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Many reports of fentanyl-related deaths from around Australia involve the injection of fentanyl extracted from patches. Nevertheless, the court was concerned enough by these preliminary findings to alert the department. Many of these apparent fentanyl-related deaths are still under investigation by Victorian coroners, so at present the court cannot confirm that there is an actual increase and, if so, whether it represents a temporary 'spike' or the beginning of a new trend. In Victoria, surveillance of deaths by the Coroners Court has identified that fentanyl involvement in drug-related deaths appears to have become far more frequent over the past 12 months. In Australia, there have been increasing reports of misuse of fentanyl patches by people who inject drugs, with evidence suggesting a particular problem in Queensland and New South Wales. Fentanyl misuse in Victoria – an emerging problemĪ number of deaths have been associated with misuse of fentanyl patches overseas, including misuse of used patches obtained from corpses or discarded from aged care facilities patches chewed or swallowed, or applied to mucous membranes multiple patches applied for intoxicating effect or injection of fentanyl extracted from new or used patches. Fentanyl is a Pharmaceutical Benefits Scheme restricted benefit for the treatment of chronic severe disabling pain that does not respond to non-narcotic analgesics. The risk of drug dependence on these patches is high. The patches can be dangerous if put in the mouth or if heat is applied to them, or if they accidentally attach to an opioid-naive individual such as a child. If transdermal patches are used appropriately, it will take around 24 hours for plasma levels to reach a steady state. It is recommended that the patient’s drug and alcohol history is assessed before any opioid is prescribed. Use in opioid-naive patients is rarely justified. Use of fentanyl patches requires special care, particularly when commencing treatment, and they are usually only appropriate for patients in whom opioid analgesic treatment is well established. Use of fentanyl patches carries a number of risks of overdose. Fentanyl is a highly potent opioid with a small margin between therapeutic dose and toxic dose.
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