Canada - Fentanyl transdermal system (Duragesic®) has been marketed in Canada since 1992 and is indicated for the management of chronic pain in patients requiring continuous opioid analgesia for pain that is not optimally managed with weak or short-acting opioids (1). Opioid-naive patients may be at risk of overdose with the use of opioid drugs, including fentanyl.

From 1998 to 2005, Health Canada received 4 reports of abuse of fentanyl patches by adolescent boys aged 14-17 years. Three of the boys died, and 1 had not recovered at the time of reporting. The patches were found either in home medicine cabinets or were prescribed to a parent. In 3 cases the use of marihuana was reported.

From 28% to 84% of the active ingredient may be recovered from a fentanyl transdermal system even after 3 days of therapeutic use, which is more than sufficient drug for potential abuse (2) The fentanyl from the patch can be abused by ingestion, intravenous injection, volatilization and inhalation, or application of multiple patches, and such abuse may result in death (3-5). Potential for overdose also exists when heating pads are applied to the skin to raise skin temperature and increase the rate of fentanyl absorption from the patch (6, 7). In addition, low concentrations of fentanyl are sufficient to induce respiratory depression (8).

Abuse of fentanyl patches depends on access to improperly discarded or secured patches. The Canadian product monograph provides recommendations for the safe disposal of patches. Specific information for the patient details the risks of fentanyl and how to apply, remove and dispose of the transdermal patches (1). Safe and secure dispensing, storage and disposal measures must be reinforced for patients, pharmacists and physicians.

Extracted from Canadian Adverse Reaction Newsletter, Volume 15 (3), July 2005.

References

1. Duragesic 25 (fentanyl transdermal system) [product monograph]. Toronto: Janssen-Ortho Inc.; 2004.

2. Marquardt KA, Tharratt RS, Musallam NA. Fentanyl remaining in a transdermal system following three days of continuous use. Ann Pharmacother 1995;29(10):969-71.

3. Kramer C, Tawney M. A fatal overdose of trans-dermally administered fentanyl. J Am Osteopath Assoc 1998; 98(7):385-6.

4. DeSio JM, Bacon DR, Peer G, Lema MJ. Intravenous abuse of transdermal fentanyl therapy in a chronic pain patient. Anesthesiology 1993;79(5):1139-41.

5. Marquardt KA, Tharratt RS. Inhalation abuse of fentanyl patch. J Toxicol Clin Toxicol 1994;32(1):75-8.

6. Frolich MA, Giannotti A, Modell JH. Opioid overdose in a patient using a fentanyl patch during treatment with a warming blanket. Anesth Analg 2001;93(3):647-8.

7. Rose PG, Macfee MS, Boswell MV. Fentanyl transdermal system overdose secondary to cutaneous hyperthermia. Anesth Analg 1993;77(2):390-1.

8. Kuhlman JJ Jr, McCaulley R, Valouch TJ, Behonick GS. Fentanyl use, misuse, and abuse: a summary of 23 postmortem cases. J Anal Toxicol 2003;27(7):499-504.