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A fatal overdose of transdermally administered fentanyl

C Kramer1, M Tawney

  • 1Mount Clemens General Hospital, Department of Emergency Medicine, MI 48043, USA. CKramer% PCS@MCGH.org

The Journal of the American Osteopathic Association
|August 8, 1998
PubMed

Insights

A case study highlights a fatal fentanyl overdose from mucous membrane absorption. A man died from respiratory arrest after using two fentanyl patches, with blood levels significantly exceeding therapeutic ranges.

Area of Science:

  • Toxicology
  • Pharmacology
  • Emergency Medicine

Background:

  • Fentanyl transdermal patches are potent analgesics.
  • Mucous membrane absorption presents a risk for rapid systemic drug delivery.
  • Accidental or intentional misuse of transdermal fentanyl can lead to overdose.

Observation:

  • A 31-year-old male presented with respiratory arrest.
  • Two 75 mcg/h fentanyl transdermal patches were recovered: one from the buccal cavity and one on the thigh.
  • Postmortem venous fentanyl concentration was 17.2 mcg/L, far exceeding the therapeutic range (1-3 mcg/L).

Findings:

  • Buccal mucous membrane absorption of fentanyl from a transdermal patch was identified as a route of exposure.
  • High systemic fentanyl levels correlated with respiratory arrest and death.
  • Co-ingestion of benzodiazepines and cocaine was noted.

Implications:

  • This case underscores the critical danger of fentanyl transdermal patches, especially when misused or placed in the buccal cavity.
  • Healthcare providers must be vigilant for non-traditional routes of fentanyl absorption in overdose cases.
  • Enhanced patient education and secure storage of potent opioids are crucial to prevent such fatalities.

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