Ensuring Safe Use and Disposal of Fentanyl Patches
In the ongoing battle against opioid misuse and abuse, initiatives aimed at ensuring the safe use and disposal of fentanyl patches, can help prevent accidental exposure and overdose. Even used fentanyl patches can retain a significant portion of their original potency. If not disposed of properly, they pose a serious risk of accidental exposure. As a result, disposal via a pharmacy take-back program is recommended.
Recently, I had a conversation with a group of pharmacy professionals from across the country about best practices for fentanyl patch disposal. Product monographs suggest that upon removal, used patches should be folded in half so that the adhesive side of the patch adheres to itself. Unused patches should be removed from their package and disposed of similarly to used patches. This is the method I was familiar with.
Others thought that using a patch return sheet would be better practice. Instead of folding a patch in half, patients are provided with a return sheet when filling a prescription and directed to stick their used patches onto the sheet. They store the sheet in a secure location, and after applying the last patch, return the sheet with the used patches to the pharmacy.
It was through this discussion that I learned that some provinces have taken the recommendation further. In Ontario, legislation was passed through the Safeguarding our Communities Act mandating fentanyl patch-for-patch programs.
How Patch-for-Patch (P4P) Programs Work
The core principle of a P4P program is a “one in, one out” model. Before a patient can receive a new supply of fentanyl patches, they are required to return their used patches to the dispensing pharmacy. This process ensures a closed-loop system, accounting for all prescribed patches and facilitating the safe disposal of those no longer needed.
Key aspects of these programs include:
- Prescriber Responsibilities: Physicians are typically required to note the designated pharmacy on the fentanyl prescription and, in some cases, notify the pharmacy in advance. For first-time prescriptions, this is usually indicated on the script, exempting the patient from immediate returns.
- Pharmacy Responsibilities: Pharmacy professionals play a critical role in verifying the prescription, dispensing the correct quantity (often a one-month supply initially), and crucially, collecting and documenting the returned patches. They are also responsible for inspecting returned patches for any signs of tampering or counterfeiting before their secure disposal. In situations where a patient returns fewer patches than dispensed, the pharmacist must use their professional judgment to determine the appropriate number of new patches to dispense and notify the prescribing physician of the discrepancy.
- Patient Responsibilities: Patients are responsible for keeping track of all dispensed patches, used or unused, and returning them to the designated pharmacy to receive their next prescription. To help with this, patients are often provided with a return record sheet where used patches can be adhered. They are also educated about the dangers of unused and used patches and the importance of safe storage and timely returns.
Program Effectiveness
Ontario’s Patch-for-Patch Fentanyl Return Program has shown some positive effects. By requiring the return of used patches, patients are encouraged to be active participants in their own healthcare and the number of patches circulating in the community is minimized.
Case Study 1: Improved Patient Compliance
One notable success story involves a patient who struggled with managing their fentanyl patch regimen. Through the program, the patient became more diligent in tracking and returning used patches. This increased compliance not only improved their pain management but also reduced the risk of patch diversion. The patient’s healthcare provider reported a significant improvement in the patient’s overall health and adherence to the prescribed treatment plan.
Case Study 2: Community Impact
In another case, a community pharmacy participating in the program saw a marked decrease in the number of fentanyl patches being diverted for illicit use. The pharmacy’s proactive engagement with patients and consistent monitoring of patch returns led to a safer community environment. Studies have shown a 60% reduction in the number of fentanyl patches dispensed that could potentially be diverted.
Challenges and Considerations
Studies also indicate that while fentanyl dispensing may decrease with P4P programs, there isn’t always a corresponding measurable impact on opioid-related hospital visits or deaths. This suggests that take back programs are likely most effective as part of a broader strategy to combat opioid misuse and overdose, which should also include harm reduction policies and safe opioid supply initiatives.
For these programs to be successful patients must understand and adhere to the return requirements. Pharmacies must have efficient processes in place for the return, documentation, and secure disposal of used patches. Clear guidelines are needed for handling initial prescriptions, and vacation supplies to ensure patient access while maintaining program integrity.
Supporting Materials and Resources
Teva Canada, a manufacturer of fentanyl patches, provides a variety of support materials and resources to ensure the success of fentanyl patch take-back programs. These include a patch return sheet, FAQs to address common questions, and a sample discrepancy form to be used if a patient has missing or altered patches. More information is available on the Teva website.
Patch-for-patch fentanyl return programs represent a significant step towards promoting the safer use and disposal of a potent opioid medication. While Ontario’s program could be a precedent setting initiative, I wonder if there has been enough exposure for that to happen.
What do you think? Do you use P4P programs in your practice? Share your thoughts in the comments below.
About the Author: Teresa Hennessey is a pharmacy technician with 25 years of front-line and leadership experience in both community and hospital pharmacies. She is the Administrator for PTSA.
References
Patch-For-Patch Fentanyl Return Program: Fact Sheet – OCPInfo.com
prescribing-drugs-fentanyl-factsheet.pdf
Assessment of the Impact of the Ontario Fentanyl Patch-for-Patch Return Program