Oral Transmucosal Abuse of Transdermal Fentanyl

Abstract

Transdermal fentanyl is an opioid analgesic that is effective on chronic pain, and which appears to be advantageous due to several factors such as ease of administration, the relatively stable serum concentration and long dose intervals. Nevertheless, the danger of abuse and dependence exists among patients who are prescribed fentanyl patches. We present a case of transdermal fentanyl abuse, where the administration route of the drug was changed. Our patient, who had no history of substance abuse and who suffered from chronic nonmalignant pain, used the fentanyl transdermal patches as oral transmucosal medication, raising the dose by ten-fold. This abuse of the drug was only for analgesic purposes without seeking anxiolysis and/or euphoria. After treatment and progressive reduction of fentanyl, the patient remains in good condition, and is currently taking the initial dose of the drug transdermally, without having experienced any withdrawal symptoms.

Routes of abuse of prescription opioid analgesics: a review and assessment of the potential impact of abuse-deterrent formulations

“…[29] In the same study, fentanyl was found to be more likely to be associated with alternative routes of abuse than other prescription opioid analgesics (i.e., abuse via routes other than that intended or via inhalation, injection or chewing); 70% of individuals abusing transdermal fentanyl and 69% of those abusing sublingual fentanyl reported other routes of abuse compared with 3-13% for other drugs. [29] Other routes of abuse that have been reported for transdermal fentanyl formulations include application of multiple patches, [38] placing the patch in the mouth, [39][40][41] chewing or sucking, [42][43][44] swallowing whole, [45,46] injection of extracted patch contents, [47][48][49] smoking [50,51] and rectal insertion. [52] Patches may also be boiled to make a "tea", which can be ingested or injected.…”

Recurrent Respiratory Depression Associated with Fentanyl Transdermal Patch Gel Reservoir Ingestion

“…However, more experienced abusers may alter the method of administration to increase the rate of absorption in an attempt to experience a more intense euphoria. Published case reports describe FTP abuse via excessive transdermal application, use of heating pads to increase cutaneous absorption, application to the oral or rectal mucosa, mastication of patches, ingestion of intact patches, ingestion of the gel reservoir, intravenous injection of patch contents, volatilization and inhalation of the gel reservoir, and ingestion of FTP ''tea'' (22)(23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Report of a patient chewing fentanyl patches who was titrated onto methadone

“…Inhalation of the patches has also been reported,10 and a fatal overdose of transdermal fentanyl by the oral mucosal route was described by Kramer and Tawney 11. Liappas et al 12 report the case of a patient who abused fentanyl patches by leaving them in her oral cavity for increased analgesia for non-malignant pain. Liappas et al note that using fentanyl transmucosally results in different pharmacokinetics compared to the transdermal route.…”