1. Julie Latimer DANA NSW Drug & Alcohol Nurses Forum September 2014

2. MSIC provides:  A practical and compassionate response to drug injecting  Supervision of injecting episodes that might otherwise occur in less safe circumstances such as public places or alone  A safer environment where immediate medical assistance is available if required  Access to health & social welfare services for a marginalised & difficult to reach population

4.  Powerful synthetic opioid analgesic  100 times more potent than Morphine  Highly lipid soluble = rapid onset  Transdermal patch  Prescription of fentanyl patches in Australia has increased dramatically since 2006

5.  First recorded use at MSIC Sept 2012  Higher incidence of overdose compared to other opioids  Increase in use now that new formulation of Oxycontin (OP) available

7.  High incidence of overdose due to potency  Fatalities internationally & nationally  Misinformation around dosage  Complicated preparation process  Tolerance rapidly increases with regular use

8.  Have you used Fentanyl before?  Do you know the Oxycontin equivalent of the patch you have?  How do you prepare it for injection?  How many 80mg Oxycontin tabs do you usually use?  Have you ever overdosed after using Fentanyl?

9.  Discussion with clients regarding dose and knowledge base  Increased chance of overdose – may happen quickly  Close observations – 1st 20 mins are important  Clients report effects are not always pleasant

10. Patch strengthFentanyl content Approximate Morphine equivalent Approximate Oxycontin equivalent 100mcg per hour 16.8mg 1680mg (16.8 x 100mg Morph) 1120mg (14 x 80mg Oxy) 75mcg per hour 12.6mg 1260mg (12.6 x 100mg Morph) 840mg (10.5 x 80mg Oxy) 50mcg per hour 8.4mg 840mg (8.4 x 100mg Morph) 560mg (7 x 80mg Oxy) 25mcg per hour 4.2mg 420mg (4.2 x 100mg Morph) 280mg (3.5 x 80mg Oxy) 12mcg per hour 2.1mg210mg (2.1 x 100mg Morph) 140mg (1.75 x 80mg Oxy)

12.  Fentanyl is 100 times more potent than Morphine  Risk of overdose is much higher  1cm square of any strength patch will have the same amount of Fentanyl on it  Find out what the client knows about Fentanyl