Overdosing on the fentanyl patch

in Uncategorized | 10 responses

It seems that most of the overdoses 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.

Comments

WilliamManginoMD
Most people who have read my comments on this and other internet sites know that I am a proponent of opioid treatment for refractory chronic pain.
I am against prosecuting doctors and patients for legitimate use of these drugs.
Having said this, it is important for all physicians and patients to clearly understand ONE THING:
THERE ARE NO INDICATIONS FOR PRESCRIBING A FENTANYL PATCH TO A SEVENTEEN YEAR OLD PATIENT WHO IS NOT HOSPITALIZED. P E R I O D.
There are few legitimate indications for the use of a fentanyl patch in any out-patient pain practice, in general. Oral medications can be properly titrated for most pain conditions.
I seriously question the use of opioids in any seventeen year old for any condition treated as an outpatient- except on a very limited basis.
Prescribing oxycontin and opioids for chronic refractory neck and back pain, when indicated, is one legitimate way to help patients.
Giving fentanyl patches to young patients is never[ in out patient settings] indicated and mostly irresponsible.
This kind of medical decision making creates the hysteria which always comes back to “Bite” the legitimate doctors-even if they are not the ones doing the prescribing.
Don’t let the fentanyl patch salespeople try to convince you-as they tried to convince me- that these patches are good choices for larger populations of patients treated for pain–THEY ARE NOT GOOD CHOICES.
Throw the salesmen out of your office, you’ll be better off.
Lisa
Fentanyl patches are much more work for the patient than conventional pain medication. First of all, by the time you need pain medication that is that strong you are also likely to mismanage your medication. Which is probably how you ended up on it to begin with, chasing down your pain rather than staying on schedule with meds.
I forget to change the patch on the right day, find I can’t change it after a certain hour of the day (7pm) or I feel like I am drowning in my sleep.
However, since my specialists cannot rid me the severe pain I seem destined to live with – you can take the fentanyl patch away from me when you wrench it from my cold, dead hands. It works and very well at that, for the people that need it.
Gasman
Dr. Bill is a little to absolutist about his proscription of the fentanyl patch for a 17 year old. This is nothing but ageism in reverse. Why should a teen be denied appropriate pain relief methods simply because of being age 17? What is the magic age at which the fentanyl patch can be used?
Anonymous
According to the link, the 17 year old took someone else’s fentanyl patch – and almost died from it.
Um – if a 17 year old is doesn’t know that taking someone else’s medicine is a bad idea, there is nothing the medical establishment can do to prevent this person from harm.
Most of the narcotic overdoses that require ICU tyupe interventions we see are not from patients in pain – they’re from drug addicts who took more than they could handle. This is not a good enough reason to withold these types of medications from patients who will use them appropriately and benefit from them.
Why is treating each patient individually coming across as a novel concept? It’s what all of us do every day.
L.J.Davis, PharmD
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.
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.
WilliamManginoMD
Dear Gasman;
I respect your questioning of my advice that few, if any, 17 year olds will need a fentanyl patch.
I’ve never seen a 17 year old kid who needed any strong opioid prescription -on an out patient basis. I seriously would have to question the decision-making ability of any doctor who puts this patch on a young person; out of hospital.
I never said youngsters don’t need or deserve opioids-but rarely would the therapeutic advantage of the patch outweigh the risks to the patient and society in this age group.
Ageism never entered into my thinking on this subject.
If you send me a kid status/post spinal fusion with refractory pain who is very stable and mature-I might consider a fentanyl patch; provided I had the absolute guarantee that he wouldn’t bring it to a party so that his friends could lick it.
Since there is no guarantee-the patch is OUT in this age group. Much the same can be said of ‘adults.’
The next question you are going to ask is, “What prevents them from abusing any drug?” – and the answer is “Nothing.”
But for those opioid naive patients who feast on somebody else’s medicines—let it be a pill–not a patch. Just Too risky—period.
Thanks for taking the time to seek out my advice. Don’t hesitate to allow me to clear up any other confusion you may have.
Best wishes.
Anonymous
I have been following all news and info on the fentanyl patch since the death of my elderly father in 2004. What I am hearing on the news and on many forums, is that many people MAKE THE ASSUMPTION that most adverse events is from people who misuse, abuse the patch. This is not true. Sure there are people who abuse it, but what about people like my 96 year old father, and many others whose stories I have read, who was prescribed the patch, and used it according to directions. In his case, his doctor, who we (family) trusted too much, prescribed it for no medical reason. Call it a medical mistake if you like, I call it negligent, and my dad is DEAD. My father had never received morphine, or any other opiate. He WAS NOT IN ANY PAIN, let along chronic or cancer pain. I still to this day don’t know why it was prescribed, maybe experimenting? Maybe for money? Maybe because some drug rep offered gifts?? We had never heard of Duragesic or fentanyl. By the time we saw depressed breathing, swelling, sweating, slow heartbeat, hallucinations, it was too late. I even researched it on the internet, and I’m no doctor, but after reading all the warnings about the elderly, it dawned on me that my father was overdosing! We asked that it be removed, and still, it was obvious that it was still in his system. The doctor never bothered to give him Narcan or Naxolone. He had an enlarged prostate (one of the warnings) and obviously being intolerant to opiods, it built up and caused his death. I tried to get legal help, I even reported it to the state medical board, and of course, their reply was they saw nothing the doctor did that was below the “standards of care”. Tell me, if it states that Schedule II narcotics require informed consent, and don’t prescribe to those not already tolerant to these drugs, the enlarged prostate issue, the issue of being extremely dangerous to the elderly, try other drugs less potent than fentanyl, then what constitutes “prescribing without a medical reason” or overprescribing? He was not in pain to justify that drug. I will be very happy ( and I really don’t care who has a problem with it) when it is removed from the market. The doctor and the nurses, never suspected that he was overdosing. It was as if their minds was set on “this 96 year old man is going to die”, Thats murder. I will never get over how he suffered and no one was held accountable. One thing I do know, when the elderly die, its as if “oh well, he lived a long life, and its ok if he dies, he’s past the life expectancy anyway. Well it ain’t over until it’s over, and I do feel that my happy, elderly (not feeble at all!) father who loved every minute of life, will get justice. And trust me, there are many, many others who have used it (not abused)and have died too. I guess hundreds or even thousands must die before a crappy drug is removed.
Donna Morton
I am a 46 year old female and am suffering from Fibromyalgia. One doctor had prescribed fentanyl for me due to the terrible pain. I was taking it as prescribed and could function everyday. My doctor left her office and went to the VA hospital. I moved to Raleigh and I cannot get a doctor to prescribe it therefore I suffer in pain everyday. If you suffer in pain, you will know how hard it is to get up everyday and try to deal with such pain.
Anonymous
I am 21 years old, and I lost my 45 year old father to this patch 4 months ago. We are still unsure where he got it from, but he had chronic back pain and apparently didnt know the strength of it when he used it. My guess is that someone just gave it to him and told him it would help his back. I dont blame anyone for what happened (other than him for not doing his research before using it), and I’m not angry with anyone. But still, I have a hard time supporting a medication that can be so dangerous. I realize that any medication can be dangerous if not taken as prescribed. However, it is a lot easier to accidentally overdose on this patch if you are misinformed/underinformed than it would be to overdose on a pill. Anyone with common sense knows not to take 15 percasets if they dont want to die… but it only takes one patch and not everyone realizes that.
Regardless, my Dad wont be here to walk me down the aisle or be a part of his grandchildrens lives, and thats a tough pill to swallow. All because he was trying to find relief for his back and underestimated the power of a single patch.
Anonymous
In addition, regarding Donna Morton, my mother has fibromyalgia as well, (as well as an extremely high tolerance for drugs unfortunately) and she takes the pills her doctor prescribes for her and she does just fine. I think there are other effective medications that can be used to treat fibromyalgia among other conditions that arent quite as dangerous. Like I mentioned, its a lot harder to accidentally overdose on a pill.