When we talk about fentanyl, you’re often shown images of pills — that’s the street form of the drug that cartels started manufacturing. As medicine, however, it largely comes in an IV. It’s a stark contrast between how the drug is being abused on the streets and how doctors depend on it to manage pain.
Dr. Maria Manriquez is an OB/GYN and addiction specialist for Banner University Medical Center, as well as a professor for the University of Arizona training the next class of doctors. In each role, she deals with fentanyl.
“In a hospital setting you use it for pain, analgesia,” she explains.
Like morphine, Dr. Manriquez says fentanyl is one of a few pain relievers that can be administered through an IV so, it’s a lifeline in the hospital. The dosing is nothing like what’s showing up in street pills.
“It’s very regulated and we know exactly what we’re giving — it’s not even comparable,” said Dr. Manriquez.
Fentanyl is used during surgery to sedate patients and suppress pain. It’s also used to manage pain for cancer patients, particularly when they’ve already built up a tolerance to other opioids. During labor, she says it’s not uncommon for new moms who need some relief from the contraction pain but don’t want or aren’t ready for an epidural to be given fentanyl through an IV. It works quickly and lasts about an hour. It also typically carries a different name, so most patients don’t realize fentanyl is ultimately what they’re getting.
“But, no one gets fentanyl going home, they get something else like oxycodone or hydrocodone.”
She says handling opioids is now a deliberate part of the training for her medical residents. The Arizona Opioid Epidemic Act of 2018 also put limitations on how many days of pills they can prescribe for patients.
“Each and every one of them is getting a full curriculum to have a good knowledge of what they’re prescribing and what the consequences are,” Dr. Manriquez says, paying particular attention to the consequences, like addiction, and how to help patients recover is also an important part of her teachings.
“Providing that non-stigma, compassionate care, which is really important in a person’s recovery.”