A few weeks ago, I disseminated an email message from Dr. Anne Bodkin about the use of pain patches. We received a few comments about this email message which are summarized below:

Dr. Dwight Moulin provided this suggestion.... "For high risk patients that I think require transdermal fentanyl, I provide no more than 5 patches at a time and put on the script that they have to return old patches to get new ones - avoids patient cutting up patches, trying to aspirate from patches (needle tracks) or smoking them. Can still take a whole patch and put against oral mucosa but does cut down on abuse. Requires higher maintenance from Pharmacist so I try to use discretion in ordering return of old patches."

Another issue that arose was with regard to the type of patches that can be abused. Aside from fentanyl patches, abuse has also be noted with buprenorphine (BuTrans) patches. This information was provided by Dr. Brooke Noftle....

Buprenorphine when not co-mixed with naloxone, i.e. pure buprenorphine, has been associated with a considerable propensity for misuse/abuse. In France, there have been several related deaths in the past.

We are not aware of any concerns with abuse of lidocaine patches.

Thanks to everyone for the responses.

Bryna