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Post by suebeeee1 on Jan 19, 2016 17:02:09 GMT -5
Background:
Fentanyl, also known as Actiq, Duragesic, and Sublimaze, is a powerful opiate used for pain control. It is similar but much more potent than morphine. It is used to treat severe pain in individuals with injuries or chronic illness, after surgery or prescribed for individuals who are tolerant to other opiates. Fentanyl use disorder often occurs either due to the euphoric effects it produces during treatment, or due to the availability of stronger versions which produce even greater positive moods when mixed with heroin or cocaine. Often what starts as appropriate pain management can turn into a situation bordering on addiction without the individual recognizing they are taking the medication for non-medical reasons. Since it works to eliminate all pain in the body, not just the pain for which it was prescribed, and produces a powerful high, its attraction is hard to resist.
Question: MannKind Corporation was working several years ago with Torrie Pines Institute on designing opiates that existing patents describe as have non-addictive properties. Is it possible that a dry formulation of fentanyl may have been developed for pulmonary delivery that could eliminate fentanyl's addictive properties?
No the TP version of the drug was a peptide that probably did not cross the blood brain barrier and was non addictive. Fentanyll is poison when used chronically. Inhaled it is a short acting poison (because it's users will die quickly from overdoses). All you state about the side effects are directly related to liposulubility and only Sufentanyl is more potent and dangerous (IVDUs using it die on average in less than a year compared to 'a few' on fentanyl and well over 10 on morpine). There is no other way of sugar coating this (and the extraordinary lapse in scientific judgement that Mannkind seems to be having if it wants to make an inhalable fentanyl): tbis is sloppy science (and maybe a desperate management...). Sorry, I know quite a number of people who have been using high dosages of Fentanyl patches for nearly 20 years (Duragesic, brand name, was released in 1995). I know them because I have run pain support groups for people in chronic pain. Not one of them has ever experienced an overdose. We have heard a story of someone committing suicide with it by ingesting the gel in the inside, but this was unverified by any of us. I'm just not doubting it happens. There are street addicts who love this patch because they can extract small amounts at a time and injrect it. But people in chronic pain tend to be very, very careful with any schedule 2 drugs they have. They know that they allow them to live as normal as possible lives and they know that life without them would be unbearable and have become unbearable when they have been forced to change doctors. I understand inhalable Fentanyl which would be fast acting, may make it more prone to addiction in those who choose to use it that way. Right now, most people using a Fentanyl patch also have breakthrough meds such as Morphine Sulphate Immediate Release. That is also just as addiction prone. But, should a person live in intractable pain because someone is afraid they are going to become dependant upon the drugs? Inhalable fentanyl could be used in the ER instead of an injectable. It could be used for the breakthrough pain. It could be used in the military. The uses are endless.
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Post by jpg on Jan 19, 2016 17:16:33 GMT -5
No the TP version of the drug was a peptide that probably did not cross the blood brain barrier and was non addictive. Fentanyll is poison when used chronically. Inhaled it is a short acting poison (because it's users will die quickly from overdoses). All you state about the side effects are directly related to liposulubility and only Sufentanyl is more potent and dangerous (IVDUs using it die on average in less than a year compared to 'a few' on fentanyl and well over 10 on morpine). There is no other way of sugar coating this (and the extraordinary lapse in scientific judgement that Mannkind seems to be having if it wants to make an inhalable fentanyl): tbis is sloppy science (and maybe a desperate management...). Sorry, I know quite a number of people who have been using high dosages of Fentanyl patches for nearly 20 years (Duragesic, brand name, was released in 1995). I know them because I have run pain support groups for people in chronic pain. Not one of them has ever experienced an overdose. We have heard a story of someone committing suicide with it by ingesting the gel in the inside, but this was unverified by any of us. I'm just not doubting it happens. There are street addicts who love this patch because they can extract small amounts at a time and injrect it. But people in chronic pain tend to be very, very careful with any schedule 2 drugs they have. They know that they allow them to live as normal as possible lives and they know that life without them would be unbearable and have become unbearable when they have been forced to change doctors. I understand inhalable Fentanyl which would be fast acting, may make it more prone to addiction in those who choose to use it that way. Right now, most people using a Fentanyl patch also have breakthrough meds such as Morphine Sulphate Immediate Release. That is also just as addiction prone. But, should a person live in intractable pain because someone is afraid they are going to become dependant upon the drugs? Inhalable fentanyl could be used in the ER instead of an injectable. It could be used for the breakthrough pain. It could be used in the military. The uses are endless. ERs aren't exactly the biggest fans of giving powerful IV narcotics for obvious reasons... As for extremely slow release fentanyl versus fast in inhaled (or IV) fentanyl there is no comparaison. It's not a queation of being cautious or reckless. It's rapid physiological (and psychological) addiction. No one can resist. It's not a choice. One week (and probably much less than that) of inhaled fentanyl and you are in trouble. Try getting someone off a fentanyl patch! Imagine peaks and valleys of a highly liposoluble narcotic like fentanyl: humans (and mammals at large) don't stand a chance. Sorry but this is not political or even social. It's purely biological (and as a side note those narcotic patches would serve patients a lot better if they had used another drug than fentanyl with such a highly liposoluble narcotic: but than again that was the one they had a patent on and no one will ever invest the money to make a better narcotic patch that doctors would anyway ignore...).
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Post by babaoriley on Jan 19, 2016 17:22:55 GMT -5
There never has been, nor will there ever be, a monopoly on accurate statements just about anywhere from just about any source, and most certainly not on a stock message board.
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Post by lakers on Jan 19, 2016 17:24:56 GMT -5
Sue, Thanks for the eloquent response. Inhaled fentanyl in battlefield is priceless compared to morphine needles which may be soiled, less effective, slower acting. Ever seen your comrade suffer in the battlefield or beg for morphine when almost mortally wounded?
There are over 120 international Arm Forces that could use Inhaled fentanyl w/ the right inhaler and carrier. The opp is huge!!
Looking forward to a Veteran Day w/ inhaled fentanyl inhalers displayed alongside.
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Post by agedhippie on Jan 19, 2016 17:26:25 GMT -5
Inhalable fentanyl could be used in the ER instead of an injectable. It could be used for the breakthrough pain. It could be used in the military. The uses are endless. It's not going to be used in ER, they will use an IV since the patient will already have a line in. Military? Don't know but I suspect they will keep what they have because it's all planned and standardized.
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Post by jpg on Jan 19, 2016 17:56:44 GMT -5
Sue, Thanks for the eloquent response. Inhaled fentanyl in battlefield is priceless compared to morphine needles which may be soiled, less effective, slower acting. Ever seen your comrade suffer in the battlefield or beg for morphine when almost mortally wounded? There are over 120 international Arm Forces that could use Inhaled fentanyl w/ the right inhaler and carrier. The opp is huge!! Looking forward to a Veteran Day w/ inhaled fentanyl inhalers displayed alongside. Priceless post! This is it: jumping the shark (but at least a patriotic military jump!). Soldiers proudly marching with their inhaled narcotic pipes. The armies of the world will be overhoyed to display their pipes? Hmmm... Hopefully the narcotic pipes will be different than the ones given to other patients not 'smoking narcotics' or crack or whatever... You are making a full circle. Imagine for a second the optics of a product being associated with drug abuse? Mannind products sold on dark street corners (hopefully they will get rid of the logo first?). Do you 'fentanyl experts' for one second even consider how poorly having narcotic addiction tainting Mannkind (and it's other products) would be? Apparently Mannkind management neither! Sad stuff. Shark jumpers everywhere...
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Post by mnkdfann on Jan 19, 2016 18:14:31 GMT -5
No the TP version of the drug was a peptide that probably did not cross the blood brain barrier and was non addictive. Fentanyll is poison when used chronically. Inhaled it is a short acting poison (because it's users will die quickly from overdoses). All you state about the side effects are directly related to liposulubility and only Sufentanyl is more potent and dangerous (IVDUs using it die on average in less than a year compared to 'a few' on fentanyl and well over 10 on morpine). There is no other way of sugar coating this (and the extraordinary lapse in scientific judgement that Mannkind seems to be having if it wants to make an inhalable fentanyl): tbis is sloppy science (and maybe a desperate management...). I know absolutely nothing about fentanyl or inhalable fentanyl, but from what I'm reading on the board, jpg believes MNKD's scientists are complete and total idiots. I'd like to suggest we introduce a little common sense into the discussion. Either they are not pursuing it in which case they are not idiots, or they are pursuing it in spite of the OBVIOUS problems being pointed out by jpg . Three choices: 1. MNKD's scientists are idiots 2. MNKD is not pursuing an inhalable fentanyl 3. MNKD is pursuing an inhalable fentanyl in spite of the obvious dangers because they've discovered something not entirely obvious I'm not voting for #1. How about: 4. MNKD is pursuing an inhalable fentanyl in spite of the obvious dangers because MNKD's management decided to do this, not MNKD's scientists?
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Post by peppy on Jan 19, 2016 18:22:48 GMT -5
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Post by kbrion77 on Jan 19, 2016 18:27:51 GMT -5
Sue, Thanks for the eloquent response. Inhaled fentanyl in battlefield is priceless compared to morphine needles which may be soiled, less effective, slower acting. Ever seen your comrade suffer in the battlefield or beg for morphine when almost mortally wounded? There are over 120 international Arm Forces that could use Inhaled fentanyl w/ the right inhaler and carrier. The opp is huge!! Looking forward to a Veteran Day w/ inhaled fentanyl inhalers displayed alongside. Priceless post! This is it: jumping the shark (but at least a patriotic military jump!). Soldiers proudly marching with their inhaled narcotic pipes. The armies of the world will be overhoyed to display their pipes? Hmmm... Hopefully the narcotic pipes will be different than the ones given to other patients not 'smoking narcotics' or crack or whatever... You are making a full circle. Imagine for a second the optics of a product being associated with drug abuse? Mannind products sold on dark street corners (hopefully they will get rid of the logo first?). Do you 'fentanyl experts' for one second even consider how poorly having narcotic addiction tainting Mannkind (and it's other products) would be? Apparently Mannkind management neither! Sad stuff. Shark jumpers everywhere... Well Afrezza is a life changing medication for diabetics and hasn't worked out so why not try this?
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Post by hankscorpio7 on Jan 19, 2016 18:28:46 GMT -5
Priceless post! This is it: jumping the shark (but at least a patriotic military jump!). Soldiers proudly marching with their inhaled narcotic pipes. The armies of the world will be overhoyed to display their pipes? Hmmm... Hopefully the narcotic pipes will be different than the ones given to other patients not 'smoking narcotics' or crack or whatever... You are making a full circle. Imagine for a second the optics of a product being associated with drug abuse? Mannind products sold on dark street corners (hopefully they will get rid of the logo first?). Do you 'fentanyl experts' for one second even consider how poorly having narcotic addiction tainting Mannkind (and it's other products) would be? Apparently Mannkind management neither! Sad stuff. Shark jumpers everywhere... Haha- actually agree with jpg. A fentanyl or any high powered pain derivative in TS form would have enormous hurdles for FDA. I said it before, say it again- a pain TS would be a money pit. If they had problems competing with insulin, how will they price in huge pain market? Any time advantage with TS will not be substantial enough to win superiority over sublinguals. Look at ACRX and sufentanil. Not that they will get approval- but already at phase III. And sufentanil 5-10 times more powerful then fentanyl- crazy! Wouldn't mind trying that- probably just knocks you out I imagine. Is there a pain candidate for TS, jpg? A rapid acting OTC(aspirin, ibuprofen..) would maybe get people who can't tolerate digesting pill form but doubt lung tissue would tolerate it well. Pricing would be strained, but depends on time to effectiveness. I don't see a military application for TS. Wounded soldiers and deep or even normal breaths seem like a gamble.
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Post by jpg on Jan 19, 2016 18:33:24 GMT -5
A lot of what Laker seems to know tends to more or less come true (except for the parnership being strong fiasco: oops...) so that is why his statement got me so 'upset' to be polite (and why I'm focusing on this latest potential catastrophy. And yes I this would be a disaster as there is no way an informed FDA would ever let this even get to a clinically meaningful endpoint. Thinking otherwise is misunderstanding the FDA...
I can actually see some Mannkind 'genious' being pushed (ie: given money to stay alive) by some shady hedge fund to make the perfect narcotics product: safe dosing until you need more and more and start stacking with or without the Mannkind inhaler (at least the logo wouldn't show up in back alleys) and no needles for those who would never dream of becoming IVDUs. This could, absent the pesky DEA, truly become a blockbuster!
Inso hope Mannkind isn't that desperate and that Lakers is having another 'oops time'.
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Post by jpg on Jan 19, 2016 18:51:21 GMT -5
Priceless post! This is it: jumping the shark (but at least a patriotic military jump!). Soldiers proudly marching with their inhaled narcotic pipes. The armies of the world will be overhoyed to display their pipes? Hmmm... Hopefully the narcotic pipes will be different than the ones given to other patients not 'smoking narcotics' or crack or whatever... You are making a full circle. Imagine for a second the optics of a product being associated with drug abuse? Mannind products sold on dark street corners (hopefully they will get rid of the logo first?). Do you 'fentanyl experts' for one second even consider how poorly having narcotic addiction tainting Mannkind (and it's other products) would be? Apparently Mannkind management neither! Sad stuff. Shark jumpers everywhere... Haha- actually agree with jpg. A fentanyl or any high powered pain derivative in TS form would have enormous hurdles for FDA. I said it before, say it again- a pain TS would be a money pit. If they had problems competing with insulin, how will they price in huge pain market? Any time advantage with TS will not be substantial enough to win superiority over sublinguals. Look at ACRX and sufentanil. Not that they will get approval- but already at phase III. And sufentanil 5-10 times more powerful then fentanyl- crazy! Wouldn't mind trying that- probably just knocks you out I imagine. Is there a pain candidate for TS, jpg? A rapid acting OTC(aspirin, ibuprofen..) would maybe get people who can't tolerate digesting pill form but doubt lung tissue would tolerate it well. Pricing would be strained, but depends on time to effectiveness. I don't see a military application for TS. Wounded soldiers and deep or even normal breaths seem like a gamble. THE perfect pain candidate would be the TP peptide (if it works obviously). It would take about 10-15 years to get to market but would (theoretically...) be very popular (baring side effects and all the usual stuff onviously) as it would be the perfect 'anti fentanyl'. And yes sufentanil is even more dangerous/ addictive than fentanyl. It doesn't even work well long term. To much tachpylaxis. As for inhaled fentanyl being superior to sublingual: not a doubt in my mind inhaled would destroy sublingual for 'liking and effectiveness' of pain relief... The repeat costumers would be very very 'high' and they would tell 2 friends and so on... Watch the movie 'blow'... All the other pain drugs I can think of (not necssarily including migraine) are as much marketing issues as medical issues.
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Post by cjc04 on Jan 19, 2016 19:09:04 GMT -5
I absolutely CAN NOT believe I'm reading this conversation right now, and still have hopes of getting any of my money back. NONE of what ANY of you are saying has ANY value to the "hear and now" of MNKD.
SOB, gimme a drink....... And make it a tall glass of Kool-aid, because a dreamy conspiracy come true BO or partner is the only thing that will let me sleep at night, and more importantly save MNKD.
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Post by suebeeee1 on Jan 19, 2016 19:55:05 GMT -5
Sue, Thanks for the eloquent response. Inhaled fentanyl in battlefield is priceless compared to morphine needles which may be soiled, less effective, slower acting. Ever seen your comrade suffer in the battlefield or beg for morphine when almost mortally wounded? There are over 120 international Arm Forces that could use Inhaled fentanyl w/ the right inhaler and carrier. The opp is huge!! Looking forward to a Veteran Day w/ inhaled fentanyl inhalers displayed alongside. Priceless post! This is it: jumping the shark (but at least a patriotic military jump!). Soldiers proudly marching with their inhaled narcotic pipes. The armies of the world will be overhoyed to display their pipes? Hmmm... Hopefully the narcotic pipes will be different than the ones given to other patients not 'smoking narcotics' or crack or whatever... You are making a full circle. Imagine for a second the optics of a product being associated with drug abuse? Mannind products sold on dark street corners (hopefully they will get rid of the logo first?). Do you 'fentanyl experts' for one second even consider how poorly having narcotic addiction tainting Mannkind (and it's other products) would be? Apparently Mannkind management neither! Sad stuff. Shark jumpers everywhere... Unfortunately, it is opinions such as this that keeps people suffering in pain from obtaining relief. Pain is a huge growing problem in our country, especially as we can keep people alive longer and longer. Intractable pain is just not associated with terminal cancer patients. Addiction and dependence are two different things. You may worry about addicts. I worry about the many, many, many people I have met that have no access to the pain medications that will allow them to live happy, successful lives. I'm not going to continue this pissing contest. It does little to advance the discussion. We are way off topic.
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Post by ricguy on Jan 19, 2016 20:55:38 GMT -5
How about TS for Viagra, maybe it will cause our PPS to rise, boing!
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