Characteristics of opioid-maintained clients smoking fentanyl patches: The importance of confirmatory drug analysis illustrated by a case series and mini-review

Andreas Kimergård, Jacklyn Dunne, Anette Bøgen, Peter Hindersson, Torben Breindahl

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
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Abstract

The increase in opioid prescribing in many European countries over the last decade has raised concerns about associated diversion, overdose and mortality. Fentanyl is one of these synthetic opioids that is typically prescribed as a transdermal patch for pain that requires continuous pain relief and has been the focus of investigations due to reports of overdose and death.
We report a case series of 14 drug addiction treatment entrants who entered treatment in one service located in the region of Southern Denmark from August 2015 to December 2015 for smoking fentanyl patches. Clients presented with difficulties breathing and pains in the lungs. The clients had a history of past opioid use, including heroin. Relapses resulted in treatment disengagement.
Immunoassays for fentanyl were used in the service. In some cases, false negative results occurred. Clients’ urine samples were subsequently analysed in a collaborating laboratory. Seven clients tested positive for fentanyl. One client was positive for both fentanyl and heroin. Analyses were also positive for other opioids and metabolites in six clients, predominantly codeine and oxycodone. Results from confirmatory analysis contributed to clearer insights into clients’ drug histories, which facilitated personalised care plans consisting of opioid agonist therapy informed by confirmed drug use.
In Denmark, prescription levels of fentanyl are high, which has been accompanied by observations of diversion and smoking in a smaller population. In addition to revision of inappropriate prescribing to reduce diversion, we recommend increased reliance upon confirmatory drug analysis in the addiction treatment sector in Denmark.
Original languageEnglish
Pages (from-to)917-926
Number of pages10
JournalDrug Testing & Analysis
Volume10
Issue number6
Early online date16 May 2018
DOIs
Publication statusPublished - Jun 2018

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