Category: Health and Wellness
With a report from CTV medical specialist Avis Favaro and producer Elizabeth St. Philip
Ontario's coroner is investigating a handful of deaths among patients who accidentally overdosed on a medication that was supposed to help them battle chronic
pain.
It's a story that's been repeating itself all too often despite alerts in Canada and the U.S to doctors and patients to use this drug carefully.
The medication is fentanyl, a powerful painkiller delivered in a skin patch. Many patients choose it over injections or pills, because of the patch's convenience,
few side effects, and long-lasting, controlled dose.
Fentanyl is sold in Canada under the brand names Duragesic, Ran-Fentanyl and Ratio-Fentanyl. Sales have more than doubled in Canada in the last four years
to over $100 million a year.
Fentanyl patches are more than 60 times more potent than morphine. That's why car accident survivor Blondette Burnette is learning how to use the patch
safely at Toronto's Mt. Sinai Hospital to treat her chronic back pain.
"I wouldn't want to have a medication and not know what to do. I can get hurt or harmed from overdosing," she says.
But some patients are accidentally overdosing. Three people in this country have died from fentanyl patches, according to the Institute for Safe Medication
Practices Canada, a non-profit organization that collects medication error reports and develops recommendations for improving patient safety. Ontario alone
is investigating three deaths linked to the patch.
"We have seen a number of patients using these fentanyl patches for pain who as a result of using too much or using it improperly have died," says Ontario
Chief Coroner Dr. Barry McLellan.
In some cases, they're being prescribed by doctors who are unaware they are so potent and who prescribe them in combination with other narcotics. They have
also been mistakenly prescribed to the wrong types of patients: those with acute post-operative pain rather than for patients with chronic pain and an
established exposure to opioid drugs.
In some cases, patients forget they have a patch on, and put on another -- in some cases a third -- triggering an overdose. Part of the problem is some
brands of batches are transparent with no markings, making them virtually invisible to users.
People using the patches need to avoid heat, which affects the rate at which the skin absorbs a drug. Sunbathing, exercise, hot tubs, even a hot shower
can trigger an overdose.
There have also been cases in which youngsters have been poisoned by chewing on discarded patches or putting them on their arms like stickers.
Several alerts have gone out in Canada and the U.S. about how to use fentanyl patches safely. Despite the warnings, label changes, and publication of prescribing
problems, some practitioners still seem unaware of the proper prescribing guidelines. As sales continue to rise, agencies continue to receive reports of
patches being improperly prescribed or used. There have been 80 such reports in Canada this year.
Those who monitor the safety of medications continue to send out the warnings.
"Yes, I am worried," says David U, the president of ISMP Canada. "Right now in our databases, we have 200 reports of errors in the last three years -- 24
cases where the patients were harmed."
Many doctors believe that the fentanyl patch is a good drug but has to be used properly and requires careful education of patients and practitioners.
"You have to educate, educate, educate," says Dr. Allan Gordon of the Wasser Pain Management Centre. "The patient has to take some responsibility. But the
only way they can do that is by knowing what the drug does and what the side effects are."
Only then, can the stick on solution fight pain without causing harm.