opioids
Fentanyl
overdoses
on the rise
CPSO supports police
program that takes aim
at prescription diversion
photo: istockphoto.com
F
entanyl patches have been implicated in the
rising number of accidental overdose deaths
in Ontario, leading the police to develop a
program that could make it more difficult for
patients to abuse or sell their fentanyl patches.
Overdose deaths attributed to fentanyl more than
doubled in Ontario in five years. According to preliminary data just released from the Chief Coroner,
there were 110 deaths in Ontario attributed to acute
fentanyl toxicity in 20131. In 2008, the number of
deaths was 45. During this period, only the far more
widespread oxycodone was connected to more deaths.
Most deaths appear to be the result of valid prescriptions being abused – either by the patient or by
someone using the patches intended for the patient.
The street price for a fentanyl patch ranges from $200$300 in southern Ontario and upwards of $500 in
First Nations communities in the north.
Originally developed as an operating room drug,
fentanyl is approximately 100 times more potent than
morphine and 40 times more potent than heroin. It has
been described by the Canadian Guideline for Safe
and Effective Use of Opioids as a second line drug for
severe pain, and should only be considered if morphine,
oxycodone or hydromorphone are not appropriate for
the patient. (Please see chart on next page.)
Physicians who prescribe the fentanyl patch are reminded to be fully aware of all the prescribing information and instruct patients on the proper use of the
(1)
fentanyl patch. Physicians should also be familiar with
the Canadian Guideline for Safe and Effective Use of
Opioids, an evidence-based guideline to help primarycare physicians and specialists safely and effectively use
opioids to treat patients with chronic non-cancer pain.
The guideline is at http://nationalpaincentre.mcmaster.
ca/opioid/. Physicians should also be familiar with the
CPSO’s Prescribing Drugs policy at www.cpso.on.ca
under Policies and Publications.
According to a study published in the September
2014 issue of Canadian Family Physician, Ontario
exhibited the highest annual rate of high-dose oxycodone and fentanyl dispensing (756 tablets and 112
patches per 1,000 population, respectively).
As is the case with all opioids, physicians should be
careful about writing prescriptions for a large number of fentanyl patches. It is recommended physicians write that no more than 10 fentanyl patches be
dispensed at one time “one patch every 72 hour x10
patches = 30 days” on the prescription.
The patches are intended to provide slow release
of the opioid over a 72 hour period and therefore,
contain a significant amount of the drug. In fact, even
patches that are properly used may retain 60% to 80%
of the original dosage. Whether the patch is new or
used, the contents can be scraped off, snorted, injected, chewed and/or smoked.
Therefore, the physician should caution the patient/
family to store the patches in a secure place, and to keep
This figure is preliminary and is subject to change once the statistical year has been completed.
Issue 4, 2014 Dialogue
57