Over on Kevin, M.D. comes this:
It seems that most of the overdoses [with the fentanyl patch] are from people who took the medication without a prescription, or by not following instructions:
"One patch is supposed to last for three days, and she used all five patches from Thursday to Sunday," the man said. "She was in such pain, she probably didn't really know what she was supposed to do."There's a reason why there are instructions on the bottle.
This and many other unfortunate cases of harm resulting from the fentanyl patch likely represent a breakdown in the entire medication use process – from inappropriate prescribing, to a lack of understanding of the patch release characteristics, and to a lack of patient education and clear direction regarding proper administration and secure storage of this highly potent narcotic analgesic. The Institute for Safe Medication Practices has nicely outlined the problem and provide recommendations in their ISMP Canada Safety Bulletin.
Few understand the appropriate use of the fentanyl patch for only chronic pain, the need to remove the previous patch before applying the next, combinations with other drugs that can increase the levels of fentanyl, enhanced absorption that can take place when a heat source is applied to the patch, and the inadvertent (or not) contact with the patch that can occur due to unsafe disposal or poorly secured storage.
It takes vigilance from all healthcare professionals involved in the medication use process and personal responsibility on the part of patients to ensure safe drug use. The fentanyl patch is an example of where things can go very wrong, very quickly if these principles are not applied.
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