Side Effects of ACTIQ Abuse

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ACTIQ is a brand name for fentanyl, an extremely powerful opioid painkiller that is used only for severe pain such as breakthrough cancer pain 1.

Fentanyl is available in a number of formulations and delivery methods, including 2,3,4:

  • Tablets and films that dissolve in the mouth.
  • Patches that are affixed to the skin.
  • Injections.

ACTIQ is different, however. This substance is what’s known as a troche, which is a lozenge containing fentanyl and several inactive ingredients like confectioners’ sugar and citric acid on the end of a handle. Because of the appearance and the method of use, ACTIQ is sometimes referred to as 3:

  • ACTIQ lollipop.
  • Fentanyl lollipop.

Over recent years, the rates of theft, fraud, and illegal distribution of fentanyl has increased dramatically. According the Drug Enforcement Administration (DEA), there were over 3,300 reports of illicit fentanyl in 2014, which is more than a 300% increase from the previous year 3. For more information, refer to our Overview on ACTIQ Abuse page.


Is ACTIQ Harmful?

Yes. Despite its usefulness in the treatment of pain that cannot be controlled with other measures for people with cancer, ACTIQ can be very harmful in many ways. Fentanyl is potent opioid with the potential to quickly and severely impact the physical and mental health of the user. The misuse of ACTIQ can lead to serious injury or even death.

Misuse can lead to serious injury or even death.

The abuse potential for a powerful drug like ACTIQ is difficult to ignore. In 2014, nearly 4.3 million people reported recent abuse of pain medications like 5. Per the DEA 3:

  • About 20,000 people presented to emergency rooms for issues related to fentanyl use in 2011, a significant increase from less than 16,000 in 2007.
  • In 2013, fentanyl was related to 292 deaths in Florida alone.

Fentanyl overdose has become a major problem in recent years. In fact, the death of legendary singer/songwriter, Prince, was attributed to an accidental fentanyl overdose in early 2016. Not only are people seeking out fentanyl for its potent high, but many heroin distributors are lacing their product with fentanyl to provide a stronger high to users and increase their profits.


Short-Term Effects

close of eye euphoria

ACTIQ provides significant pain relief and, when misused, a euphoric high. Like other opioids including heroin, oxycodone, hydrocodone, the fentanyl in ACTIQ binds to and activates opioid receptors in the brain—a biochemical event that is associated with an increased release of a neurotransmitter called dopamine 2.

Dopamine is present in areas of the brain involved in the regulation of emotion, movement, and motivation 6. The release of dopamine is, in part, associated with the pleasurable short-term effects of ACTIQ, such as 2,3,7:

  • Euphoria.
  • Physical and mental relaxation.
  • Drowsiness and sedation.

The increased levels of dopamine in the brain provide very strong feelings of pleasure and reward. There is a normal release of dopamine that occurs when an individual engages in healthy activities; drugs like ACTIQ, however, elicit a release of excess amounts that normal healthy activities can’t match. This artificial stimulation of our innate reward system can soon result in abusers prioritizing use of the drug above all else, regardless of the fact that it is actually causing harm, not positive benefits 6,7.


Side Effects

People that use and abuse ACTIQ are at risk of many unwanted side effects, even if the drug is being used exactly as ordered by their prescriber. Both acutely and over time, some side effects of fentanyl may include 4:

  • Fever.
  • Chills.
  • Nausea.
  • Vomiting.
  • Dehydration.
  • Weight loss.
  • Weakness.
  • Changes in blood pressure.
  • Sleepiness or trouble sleeping.
  • Hyperalgesia, or an increased sensitivity to pain.

  • Migraines.
  • Cough.
  • Sweating.
  • Constipation.
  • Itching skin.
  • Dizziness.
  • Confusion.
  • Agitation.
  • Anxiety.
  • Depression.

The most serious side effects of ACTIQ include 1,4:

  • Depressed breathing that could lead to death.
  • Cardiac depression that could lead to dangerously low blood pressure.
  • Fainting.
  • Seizures.

ACTIQ Overdose

With powerful drugs like this, there is an increased risk of overdose relative to less potent opioids. Fentanyl is much more potent than many other opioids—between 50 and 100 stronger than morphine—so ACTIQ must be administered carefully. When people abuse it and/or try to increase doses on their own, they results may be lethal 2.

Signs and symptoms of overdose include 4:

  • Marked disorientation.
  • Copious, uncontrollable vomiting.
  • Non-reactive, pinpoint pupils.
  • Profound drowsiness.
  • Loss of consciousness.
  • Slowed or stopped breathing.
  • Cyanotic appearance, or bluish tinge to lips and nailbeds.
  • Death.

Overdose of opioids can be treated with an opioid antagonist, naloxone, to reverse some of the potentially lethal drug effects. Due to fentanyl’s potency, the overdosing person may require much higher levels of this drug (and/or repeated administration) before the antidote takes effect 2.


Long-Term Effects of Abuse

ACTIQ has some unique risks related to the “lollipop” administration 1:

  • Dental problems related to the amount of sugar in the lozenges:
    • Tooth decay.
    • Tooth loss.
    • Gum erosion.
  • Oral health issues at the site of administration:
    • Pain.
    • Irritation.
    • Ulcers.

In the long term, someone abusing ACTIQ could see an increase in severity and frequency of appearance of many side effects. For example, the mental health symptoms that begin as depression, anxiety, and agitation can increase in intensity, or additional symptoms may appear like 1,4:

  • Hallucinations – Having sensory experiences that are not real, such as hearing and seeing things that are not present.
  • Paranoia and/or unusual or deluded patterns of thinking.
  • Having unusual dreams.

People using opioids over a long period of time may experience harm related to repeated periods of depressed respiration. As mentioned, ACTIQ may slow a user’s breathing, especially at high doses.

When a person’s breathing is impaired, the individual is at risk of inadequate oxygen delivery throughout the body—a condition known as hypoxia. Effects of this condition may include brain damage and coma.


ACTIQ Addiction

Someone using ACTIQ is at risk of become addicted to the substance. Addiction is closely linked to both tolerance and dependence.

It is an extremely potent opioid, and so is only prescribed for people tolerant to other opioids. Once tolerance develops, a substance will no longer produce the wanted effect at previously effective doses. To counteract tolerance, the person must consume the drug in larger amounts and/or at increased frequencies 6.

With persistently elevated levels of an opioid like ACTIQ, an individual will begin to feel as if they require the drug to function normally—a point at which physical dependence is said to have developed 6. Dependence and tolerance are common occurrences seen in association with opioid use and happen to both those abusing the drug and those taking it for medical need.

Those who use ACTIQ—and especially those who misuse it—are at risk for developing the compulsive drug use behaviors seen in substance addiction. Though there are commonalities between the two, addiction and dependence are not synonymous.

woman with dependency

Addiction is a complex condition that has biological, psychosocial, and environmental factors that influence it. It is displayed through behaviors like 1:

  • Inability to control use.
  • Using impulsively.
  • Continuing to use even when ill effects are likely to occur.
  • Strong cravings for more of the substance.

Addiction and addictive behaviors will be more apparent than dependence, since dependence has few outward indicators.

Perhaps the clearest way to confirm that physiological dependence exists comes when use of ACTIQ is cut down or stopped. At this point, should dependence be a factor, withdrawal symptoms will begin 6.


Withdrawal and Addiction Treatment

 For many who struggle with opioid use disorder, withdrawal is a major driver of continued, compulsive drug abuse and addiction. Opioid withdrawal, while rarely dangerous, is physically and emotionally distressing and can trigger a relapse in the most well-intentioned user.

Fentanyl withdrawal symptoms include 6,7:

  • Insomnia.
  • Anxiety.
  • Pain.
  • Diarrhea.
  • Vomiting.
  • Fever.
  • Chills.
  • Diaphoresis or increased sweating.
  • Muscle cramps.
  • Involuntary muscle movements.
  • Feeling jittery.

These symptoms can be extremely unpleasant, and users going through ACTIQ withdrawal may require assistance in staying abstinent with the help of medically supervised detoxification 9.

For someone with a prescription for ACTIQ, they may be given another medication to manage their pain. Others may be stabilized with the help of different medications prescribed for withdrawal to minimize cravings and manage the effects of opioid withdrawal. Medications used as part of MAT include 8,9:

A full or partial opioid agonist like methadone or buprenorphine that produces opioid effects at significantly lower levels to reduce cravings and withdrawal symptoms.

  • Probuphine, a buprenorphine implant that provides low doses at a steady rate for 6 months.
  • An opioid antagonist like naltrexone, which is only used once the immediate withdrawal symptoms have subsided. Antagonists can attach to opioid receptors and block the effects of opioids and in doing so potentially decrease the drive to continue using.
  • A non-opioid medication originally used for blood pressure called clonidine that can minimize some of the unpleasant withdrawal symptoms.

Whatever steps are used to manage dependence and withdrawal, behavioral therapy will be an important part of the recovery process. In fact, MAT is called medication-assisted treatment because the treatment is assisted by—not solely made up of—medication. Treatment may take place on an in-facility or inpatient basis or outpatient/outside basis.

If you have been abusing ACTIQ or you know someone how is, you can find help now. To begin the process, call 1-888-744-0069 .


References:

  1. S. Food and Drug Administration. (2011). ACTIQ.
  2. National Institute on Drug Abuse. (2016). DrugFacts: Fentanyl.
  3. Drug Enforcement Administration. (2015). Fentanyl.
  4. S. National Library of Medicine: Medline Plus. (2016). Fentanyl.
  5. Substance Abuse and Mental Health Services Administration. (2015). Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.
  6. National Institute on Drug Abuse for Teens. (2016). Prescription Pain Medications: Opioids.
  7. Kosten, T., George, T. (2002). The Neurobiology of Opioid Dependence: Implications for Treatment. Science and Practical Perspectives, July 2002, 13-21.
  8. National Institute on Drug Abuse. (2014). Research Report Series: Prescription Drug Abuse.
  9. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
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Eric Patterson, MSCP, NCC, LPC, is a professional counselor who has been working for over a decade to help children, adolescents, and adults in western Pennsylvania reach their goals and improve their well-being.

Along the way, Eric worked as a collaborating investigator for the field trials of the DSM-5 and completed an agreement to provide mental health treatment to underserved communities with the National Health Service Corp.

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