Fentanyl Overdose: Street vs Surgery (and San Francisco Opioid Crisis)
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- Опубліковано 16 вер 2022
- The opioid epidemic is related to pain medication used in surgery. Most patients don't know they're receiving fentanyl under anesthesia. Here's the difference between surgery and the streets.
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Fentanyl is one of the most widely used and abused medications, causing overdose both on the streets and in the operating room. It is a synthetic opioid that has become very cheap in recent years and has spilled on the streets of San Francisco and the rest of the United States, well outside of the operating room where I use it safely every day in surgery for anesthesia.
I practice anesthesia and integrative medicine in the San Francisco Bay Area, where the opioid epidemic has caused countless deaths from overdose, over 150 per month. Fentanyl has caused a plurality of these overdoses and deaths, particularly in San Francisco. It breaks my heart to see how tragic an effect such a powerful medication has in the wrong hands without the proper training.
The problem has become so severe that my patients often get anxious and scared before surgery when they hear that I will be giving them fentanyl for their anesthesia. This extra anxiety and fear can cause complications in the operating room and in recovery after surgery.
I want to reduce the anxiety and fears that my patients have before surgery, because mental health is so important to our wellbeing and physical health inside and outside the operating room. That's why we will discuss the dose of fentanyl used in surgery versus the dose used on the street, what it actually does to your body, and ultimately why it is safe and necessary to use in the operating room, but so dangerous on the streets.
We will also discuss the steps San Francisco has taken to reduce the opioid overdose crisis from fentanyl under District Attorney Brooke Jenkins. Overcoming the opioid epidemic, particularly in San Francisco, is a complicated problem. The solution will heavily rely on all of us being accountable to each other as much as we are accountable to ourselves. We have more power to control our health than we have ever been told, and with that accountability and responsibility for our health is great hope for saving lives and living safer.
Music credits: Disco Lounge by Kevin MacLeod
Just had major abdominal surgery. I am on a patch from my palliative care team. I was surprised how many residents and nurses are sharing misinformations on this med. it’s serious but I was judged so many times. It allows me to live a relatively active and more important MEAningful life
That's a powerful experience to share!
@@MedicalSecrets thank you for being do caring. You give me hope for the future of medicine.
My wife had West Nile about 10 yrs ago. Ascending paralasys, menengits, encephilitis and demyelinating myelitis. The fentynal patch (time release) saved her.
Probably saved me as well - no I didn't take it, I was just losing my mind as she was in so much pain after she was released from 6 weeks in hospital.
Same this my mom when she went into hospice.
Thank you for explaining this subject of fentynal. I have a bad spine since 2008 & I have the fentynal patch as well as breakthrough meds. The patch has been a godsend for me as it doesn't give me the up/down pain like morphine pills did. That's why the dr gave it to me. Since 2016 I was forcibly reduced very quickly & my quality of life diminished overnight. There's so much misinformation about the opiod epidemic. Though prescribing is down 60% the overdoses are up 600%. You would think that the govt, cdc etc would see that they're doing something wrong with the epidemic. They're only hurting pain patients & not cartels & dealers. I'd much rather have safer prescription opioids on the street than the illicit stuff because it's harder to OD from the pharmaceutical kind. Obviously from the huge number of overdoses we have now.
I fell a home and fractured my rib. I didn't realize for a while how injured I was, but the pain got more and more excruciating. When EMS got an IV in me in the ambulance and I said my pain level was a 9.5 he said he was going to give me fentanyl. I might have really freaked out hearing that if I had not worked in a hospice house where they used fentanyl patches on patients. I trusted them. This is a miracle drug! I was in excruciating, excruciating pain. As soon as that push in my IV the pain halted. It was really like a miracle to have that dramatic of a change in a split nanosecond!
Fortunately no punctured or lacerated organs. Just an encased 11th right rib. Doing well. Managing on Tylenol. Trying to avoid the hydrocodone. Thanks for all you do!
This doctor is awesome. Thank you
This was explained so well. That is so scary with the comparison to street drugs, I had no idea. Thank you for the education and for being a great anesthesiologist and teacher!
Thank you!
We carry fentanyl on our ambulance now. People worry about getting addicted. We have to explain how little we actually need to use.
thank you for speaking about such an important topic!
I appreciate your professional skills and kindness sharing the video with kindness and respect
Thank you for this video. I am on fat now for prostate cancer and it made friends with both of my lungs and both of my kidneys and it also is in my tail bone and I was afraid to use it now because of everything I’ve seen on TV are you sure made me feel a lot better about being on it!! thank you
Another great, informative video. Thank you.
I have my procedure rescheduled for tomorrow, I feel much more prepared and comfortable thanks to your videos. Thank you for answering my question about pain when getting propofol administered in the live chat. I'm going to ask for an elbow IV tomorrow!!!
I wish you the best tomorrow! 🙏
@@MedicalSecrets I’m ashamed to admit I backed out of getting a colonoscopy for a 2nd time, they actually got the IV into me but I panicked when my arm started to get cold. Both the anesthesiologist and doctor tried to talk to me and make me more comfortable but i experience absolute fear of not being able to go home. I am going to check your home page and look to connect with you (for a fee of course) I don’t want this fear to end up killing me. Maybe we can schedule a 15 min call i thought that I was prepared today but it all crumbled when they got the IV into me.
@@manley1979 that takes a lot of vulnerability to admit. That's an important part of the process. I wish the best for you in finding a provider to help you overcome your fear, naturally if possible 🙏
Excellent informative video ❤
I used to live near The Mission in the 90s and got myself a pretty good H habit. Thankfully, got off it 23ish years ago.
Now the fent is showing up everywhere including 'street' drugs (weed, coke, meth, etc.) So grateful to be away from all of that, and I really feel for those who are still 'out there'. And now, to make matters worse, there's 'traq dope' (xylazine-fentynal). Just heartbreaking.
Love this guy!!!!
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Thank you!
Thanks for another great video , i really enjoy them ...
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This happened to me today during eye surgery. They blamed me, said I’m just a lightweight. I don’t drink, do drugs smoke or anything like that. They knew that. I just want to know what happened to me. I’m in so much pain -literally needles in my eye pain bc the Narcan was used.😢 Thank you for making this video.
First time. I turn the post notifications on let’s go doctore
I hope you learned something! Keep on empowering yourself!
this is so interesting 😊thank you dr
I recently had a major surgery. I don’t tolerate opiates well & can only take synth opiods - tramadol & apparently now fentanyl for iv. When meeting my anesthesiologist pre-op I was explaining my concerns re: opiates & he suggested fentanyl. Like the patient you described in this vid, I was concerned about the use of fentanyl bc of the street version. I did end up tolerating it well.
I typically have a high pain tolerance, so much so that I rarely take any rx pain meds post op. Since my tonsillectomy 20’ish years ago when I was given an opiate & got sick, I stopped taking pain meds not understanding the different options. I had a few more surgeries & didn’t take any rx pain meds. I did have a few surgeries since (a tubal, acl reconstruction, bunionectomies, hand surgery, etc.) & only took tramadol for 1 of the bunionectomies (x1) & the hand surgery (x2 iirc).
This last injury that resulted in facial reconstruction surgery was beyond excruciating. I ended up needing 3 pushes of fentanyl (I thought it was more, but my records say 3) post op & I remember it not being enough. I think they ended up “kicking me out” of recovery. 😂. I was still in excruciating pain. The next few days were miserable. I was finally discharged a few days later when they felt they had my “pain under control.”
Great info!
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Thank you very much I learned a lot
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That is crazy how much higher the doses are on the streets. No wonder there are so many opioid related deaths and overdoses. It is such a strain on the medical system
well yes and no……a lot of the time the doctor didn’t mention those who became dependant from prescription medications taken exactly like their doctors ordered. Just everyday people taking their medicine and following doctors advice. then mix that with other medications like anti depressants and anti anxiety med cocktails. the problem is many doctors are i’ll informed and under educated when it comes to pharmacology.
❤ Thanks for the informative video. So pre-surgery anxiety could possibly make it look like one has used fentanyl or other prescription or street drugs before? Wow. Good to know.
Very well done thank you
I'm happy you appreciated it!
Very informative thank you! I’m not a big fan of opiates but if I need them you know after surgery or something like that I will take them but I definitely don’t wanna keep taking them!
I guess the tricky thing about the profession is having to have the tough conversation with a Px before planning for a surgery about their drug use (even illegal drug use), so that an anesthesiologist can plan for proper doses in the O.R. Fortunately, there are some ad hoc things that can be done to help with Px safety, but I have to wonder how many people may lie about their drug use to their doc out of fearing retaliation with the law or other issues of reputation.
I feel better about getting my knees replaced - I am told that analgesia is important for healing and avoiding scarification, but I don't want to wind up as an addict.
Opioid hysteria has gone too far in medicine in America. Cancer, hospice, elderly & chronically ill patients are being abandoned & denied humane pain care. The stories are horrendous & modern day torture. You don't want to get sick in America. Drs are torturing people, afraid to prescribe. I'd rather get treatment in Mexico than enter a US ED where doctors don't treat pain & have become modern day eugenicists, culling disabled & elderly by torturing them. I never thought I'd live to see the day doctors in America tortured the sickest in society but after doing research it now makes sense... The 3rd cause of death of Americans is MEDICAL MISTAKES. 1 in 3 drugs have safety issues after FDA approval. Scary! Statistics that make you see why it's not safe to get care in the US. You'll likely be maimed in surgery, then abandoned in horrific life altering pain with no pain care after they botch & butcher you. You're a rarity in the US health field.
I worked in surgery for 16 years and never witnessed a botched surgery.
@@ccoop3774 how long did you follow / study patients after they left the operating theatre?
@@snafu22 I developed MSSA after a spine surgery after I retired. That was 3 weeks post op. That was on me, not the hospital.
@@ccoop3774 sorry to hear that. However that doesn’t answer my question.
@@snafu22 I already answered your question! I wrote that I worked in surgery. That means 8+ hours per day, 5+ days per week, 50 weeks per year! That was my job! My job description didn't include anything else!
When I got my last colonoscopy one of the nurses said that fentantyl was one of the drugs used. I wasn't worried, I just assume they know what they are doing. I was in and out of sleep during the procedure but managed to talk to dr. and nurses and watch as a polyp was removed. I was diagnosed with fibromyalgia in the 90's. I have had chronic pain since as I also have sheurmanns disease in my spine.These last years are Have been unbearable with pain. I have to say, The rest of the day after the procedure was amazing. No pain, no drugged feeling. It was marvelous. I joke sometimes and say how I should go for one weekly..
hey doc…….how come it’s easier to withdraw from street or illicit drugs like heroin than some prescription meds like benzos and antidepressants?
Can you please do an episode on analgesia in recovery or PACU and reversal agents?
That's a great topic! What in particular did you want to learn more about?
Morphine and fentanyl usual doses and reversal agents as well as considerations in their use after different types of anaesthetic. Ondansetron granisetron and cyclizine doses. Please.
Very informative thanks Doctor❤, scary but educational
I’m curious *why* we use synthetic opioids instead of organic?
Oh yeah and my cousin was addicted to Fentanyl then he got off of it for 6 months and then he went to a rehab and he was about to get out and for some reason he went to his room and smoked fentanyl and overdosed and died. How does that happen at a rehab? He was only 36, good looking, great young man.
When I had a hysterectomy they gave me through my IV valium, fentanyl and I think moraphene. After the surgery they only gave me two percocets in pill form. I was waiting for them to put it in my IV cuz it works better and she brought me those 2 pills and they did nothing.
Was given fentanyl for cardiac cath. Diastolic tanked to 40.
I have been on Morphine and Fentanyl after my neurosurgeon botched up my surgery. You may have heard of my DFW surgeon, Dr Death. I have been on the Fentanyl/Morphine combo since 2012. I have been evaluated for a pain stimulator and told that I am not a candidate. I have also considered the pain pump however the pump is still going to require some type of opiate therapy. I have inquired about a permanent nerve block and because of the level of the spinal cord damage that too is not an option. I am a clinical social worker by trade and have seen the damage long-term opiate therapy can cause. Any suggestions?
I am so sorry about what you experienced, that's so heartbreaking to hear. Have you considered an integrative pain specialist?
I would like to know your opinion regarding a friend of mine. He had a total knee arthroplasty. He is one month post op. Still needing walker to ambulate. He is getting Percocet 40 tabs every 5 days. Should his wife be concerned?
If he's in pain, leave him alone. Do you want him to suffer?
Iam a chronic pain patient and on hydrocodone with Tylenol presently. The strongest stuff I personally have taken is oxycodone with Tylenol. This md scares the crap out of me. All u would have to do is touch this stuff to Overdose. I would even be scared to be prescribed this md in hospital honestly
U say the body builds a tolerance! I have had like 4 surgery’s but like 3 yrs apart from each other and my last one was hernia repair in 2019, if I need another surgery like in let’s say a week. Will I be too tolerant? I hope I don’t need surgery soon but if I do can I still have general anesthesia? I do not use drugs and am anti street drug use
i’m no expert like this brilliant doctor but generally speaking in most cases excluding certain parameters like genetics etc tolerance happens when drugs are used chronically. for example, many people will use a benzodiazepine occasionally to help with flying, either anxiety from flying or help sleep for jet lag or may use it once or twice for a dental procedure and so shouldn’t form a dependency . however some doctors prescribe them to be used daily to treat an anxiety disorder or grief after the loss of a love one or chronic sleep issues and so using them everyday for more than a few weeks dependency can arise that quickly as they make changes to your brain and CNS by down regulating or trimming back GABA receptors so that’s when tolerance hits and you’ll need more and more of the drug to get the same effect or if you stop the drug you’ll go into a withdrawal state. Which can take days to weeks to months or even years in some instances to recover from. i know, pretty scary huh! But a one off surgery or a couple a short time like even a few weeks apart shouldn’t be an issue especially a life saving surgery. So for you, three years since your last operation, you won’t be tolerant
You'll go under just fine, Mike!
hi, SNAFU summed it up well. We can always chat about it on the next live, too!
I'd mainline the fentynal if that's where the relief is.
I have had a few surgeries in the past, but with my last one earlier this year I stopped breathing when they pushed me back into the wards. The doctor said that it could have been the opioids they gave me in the OR that suppressed my breathing, but nothing like this has ever happened before. What could have caused this sudden reaction?
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Quite possibly from higher doses of opioids medications
I had a reaction from something with my last surgery, I woke up in so much pain and I couldn’t even open my eyes and focus the pain was so severe, additionally, I was so cold they had to put the hypothermia machine on me, and couldn’t get my temperature. No one ever told me what happened to me. Any ideas??
Without knowing more information, about the type of surgery, in particular, I can't really comment. I'm so sorry that you experienced that, and we can definitely talk about it on the next live stream if you would like
still don't understand why people do not become addicted to fentanyl after surgery. Is it just b/c the dose is so much lower compared to street fentanyl?
For a hundred years powerful drugs have been used in hospitals, without everyone getting addicted. If you have pain and take as prescribed, most won't have a problem.
Are you a ÚCSF doctor?
I used to be a researcher at UCSF, but now I practice another centers in the San Francisco Bay area
I think I've found why your costs in the hospital for fentanyl are so high. It's all those extra tubes and stuff you stick in them patients!
-Dr. Feelgood (Doctors Without Licenses)
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Hello Doc,
I have a question about general anesthesia and it's safety.
I'm really terrified of going under General Anesthesia I have surgery scheduled next week (adenoidectomy + septoplasty) but I'm really scared to go under GA. I have this irrational fear that I won't wake up from it.
Though I'm a healthy and athletic (22 yrs old) male, the thought of losing control over my senses terrifies me. My resting heart rate has always been around 45-55bpm. I don't have any medical conditions except for some fluctuations in my BP it was around (130/85) when I went for routine health check up. All my other blood work (Surgical profile) appears to be normal. (Alhamdulillah) I've been cleared by the anesthesiologist as being 'fit for surgery'
This is the first time I'm going under and I have no idea how it feels. However my sister underwent GA for some cosmetic surgery without having any adverse reaction. So hopefully I can make it without any complications too (In sha Allah)
I know general anesthesia is quite safe (especially for my age and health condition plus I'm getting my procedure done in a reputed hospital [Apollo]) but still I can't seem to get over my fear. I just don't want to embarrass myself or my parents by trying run to away or resist while being taken to the operating room.
I have this fear that while they give me propofol everything will suddenly go all black and it scares me.
And another doubt I have is that what if something goes wrong like if they have difficulty putting the breathing tube in time? Will I die as I won't be breathing on my own or a person can still breathe on his own after being given general anesthesia?
Is there any way they can calm me down before taking me to the operating room? I've heard versed (Midazolam) helps with anxiety and calms the patient. But my anxiety and fear is severe and I'm afraid it won't have much affect on me.
I can't even avoid this surgery as it's severely effecting my hearing by blocking my Eastuchian tube.
Thankyou.
Are you doing ok now?
You are very human but how about the surgeon? His attitude may be far from your’s. They tend to do it as a routine and one is just a living cadaver.
I worked with surgeons for years and have never seen any one of them refer to a patient as a living cadaver!
There is a lot of variability in doctors, for sure, but I believe the vast majority treat patients respectfully
I have seen dozens upon dozens of red poppy seed plants 🪴 in my life.