de fentanilo ocorrem
maioritariamente devido à indução de estados de depressão respiratória grave e rigidez muscular, sendo mais dificilmente revertidos pela naloxona, o antagonista opioide utilizado no tratamento de sobredosagem de opioides. Adicionalmente, devido ao seu rápido início de ação, a margem temporal para intervenção terapêutica nestas situações é muito curta. O fentanilo é a principal substância de abuso associada às últimas vagas da crise de opioides, que tiveram início nos Estados Unidos da América, mas também têm vindo a crescer na Europa. A maior problemática da atualidade é a produção de fentanilo em laboratórios clandestinos, sem medidas de controlo de qualidade de segurança, sendo posteriormente vendido ilicitamente. Também tem sido utilizado como adulterante de diversas substâncias de abuso, como a heroína, sendo que as interações e efeitos que provocam no organismo não são ainda conhecidos, aumentando exponencialmente o risco
de morte por sobredosagem. Assim, diversas medidas têm vindo a ser implementadas numa tentativa de combater este problema de saúde pública, contudo, o mercado de venda ilícita de substâncias de abuso continua a desenvolver estratégias de forma a contorná-las.
Fentanyl is a synthetic opioid analgesic with high potency, rapid onset of action and short duration of action. Since it was first synthesized in 1960, several analogs have been developed, with specific pharmacological characteristics. This drug presents a high clinical value, with various therapeutic indications, such as adjunct in various anesthesia technics and oncologic or non-oncologic chronic pain treatment. However, it presents a great potential to be used as an abuse drug, since it induces reward, physical dependence and addiction. Currently, fentanyl is responsible for a great number of overdose induced deaths, due to its high potency, with these number rising substantially every year. Fentanyl overdoses occurs due to its respiratory depression and muscle rigidity effects which are more difficult to reverse by naloxone, the opioid antagonist used in opioid overdose treatment. Furthermore, due to its rapid onset of action, the available time frame for therapeutic intervention in these clinical situations it´s very short. Fentanyl is the leading abuse substance associated to the last waves of the opioid crisis, which firstly began in the United States, but have also been rising in Europe. The greatest nowadays problem is the fentanyl production in clandestine laboratories, without quality control and safety measures, which is sold illegally afterwards. Fentanyl has also been used as an adulterant of many other abuse substances, including heroine, whose interactions and effects produced on the body, are yet unknown, which increases exponentially the risk of overdose induced deaths. All things considered, many measures have been developed to try to fight this public health issue, nonetheless, the illegal drug market continues to develop strategies to overcome these obstacles.
Fentanyl is a synthetic opioid analgesic with high potency, rapid onset of action and short duration of action. Since it was first synthesized in 1960, several analogs have been developed, with specific pharmacological characteristics. This drug presents a high clinical value, with various therapeutic indications, such as adjunct in various anesthesia technics and oncologic or non-oncologic chronic pain treatment. However, it presents a great potential to be used as an abuse drug, since it induces reward, physical dependence and addiction. Currently, fentanyl is responsible for a great number of overdose induced deaths, due to its high potency, with these number rising substantially every year. Fentanyl overdoses occurs due to its respiratory depression and muscle rigidity effects which are more difficult to reverse by naloxone, the opioid antagonist used in opioid overdose treatment. Furthermore, due to its rapid onset of action, the available time frame for therapeutic intervention in these clinical situations it´s very short. Fentanyl is the leading abuse substance associated to the last waves of the opioid crisis, which firstly began in the United States, but have also been rising in Europe. The greatest nowadays problem is the fentanyl production in clandestine laboratories, without quality control and safety measures, which is sold illegally afterwards. Fentanyl has also been used as an adulterant of many other abuse substances, including heroine, whose interactions and effects produced on the body, are yet unknown, which increases exponentially the risk of overdose induced deaths. All things considered, many measures have been developed to try to fight this public health issue, nonetheless, the illegal drug market continues to develop strategies to overcome these obstacles.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Fentanilo Opioides sintéticos Sobredosagem Droga de abuso