Fentanyl transdermal patch: The silent new killer?

Zanon, Marco; Valentinuz, Eleonora; Montanaro, Martina; Radaelli, Davide; Consoloni, Lara; D’Errico, Stefano

doi:10.1016/j.fsir.2020.100104

Cited by 3 publications

(6 citation statements)

References 41 publications

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“…Any rise in skin temperature caused by fever, external application of heat, muscle activity, or local inflammation can gradually increase blood flow to the skin. Higher perfusion leads to increased systemic absorption and higher fentanyl serum concentrations [ 9 ]. It is also possible to inject fentanyl from a matrix patch.…”

Section: Discussionmentioning

confidence: 99%

Serotonin Syndrome Precipitated by the Use of Cocaine and Fentanyl

Khan¹,

Lahmar²,

Asif³

et al. 2022

Cureus

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Serotonin syndrome (SS) is a condition that occurs following the administration of serotonergic drugs. The syndrome is classically associated with the simultaneous administration of two serotonergic agents. Herein, we present a unique case of SS precipitated by cocaine and fentanyl in conjunction with previously prescribed oxycodone/paracetamol, trazodone, and mirtazapine. The patient was brought to the hospital with chief complaints of altered mental status, abdominal pain, nausea, and vomiting. The patient used her friend's fentanyl patch, and her urine drug screen was positive for cocaine. She was intubated and admitted to the intensive care unit for a low Glasgow Coma Scale score of 6 and autonomic instability. All the inciting agents were stopped, supportive treatment was given, and the patient was sedated with benzodiazepines and propofol. She received cyproheptadine, and the patient was extubated and clinically improved over the next 24 hours. Cocaine and fentanyl are not classically associated with SS. We did not encounter any cases where SS was precipitated by the combined use of cocaine and fentanyl in patients taking psychotropic medications during our literature review. This case report underlines the association of SS with cocaine and fentanyl. SS should be suspected in patients using cocaine and fentanyl or any other substance of abuse along with psychotropic agents.

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Section: Discussionmentioning

confidence: 99%

Serotonin Syndrome Precipitated by the Use of Cocaine and Fentanyl

Khan¹,

Lahmar²,

Asif³

et al. 2022

Cureus

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“…or oral administration of the extracted fentanyl [11]. For those overdoses associated with the IV administration, the fentanyl containing gel was extracted from the transdermal reservoir and then injected resulting in death (for a review, see reference 5).…”

Section: Forensic Toxicological and Pathological Considerationsmentioning

confidence: 99%

“…One case study, in particular, described the deaths of seven individuals (aged 20-51) due to "oral abuse," which was defined as ingesting patches, sucking on/soaking the patch in the mouth, and chewing on patches [13]. In a review by Zanon et al, case reports and publications found on PubMed describing fentanyl patch-related deaths going back 26 years were compiled, which totaled 658 reported deaths; of these, the most commonly seen methods of abuse were transdermal, oral, and then intravenous, in that order [11].…”

Section: Introductionmentioning

confidence: 99%

“…The child found the patch and ate it, ultimately killing her. While these accidental contacts do happen, abuse of the used patches is more prevalently reported [11]. The use and abuse of discarded fentanyl patches in a number of imaginative ways has been documented, including: ingestion, using more patches than prescribed, injection, and inhalation [12].…”

Section: Introductionmentioning

confidence: 99%

“…| CON CLUS IONAfter transdermal fentanyl patches are used, they still have a dangerous amount of residual fentanyl left behind in the adhesive[7,8]. Not only does the amount of fentanyl left behind in these patches have the potential to harm children or animals, there is also a huge potential for abuse[10,13,11]. Currently, these used patches are simply disposed of by flushing them down the toilet; however, this disposal method does not deal with the real problem at hand, as it does not address the residual fentanyl[15].…”

mentioning

confidence: 99%

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Fentanyl transdermal patches: Extraction and evaluation of a novel disposal method using NarcX^®

Palmer

Canfield

Sprague

et al. 2021

Journal of Forensic Sciences

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Currently, there is no known commercially available product for disposing of used fentanyl transdermal patches. To eliminate the potential for harm and abuse, a proper disposal method is needed–one that neutralizes the dangerous amount of residual fentanyl that remains after therapeutic use of the fentanyl patch. The patent‐pending liquid solution of activated carbon, known as NarcX®, was investigated as a potential fentanyl adsorbing agent. In order to determine the amount of fentanyl remaining after a patch is treated with NarcX®, here, we utilized hexanes to first dissolve the patch adhesive and then followed with liquid‐liquid extraction with methanol to recover the fentanyl. Using liquid chromatography coupled to tandem mass spectrometry (LC/MS‐MS), the extracts obtained with this method yielded between 85% and 117% recovery of fentanyl from new and unused patches. Further optimization of this method allowed for a quantitative evaluation of NarcX®‐treated fentanyl patches. 100 µg/h Apotex brand fentanyl patches were exposed to NarcX® for 1, 24, 48, and 72 h. NarcX® was shown to adsorb fentanyl from the patches with varying degrees of success, demonstrating an average of 66.98 ± 0.75% fentanyl adsorption after 72 h. These findings suggest that more work is needed to successfully neutralize the fentanyl patches in their entirety using NarcX®; however, this work does demonstrate proof of concept.

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Does occupational exposure to fentanyl cause illness? A systematic review

Adams,

Maloy,

Warrick

2023

Clinical Toxicology

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Fentanyl transdermal patch: The silent new killer?

Cited by 3 publications

References 41 publications

Serotonin Syndrome Precipitated by the Use of Cocaine and Fentanyl

Serotonin Syndrome Precipitated by the Use of Cocaine and Fentanyl

Fentanyl transdermal patches: Extraction and evaluation of a novel disposal method using NarcX^®

Does occupational exposure to fentanyl cause illness? A systematic review

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Fentanyl transdermal patch: The silent new killer?

Cited by 3 publications

References 41 publications

Serotonin Syndrome Precipitated by the Use of Cocaine and Fentanyl

Serotonin Syndrome Precipitated by the Use of Cocaine and Fentanyl

Fentanyl transdermal patches: Extraction and evaluation of a novel disposal method using NarcX®

Does occupational exposure to fentanyl cause illness? A systematic review

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Product

Resources

About

Fentanyl transdermal patches: Extraction and evaluation of a novel disposal method using NarcX^®