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Transdermal patches pose a new and potentially fatal risk to curious kids

Dominika Osmolska Psy.D.'s picture

Babies and toddlers are notorious for sampling just about anything they can manage with their mouth. For as long as there have been babies, their caretakers have had to keep a close watch over the little scamps’ roving, curious fingers. A whole industry has arisen in the child-proofing department in order to forestall potential disasters. Now a frequently overlooked hazard has come into the spotlight: drug patches.

In June, parents of an unconscious, barely-breathing 8-month-old boy rushed him into the emergency room. The ER staff discovered, upon a thorough examination, a 50-microgram-per-hour fentanyl patch stuck to the roof of his mouth. He was treated with a powerful dose of an opiate antidote and survived, but the case highlights the potential hazards to kids posed by growing numbers and types of transdermal medications that parents, grandparents and caregivers increasingly use.

Some children have found the patches in home trash cans, or had them adhere to their skin after they rubbed off during close contact — even a grandparent's hug — leaving kids vulnerable to inadvertent overdoses of drugs ranging from painkillers and nitroglycerin to nicotine from stop-smoking patches.

“Even after they’re used, after 72 hours, there’s still a residual drug that can be left in the patch and can be dangerous for a child,” noted Clemence, who reported the Maine incident to the Institute for Safe Medication Practices, an advocacy agency that tracks medical dangers.

Grandparents of the Maine boy still don’t know how he got hold of the patch, which they did note as missing. Government records show that at least four children have died and six have been hospitalized since 1997 after being exposed to just this one type of transdermal drug, the fentanyl patch.

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Fentanyl is a potent synthetic opioid with a rapid onset and short duration of action and is approximately 100 times more potent than morphine. It is used intravenously in conjunction with major medical interventions such as surgery. Transdermal patches of fentanyl are used for the management of chronic pain, such as can occur in the treatment or management of cancer. Fentanyl also comes in the form of lozenges – a form which can only pose an even greater risk for ingestion by unwary children. These come on a stick in the form of a lollipop that dissolves slowly in the mouth for transmucosal (soft tissue) absorption in patients who are opioid-tolerant. This form of fentanyl is especially effective in treating breakthrough pain for those suffering bone injuries, severe back pain, neuropathy, arthritis, and cancer.

No complete data are available for child poisonings related to medication patches. Not even the American Association of Poison Control Centers can easily say how many children are exposed to drugs through skin patch medications.

The rapidly growing market for such drugs means there’s more chance for children to be exposed, and many incidents may never be reported, experts said. Last year, nearly 60 kinds of drugs were sold in transdermal form, totaling nearly 22 million prescriptions, according to figures from Wolters Kluwer Pharma Solutions.

Fentanyl was the most prevalent patch used, with 4.7 million prescriptions in 2010. The FDA issued safety warnings in 2005 and 2007 warning about proper use and disposal of the patches, including advice to flush the drugs down the toilet to protect vulnerable children and pets.

Nitroglycerin patches, with more than 1 million prescriptions a year, could cause life-threatening heart conditions in kids. Nicotine patches, prescribed nearly 97,000 times, could cause nausea, rapid breathing, weakness and even seizures or death in children. And some popular birth-control patches, with about 7 million prescriptions a year, likely would not cause immediate harm, but could cause long-term problems, he added.

It’s critical to keep all medication patches away from children, just as if they were drugs dispensed in pill or liquid form. For fentanyl and other dangerous drugs, the FDA specifically warns that used patches should be folded, sticky sides together, and flushed down the toilet. Less-dangerous patches should be folded together and sealed in child-proof container before being disposed with household trash.

Remember that the drug patches remain powerful, even after use. Check after showering or changing clothes to make sure the patch is still in place. Keeping careful track of patches as they are changed may be key to avoiding a tragedy.