Actiq (Fentanyl) Lollipop Abuse
Actiq is a brand name for the opioid drug fentanyl.3 Actiq comes as a lozenge on a handle (like a lollipop) and the fentanyl is quickly absorbed through the oral mucosa (along with fentanyl that is swallowed being slowly absorbed through the gastrointestinal tract), helping to relieve pain.1,3 It is for controlling breakthrough cancer pain in individuals taking opioid medications around-the-clock and tolerant to them.1
Fentanyl, the active ingredient in Actiq, is between 50 and 100 times stronger than morphine.
The active ingredient in Actiq is fentanyl citrate.1 A manmade opioid pain medication, fentanyl's potency is between 50 and 100 times more than that of morphine.2 Fentanyl is prescribed in a number of forms and brands, including sublingual tablets (e.g., Abstral), patches placed on the skin (e.g., Duragesic), and injectable forms.3
In Actiq, the fentanyl is combined with inactive ingredients including citric acid, berry flavoring, and edible glue made with modified food starch and confectioner's sugar to create a berry-flavored medications sometimes referred to as fentanyl lollipops.1,3
Special care must be taken with Actiq. It may cause deadly respiratory depression and other adverse effects. It should be used only in individuals tolerant to opioid and should not be used for postoperative or acute pain. It should be kept where children cannot obtain it. Misuse of Actiq may occur.1
Prescription pain medication misuse and addiction are epidemic in the United States. Based on 2017 surveys, it was estimated that over 11 million people ages 12 and up misused prescription pain medications in the past year, including an estimated 245,000 who misused fentanyl in the past year. Additionally, it was estimated that over 1.6 million individuals ages 12 and up had a substance use disorder (SUD) involving prescription pain medications in the past year.5
The potent narcotic fentanyl and/or other synthetic narcotics (not including methadone) have been involved in a rapidly growing number of overdose deaths in the United States. Over 28,400 of the overdose deaths in 2017 were related to fentanyl and/or other synthetic narcotics (excluding methadone).8
Fentanyl misuse includes:5,7
- Taking the substance differently than prescribed (such as more often, in higher doses, or in a different manner).
- Taking the substance to get high or for euphoric feelings.
- Taking the substance without a personal prescription.
Fentanyl can produce effects similar to that of heroin but is actually a much more potent drug.9 Fentanyl's effects may include:2,3
- A euphoric "high."
- Pain relief.
The effects of fentanyl start quickly and have a short duration.3 Misusing opioids raises the risk of developing a SUD and of overdosing.10 Overdosing on Actiq can cause respirator depression and death.1
Whether someone is using Actiq appropriately or misusing it, they may experience side effects. Possible side effects that occur most often include:1
- Feeling dizzy.
- Sleep problems.
- Being confused.
Other potential side effects may include:1
- Respiratory depression.
- Low blood pressure.
- Weight loss.
- Decreased sexual desire.
- Difficulty swallowing.
Actiq overdose may occur in an individual who is not prescribed Actiq correctly, in an individual who takes the drug differently than prescribed, or in an individual who uses it without a personal prescription. The depression of the central nervous system (CNS) may be heightened in individuals combining Actiq and other substances, such as alcohol, other opioids, sedatives, or other substances that depress the CNS.1
Opioid overdose symptoms might include:4
- Breathing that is shallow and slow.
- Going to sleep.
- Becoming unconscious.
- Small pupils.
- Skin that is cold, pale, and/or blue.
Fentanyl overdose can be treated with naloxone, but due to the potent nature of the painkiller, more than one dose of naloxone may be required.2
If you suspect that a person may have overdosed on opioids, right away call 911. Do not leave the person before first responders get there. If you have naloxone, give it to the person. Do your best to make sure the individual stays breathing and awake. To avert choking, the individual should be positioned on his or her side.4
Effects of Actiq Use
Fentanyl attaches to opioid receptors.2,11 One effect of this is the release of a neurotransmitter called dopamine—a physiologic response that can prompt the person to desire taking the drug again.11
Drug use may increase dopamine more than natural rewards like food or sex.12
Actiq use may lead to tolerance, dependence, and addiction.1,2
Like many other drugs of abuse, continued use of Actiq can lead to tolerance.2,11 When tolerance has developed, the medication can no longer produce the same effects in the user at the same dose, which can drive the individual to take more.12
Actiq should not be prescribed to individuals who are not already tolerant to opioids.1
Over time, an individual may become dependent on Actiq, where nerve cells require the drug to normally function.1,2,10 Dependence can occur in those taking fentanyl as prescribed; however, it sometimes may result in or be an element of addiction.2,10 Suddenly stopping or decreasing fentanyl use will cause uncomfortable withdrawal symptoms in people dependent on fentanyl.10
Fentanyl withdrawal symptoms may include:2
- Bone pain.
- Muscle pain.
- Trouble with sleep.
- Legs moving uncontrollably.
- Cold flashes.
According to diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, an opioid use disorder is when an individual uses opioids in a troublesome pattern that considerably distresses or impairs that individual, demonstrated through two or more of the listed symptoms in the span of a year. Diagnostic symptoms include:13
- Craving opioids.
- Frequently using opioids more or for more time than intended.
- Use leading to stopping or decreasing significant work-related, fun, or social activities.
- Getting, using, or recovering from opioids takes up a lot of time.
- Still taking the same opioid dose is noticeably less effective, or requiring distinctly higher opioid doses for the effects wanted.*
- Not succeeding in decreasing or managing use despite attempts to do so, or persistently wanting to manage or reduce use.
- Although opioids are bringing about or worsening social issues that occur repeatedly or chronically, still using them.
- Using opioids still even when knowing that they are probably generating or worsening a mental or physical issue that occurs repeatedly or is chronic.
- Using opioids repeatedly in dangerous situations.
- Experiencing opioid withdrawal, or using opioids or similar drugs to prevent or reduce symptoms of withdrawal.(These do not count as diagnostic symptoms for opioid use disorder if a person is only using opioids while being properly overseen by a medical provider).
- Not carrying out important responsibilities at school, work, or home due to regular use.
When the opioid being used is fentanyl, this is called a fentanyl use disorder.13
- Cephalon, Inc. (2011). Highlights of Prescribing Information: Actiq.
- National Institute on Drug Abuse. (2019). DrugFacts: What is fentanyl?
- Drug Enforcement Administration. (2018). Fentanyl.
- Centers for Disease Control and Prevention. (n.d.). Preventing an Opioid Overdose.
- Center for Behavioral Health Statistics and Quality. (2018). 2017 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration.
- National Institute on Drug Abuse. (2018). Misuse of Prescription Drugs: Overview.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse. (2019). Overdose Death Rates.
- Centers for Disease Control and Prevention. (2018). Synthetic Opioid Overdose Data.
- National Institute on Drug Abuse. (2018). What classes of prescription drugs are commonly misused?
- National Institute on Drug Abuse. (2019). DrugFacts: What are prescription opioids?
- National Institute on Drug Abuse. (2018). Drugs, Brains, and Behavior: The Science of Addiction: Drugs and the Brain.