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Warning on painkiller drugs

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Durban - South African health professionals have revealed that a handful of medicines sold locally contain the opioid, fentanyl.

Pharmacists say addiction to schedule-six medicines containing fentanyl is not common, although packaging inserts warn that the drug is an opioid and should “be prescribed only by persons knowledgeable in the continuous administration of potent opioids”, and with caution to former drug addicts.

Independent Community Pharmacy Association chairman Sham Moodley said medicines containing the opioid fentanyl were sold as painkiller patches and injections. Patches include the brands Adco-Tenyl and Duragesic, while the three brands of injections are Fentanyl-FSK, Pharma-Q Fentanyl and Sublimaze.

Moodley said since schedule-six medicine patients needed a doctor’s prescription it had to comply with special legal requirements when written.

“The medicines are used in management of chronic intractable pain that requires opioid analgesia, which cannot be managed by a lesser means such as paracetamol-opioid combinations, non-steroidal analgesics or as required dosing with short-acting opioids. Only if a doctor has failed with other treatment will it be used and the prescription won’t be repeated.

“Very few chronic patients are on this medication and it is usually only prescribed if the patient has late-stage cancer and it is used to make them comfortable.”

When a patient is prescribed the medicine in patches it would be a maximum three-to-five-day supply, Moodley said.

Moodley said “stringent precautions” were taken. Every patient prescribed the medicine had to be entered into a pharmacist’s schedule-six register which the SA Pharmacy Council inspected for irregularities.

But Moodley said no regulation required that the manufacturer should display a special warning on the potential side effect of becoming addicted to the drug, on the packaging.

“As this is an opioid, the prescriber will be aware of this potential and take this into account with each individual patient.

“The package insert carries a list of precautions and side effects, which the health-care professional will weigh against the risk of pain relief and discuss with the patient.”

Sparkport City pharmacist Ebrahim Paruk said the packaging insert warned that Durogesic should be “used with caution in patients who have a history of drug or alcohol abuse, especially if they are outside a medically controlled environment”.

“Tolerance, drug dependence and psychological dependence may develop on repeated administration of opioids.”

But Moodley said that used under the supervision of a doctor and pharmacist, the drugs were useful tools in patient care.

The University of Cape Town Medicines Information Centre, which provides information to pharmacists, said the drug, when used correctly under doctor’s supervision, could play an important role to relieve severe pain. - Independent on Saturday

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