A collection of different brand and dosages of the Fentanyl patch, clearly marked wit warnings about non-precribed uses, Wednesday, April 26,2006 in St. Louis.TOM GANNAM/The Associated Press
The College of Pharmacists of B.C. should do more to ensure used fentanyl patches are disposed of safely, including considering a requirement for pharmacies to take them back from consumers, says a pharmacist who has written guidelines on how health professionals should use the powerful product.
The vast majority of pharmacies in the province – about 95 per cent – participate in a provincial program that allows consumers to return medications, but a few do not. This means used patches with residual amounts of the opioid painkiller could pose a risk.
Fentanyl patches are used as pain control for patients who, for example, are unable to swallow. Residual amounts of it are left after the time period for use has expired.
"Unless we get these used patches back [and] disposed of properly, it's just another source of illicit use," pharmacist Bruce Kennedy said on Sunday.
"We do a better job of returning milk jugs for recycling than we do for pharmaceuticals, especially this fentanyl patch."
Mr. Kennedy, who wrote guidelines for fentanyl-patch use by health authorities in 2006 and updated them this year, discussed his disposal concerns in a presentation to the board of the College of Pharmacists of B.C. in April.
That presentation was informational only and the board was not asked to take specific action. But staff will review it and update pharmacists and pharmacy technicians "as needed," college spokeswoman Gillian Vrooman said.
"We haven't begun this yet, but expect to begin to look at it soon," she added.
Ontario passed a private member's bill last year – Bill 33, the Safeguarding our Communities Act, or the Patch for Patch Return Policy – that requires users to bring used patches to pharmacists before new ones are provided.
Concerns related to fentanyl patches are part of a national health crisis. In April, B.C. declared a public-health emergency amid a surge of overdoses. Last year had 480 apparent illicit drug overdose deaths, up 31 per cent from the previous year.
As of April 30, the number of drug overdose deaths in 2016 had reached 256.
Fentanyl, on its own or mixed with other drugs, was detected in 49 per cent of overdose deaths in the first three months of this year, compared with 32 per cent last year. In 2012, fentanyl was detected in only 5 per cent of overdose deaths.
Police in B.C. have said diversion – illicit use of fentanyl prescribed to people in hospitals, seniors' homes or living on their own – accounts for a relatively small percentage of overdoses, and that most fentanyl abuse involves drugs imported from China.
The patches are designed to provide a continuous dose of medicine over 72 hours for relief of severe pain, and the amount of drug left over is enough to kill someone if misused.
In the presentation, Mr. Kennedy cited dozens of media reports highlighting the dangers of improper disposal, including the case of a two-year-old boy who died after he put into his mouth a used patch that stuck to the wheel of his toy truck as he was rolling it across the floor.
The presentation also noted patches can be abused in multiple ways, including being smoked, boiled into tea or swallowed whole, and that even the lowest-dose patches contain enough residual medication to be fatal if consumed all at once.
Fentanyl is a synthetic opioid that is approximately 100 times more potent than morphine. Patches, available in varying strengths, allow the drug to be absorbed through the skin into the blood stream.
The residual amount varies according to the dosage on each patch, but the highest-strength patch contains nine times the potential lethal dose.