Fentanyl is a medication that’s been in the media a great deal recently. It plays a large part in the current opioid overdose crisis. It’s important to remember that this crisis is mainly due to illegal opioids being used for non-medical reasons. Street drugs can contain a variety of medications with unknown strengths mixed together. This non-medical use is resulting in opioid overdoses and deaths.
Benefits when used properly and safely
When used properly, fentanyl has many benefits for patients. It’s a very potent opioid, much stronger than morphine, and is used for severe pain. It’s also used in other ways for pain treatment in the hospital or community.
When opioids are prescribed properly, used for control of pain and also watched closely for the effect, then serious problems are uncommon. Addiction and overdose are uncommon. They happen when the medicine is:
- Inappropriately prescribed.
- Not properly overseen by the health care team.
- Misused.
- Instructions aren’t followed properly.
Tolerance
Tolerance may develop if the body becomes used to an opioid medication – in which case, the dose may need to be increased to get the same pain effect. This is different than addiction. If tolerance is an ongoing problem, it may be helpful to change to a different opioid.
Withdrawal symptoms
Sometimes when an opioid is stopped suddenly, people experience withdrawal symptoms. This is because the body becomes physically dependent on the medication.
- In order to avoid this, opioids are usually decreased slowly.
- This doesn’t mean that the person is addicted to the medication.
Addiction
Addiction happens when a person has an overwhelming preoccupation with obtaining more medication – when there’s no medical need. This almost always has a negative overall effect on the person’s life, including employment, relationships and behavior.
According to the Centre for Addictions and Mental Health, a simple way to describe addiction “is the presence of the 4 Cs:
- Craving
- Loss of control of amount or frequency of use
- Compulsion to use
- Use despite consequences.”
It’s very uncommon for people to develop addiction when they use opioids in palliative care as prescribed by their health care provider to manage symptoms.
Using fentanyl patches
Fentanyl is commonly used within a patch that is placed on the skin; this is called a transdermal patch. Fentanyl patches should ONLY be used to treat long-term stable pain that is well managed with current medications.
- They should be used with people who have previously taken consistent doses of opioids for at least 7 days.
- They should not be used for someone who is opioid-naïve or has intermittent or acute pain.
When a fentanyl patch is first used, your health care team will instruct you on:
- When to start the patch.
- What other pain medications to stop.
- Which short-acting pain medication to continue using “as needed” to manage breakthrough pain.
Transdermal fentanyl patches can cause serious injury.
- Safe storage and handling is essential.
- It’s important to take the medication as directed.
When picking up the prescription
Talk to your pharmacist
Tell them:
- The type of pain you’re experiencing.
- Any other pain medicines you’ve been taking and for how long.
While wearing or replacing a fentanyl patch
Follow directions
- Use the patches exactly as directed to prevent serious side effects.
- Don’t use more patches than prescribed.
- Use intact patches - never cut the patches or use damaged patches (this could result in an overdose).
Handle medication safely
- If you’re a caregiver and applying or removing a patch, wear gloves.
Choose an appropriate site
- Apply patches only on skin without cuts or sores.
- Avoid broken skin.
- Don’t shave the area before applying the patch.
To change patches
- Take off the old patch before applying a new patch.
- Place the new patch on a different area of the skin so the same place isn’t used twice in a row.
- If you’re using more than one patch, change them all at the same time.
- Document where you’ve placed each patch and the strength of each patch.
Don’t expose the patch to excessive heat
- While wearing a fentanyl patch, don’t expose the site to heat sources such as a heating pad, electric blanket, sauna, hot tub or heated waterbed.
- Also, avoid excessive sun exposure or strenuous exercise.
- The body may absorb too much medicine with excessive heat.
- Avoid overheating and watch for signs of opioid toxicity.
Monitor the patch site
- Monitor the site regularly to make sure the patch is intact and hasn’t been accidentally removed.
- If the patch starts to peel off the skin, place tape around the edges to keep it in place.
- Patches shouldn’t be applied to the waistline, or tight clothing worn over the patch, as this may cause them to be removed.
- If a rash or skin irritation develops at the site, contact your health care team.
Address any signs of an opioid overdose
- Signs of an opioid overdose include:
- Trouble breathing, shallow or very slow breathing.
- Extreme sleepiness.
- Inability to think, talk, or walk normally.
- Feeling faint, dizzy or confused.
- Depending on the severity of symptoms, access emergency health services or contact your local health care team.
Store and dispose of patches safely
- Pain patches should not be placed in the garbage!
- There’s still medication left in used patches so it’s very important to store and dispose of them safely.
- Used and unused pain patches may cause harm or death to adults, children and pets if they’re misused or used by accident.
For more information on safe disposal, see: