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  • Title: Recurrent respiratory depression associated with fentanyl transdermal patch gel reservoir ingestion.
    Author: D'Orazio JL, Fischel JA.
    Journal: J Emerg Med; 2012 May; 42(5):543-8. PubMed ID: 21530138.
    Abstract:
    BACKGROUND: Opioid abuse is common in the United States and is currently on the rise. Fentanyl transdermal patches (FTPs) have been on the market since 1991, and have recently become a popular source of opioids for abusers. There are currently two distinct FTP designs available on the market today; a gel reservoir system and a matrix construct. The gel reservoirs of FTPs contain massive amounts of fentanyl and are easily extractable for abuse. Ingesting the gel reservoir of an FTP is potentially lethal. CASE SERIES: In this case series, 4 patients ingested the gel reservoir of an FTP and experienced severe and recurrent respiratory depression necessitating continuous naloxone infusions. All patients responded adequately to initial prehospital doses of naloxone (0.8-2 mg intravenous) but developed recurrent respiratory depression within 2 h of presentation to the hospital. CONCLUSION: The gel reservoir of an FTP contains massive amounts of fentanyl. Ingestion of the gel may cause severe and recurrent respiratory depression necessitating repeated naloxone boluses, continuous naloxone infusion, and a prolonged observation period.
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