Ontario's chief coroner is investigating the deaths of three patients who appear to have overdosed on pain medication that was administered using a stick-on patch. And at least three more deaths in B.C. have been linked to the same drug.
The news is drawing attention to the dangers of fentanyl patches, which have been growing in popularity despite repeated warnings from health regulators that they should not be used indiscriminately.
David U, president and chief executive officer of the Institute for Safe Medication Practices, said the painkiller patch is a good drug and a convenient alternative to the pills, injections and pumps often relied upon by chronic pain sufferers, but fentanyl patches are being widely misused.
"These cases are preventable," he said of the deaths and the dozens of reports of illness among patients using fentanyl patches in Canada.
David U of the Institute for Safe Medication Practices said the fentanyl painkiller patch is a convenient drug but it's being widely misused. (Ryan Carter/The Globe and Mail)
"But it's being given to the wrong type of patient."
Mr. U, who is a pharmacist by training, said the powerful painkiller - it is about 60 times more potent than morphine on a gram-per-gram basis - should be used only by chronic pain sufferers.
It shouldn't be prescribed to patients who have not previously taken opioids (opium-based drugs), and the patch should not be prescribed postoperatively.
Mr. U also stressed that only one patch should be used at a time. In many of the deaths recorded, patients had two to three patches, resulting in an overdose. (The patches are virtually invisible on the skin and patients and caregivers can lose track of them.)
The U.S. Food and Drug Administration first issued a warning about fentanyl patches in July, 2005, saying they should be prescribed at the lowest practicable dose, should not be used to treat short-term pain or pain after an operation, and should only be used by patients already on opioid drugs.
The regulator also told physicians that patients prescribed the drugs should be fully advised about safety concerns.
Since then, there have been several more warnings and a growing number of deaths worldwide. There is also a burgeoning concern about other drugs delivered by patch, such as contraceptives and medications for a host of conditions such as attention deficit hyperactivity disorder, Alzheimer's and Parkinson's disease.
In Canada, there have been almost 600,000 prescriptions for fentanyl patches in the past year, at a retail value of more than $116-million, according to IMS Health Canada, a private company that tracks prescription drug sales.
The fentanyl transdermal patch, which is sold under three product names in Canada - Duragesic, Ran-Fentanyl and Ratio-Fentanyl - has been on the market since the early 1990s. Use of the patch has doubled over the past four years.
Blondette Burnette of Toronto has lived in chronic pain for more than a decade from injuries suffered in a motor vehicle collision. She said fentanyl patches are the right choice for her.
"I know how to use it properly and safely so that's the way for me to go," she said recently as she underwent training at the Wasser Pain Management Centre of Mount Sinai Hospital in Toronto.
Her neurologist, Allan Gordon, stressed that appropriate prescription of the drug, coupled with training of patients, is essential.
"It is a very good drug but it has to be used properly with the right kind of assessment, knowledge and the right kind of education of patients and practitioners," he said.
"You have to educate, educate, educate."
Barry McLellan, Ontario's chief coroner, said his investigation should also help inform health-care professionals and patients alike about the limitations of fentanyl patches.
"If we have any information that will help prevent a death in the future, we want to make sure it's in the right hands."
In the meantime, Mr. U said, patients need to be vigilant and not simply accept a more risky drug such as a fentanyl patch just because it is more convenient to take than traditional painkillers.
"This is a high-risk drug. It needs serious precautions."
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