Complications of oral exposure to fentanyl transdermal delivery system patches.
OBJECTIVE
Fentanyl is a synthetic opioid available therapeutically as an intravenous, transbucal, or transdermal preparation. It is also used as a drug of abuse through a variety of different methods, including the oral abuse of transdermal fentanyl patches. This is a series of patients with oral fentanyl patch exposure reported to our center and represents the first series of oral fentanyl patch exposures collected outside of the postmortem setting.


METHODS
In this series, we examined the New York Poison Control Center database for all cases of oral abuse of fentanyl reported between January 2000 and April 2008.


RESULTS
Twenty cases were reported, nine were asymptomatic or had symptoms of opioid withdrawal; 11 had symptoms of opioid intoxication. Eight patients were administered naloxone and all showed improvement in clinical status. Only one case resulted in a confirmed fatality-this patient had an orally adherent patch discovered at intubation.


CONCLUSIONS
Oral exposure may result in life-threatening toxicity. Patients should be closely assessed and monitored for the opioid toxidrome, and if symptomatic, should be managed with opioid antagonists and ventilatory support.
Division of Emergency Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 525 E. 68th St. M130, New York, NY 10065, USA. jprosser100@gmail.com
Jane M
JM
Prosser
Brent E
BE
Jones
Lewis
L
Nelson
D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D016208:Databases, Factual; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D011041:Poisoning / Q000097:blood / Q000209:etiology* / Q000628:therapy; D012121:Respiration, Artificial; D019966:Substance-Related Disorders; D013406:Suicide, Attempted; D057968:Transdermal Patch / Q000009:adverse effects*; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D005283:Fentanyl