The reason of death in two cases was due to overdose of fentanyl. The deceased had used fentanyl patches that had been prescribed for someone else. The three organizations met to discuss the issues raised by the chief coroner and have jointly agreed to inform their registrants about the potential for misuse and abuse of both used and unused patches.
A fentanyl patch is used to provide continuous opioid pain killer for 72 hours, after which it should be removed and replaced with a new patch. A used fentanyl patch may contain enough residual drug to cause harm. Studies have found that after three days of continuous use, fentanyl patches may still contain 30% to 50% or more of the labelled amount of fentanyl. Therefore, the appropriate disposal of used and unused patches is imperative in health care facilities and in the community.
The manufacturer's product monograph recommends flushing used and unused patches down the toilet. Given concerns about the environmental impact of drugs in the water supply, other disposal methods should be considered when possible. In addition, flushing is not a suitable alternative in locations with septic fields or septic tanks.
Health care facilities should establish policies for the proper disposal of fentanyl patches. Policies should instruct the nurse to remove the patch from the patient and fold the patch in half so the adhesive backing is folded together and adheres to itself. The patch should then be disposed of in a sharps container. Destruction must render the product unusable so that the patch does not represent a hazard to others. This disposal should be documented on the patient's record.
Patients in the community who have leftover, unused or expired fentanyl patches should be encouraged to return them to the dispensing pharmacy for appropriate disposal.
Health care providers must educate patients and caregivers about the safe administration, removal and disposal of fentanyl patches. Gloves should be worn when handling the patch. The product monograph indicates that the gel from the drug reservoir must not accidentally touch the skin; if it does, the skin must be flushed with water. Soap, alcohol and other solvents should not be used to take out the gel from the skin because they may boost the drug's ability to go through the skin.