By Lt. Cmdr. Ian Fowler, Naval Medical Center Portsmouth, Va.
Morphine has been used to alleviate pain from war injuries for more than 100 years. It was widely used back in the Civil War, and is still used by Navy corpsmen and Army medics in war zones.
But another drug is starting to supplant morphine on the battlefield. It’s the fentanyl “lollipop.” Although it’s called a lollipop, it is far removed from the candy every child loves.
This lollipop is basically a white lozenge on a stick. The corpsman or medic places the lozenge either under the tongue or inside the cheek and the medication is taken up through the tissue in the mouth. Unlike morphine which takes 15 to 20 minutes to relieve pain, the lollipop is effective within five minutes.
It’s also much easier to administer than morphine, which must be injected into a large muscle, and if the dosage is too strong the lollipop can be rapidly removed. The effects of morphine cannot be halted.
As a pain specialist at Naval Medical Center Portsmouth, Va., I encounter patients every day who seek relief from chronic and acute pain. We have many medications and strategies for managing the devastating effects pain has on the individual. One of our tools is the fentanyl lollipop.
We’ve been using it in a clinical setting for years and only prescribe it for patients who suffer extreme debilitating pain. It’s usually reserved for end-stage cancer patients who suffer what’s called breakthrough pain. We counsel them on the effects (and side effects), how often they can use it, and other important information.
This is a C-2, or Schedule II, drug, which means it’s highly regulated. It’s a controlled substance with a high potential for abuse. And even though the drug doesn’t look like a traditional lollipop, we warn patients to keep it away from children. We counsel patients, the pharmacists counsel patients on keeping this medication completely out of sight of children who might think or misinterpret it as candy.
The fentanyl lollipop and morphine injectors are both being used on the battlefield. I was deployed to Afghanistan last year and saw that the Army was using the lollipop. Navy corpsmen, too, are now authorized to carry it with their Marine units. All lollipops and morphine syrettes must be accounted for.
So will the fentanyl lollipop replace the traditional morphine injectors that have been carried into battle for more than 150 years? That question has not been answered, but I would expect that the pros and cons of each are being thoroughly studied.