5 Treacherous Problems with Fentanyl Patches

Although using a patch formulation of fentanyl can have some advantages, here are 5 common problems I've encountered with it in my pharmacy practice:

1. Fentanyl patches are extremely potent.

Many health care professionals don’t realize how strong a fentanyl patch really is. Opioid conversions are never perfect, but conservatively, a total daily dose of oral morphine 45 mg to 60 mg is approximately equivalent to a fentanyl 25 mcg patch. Because of this, I’ve seen numerous cases of inappropriately high starting doses, especially in the elderly population.

2. Lost or missing fentanyl patches should scare you.

There are significant risks when children or pets get access to a used fentanyl patch, so take a lost or missing patch very seriously. Simply do a Google search of fentanyl patch deaths and you’ll understand what I’m talking about. The Institute for Safe Medication Practices recommends flushing used patches.

3. Fentanyl patches are meant for chronic pain.

I’ve seen numerous orders for fentanyl patches from the emergency department or primary care providers for the treatment of acute pain, but these patches don’t relieve acute pain. With an onset of action that takes hours to days once applied, a patient can be in pain for a long period of time before a fentanyl patch begins to take effect.

4. Fentanyl patches can cause delayed withdrawal symptoms.

Fentanyl patches basically create a deposit of drug being slowly absorbed through the skin.

I remember a case where a patient was on a chronic higher dose (100 mcg) and the patch was discontinued in the emergency department without any follow up or supplemental opioids. Long story short, the patient ended up having withdrawal symptoms, but not until hours after they were discharged because of the patch’s slow onset, as well as its slow elimination and offset.

5. Fentanyl patches get diverted.

Whether at home or in health care settings, I’ve dealt with numerous cases of drug diversion. These cases even go to the point of diverters removing used fentanyl patches from dementia patients.