title: Recurrent respiratory depression associated with fentanyl transdermal patch gel reservoir ingestion.
abstract: BACKGROUND
  Opioid abuse is common in the United States and is currently on the rise. Fentanyl transdermal patches (FTPs) have been on the market since 1991, and have recently become a popular source of opioids for abusers. There are currently two distinct FTP designs available on the market today; a gel reservoir system and a matrix construct. The gel reservoirs of FTPs contain massive amounts of fentanyl and are easily extractable for abuse. Ingesting the gel reservoir of an FTP is potentially lethal.
  
  
  METHODS
  In this case series, 4 patients ingested the gel reservoir of an FTP and experienced severe and recurrent respiratory depression necessitating continuous naloxone infusions. All patients responded adequately to initial prehospital doses of naloxone (0.8-2 mg intravenous) but developed recurrent respiratory depression within 2 h of presentation to the hospital.
  
  
  CONCLUSIONS
  The gel reservoir of an FTP contains massive amounts of fentanyl. Ingestion of the gel may cause severe and recurrent respiratory depression necessitating repeated naloxone boluses, continuous naloxone infusion, and a prolonged observation period.
authors.affiliation: Division of Medical Toxicology, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA.
authors.forename: Joseph L
authors.initials: JL
authors.lastname: D'Orazio
authors.forename: Jason A
authors.initials: JA
authors.lastname: Fischel
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D005260:Female; D005283:Fentanyl / Q000506:poisoning*; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000139:chemically induced*; D057968:Transdermal Patch; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D005283:Fentanyl