The Dangerous First Dose and Application of a Fentanyl Patch

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by Jim Orr

A patient’s very first use of a fentanyl patch can be deadly. The warnings provided to doctors in the package insert that accompanies the fentanyl patch states:

Overestimating the fentanyl transdermal system dose when converting patients from another opioid medication can result in fatal overdose with the first dose.

The package insert also warns the powerful patch can kill even when used properly:

Respiratory depression and death may occur with use of DURAGESIC, even when DURAGESIC has been used as recommended and not misused or abused.

Given such extreme dangers, it is hardly surprising that the insert also warns:

Proper dosing and titration are essential and DURAGESIC should only be prescribed by healthcare professionals who are knowledgeable in the use of potent opioids for the management of chronic pain.

Fentanyl patches are only to be used if less potent pain medications have failed to control the pain at issue. As a result, patients who start fentanyl patch therapy are almost always being converted from another opioid pain medication to fentanyl patches. The package insert warns that when this is done, the correct dose has to be carefully selected and that overestimating the initial dose can cause death on the first patch.

Despite this clear warning, our firm has routinely seen doctors prescribing fentanyl patches at the larger sizes when only the smaller sizes are justified based on the opioid tolerance of the patient. Our firm has settled numerous wrongful death lawsuits involving this error that cause the patient to die on the first patch.

A study published last year in Pain Medicine, the journal of the American Academy of Pain Medicine, noted that one of the major causes of opioid overdoses is switching from one painkilling opioid to another.

The study, entitled “Review and Critique of Opioid Rotation Practices and Associated Risks of Toxicity”, by Lynn R. Webster, M.D. and Perry Fine, M.D., found that changing from one opioid to another, even at recommended dosages, greatly increases the risk of an accidental opioid overdose. Webster and Fine studied reports of fatal or near-fatal outcomes that occurred during opioid rotation and concluded that most of the fatal outcomes were preventable, and that the conversion guidelines relied by doctors were inconsistent and had “important flaws that must be corrected.”

The lawyers at Heygood, Orr & Pearson are among the nation’s leaders in handling cases involving potent opioids, and our law firm has the experience to prosecute medical malpractice cases involving a wide array of serious opioid painkillers. Some of the most commonly prescribed opioid painkillers include hydrocodone (Vicodin), oxycodone (OxyContin), methadone, and the fentanyl pain patch (Duragesic).

With respect to fentanyl, Heygood, Orr & Pearson has successfully prosecuted more cases involving deaths due to fentanyl products than all other firms in the country combined. We have spent years studying fentanyl, its uses and its misuses. We have deposed hundreds of doctors, scientists and experts on the subject of fentanyl products.

If you or a loved one has experienced the tragedy of losing a family member as a result of Fentanyl pain patch usage or from an accidental prescription drug overdose, you and your family deserve answers to your questions. If the loss was as a result of a prescribing error, you have the right to demand that the responsible healthcare provider be held accountable.

The lawyers at Heygood, Orr & Pearson have handled dozens of lawsuits involving medical malpractice related to painkiller prescriptions, and are available for a free legal consultation about your case. Contact us for a free consultation so we can help you determine the best way to protect your legal rights and interests.