My colleague, Anne Asher, About.com guide to back and neck pain, shared a reader comment with me that makes me weep. It removes that "it only happens to other people, it would never happen to me" from our list of excuses.
A reader named Paula lost her sister to an overdose of fentanyl. Fentanyl is a painkiller for people who have long-term, chronic pain and is delivered in the form of a patch. The drug is infused in the patch, and when the patch is adhered to the skin, the drug osmoses slowly through the patch and then the skin (called transdermal.) According to Paula, when her sister died, they all assumed she had not managed the drug's use correctly. In fact, it may possibly have been something else....
Paula's sister died six weeks after more than a dozen lots of fentanyl patches were pulled off the market. There have been at least four recalls, from three different manufacturers, including PriCara / Johnson and Johnson / Sandoz, brand name Duragesic, Watson and Actavis, due to manufacturing defects. In all cases, manufacturing defects cause the gel to leak from the patch. Patients or caregivers were getting too much of the drug on their skin at once. That caused respiratory distress in some, and overdose -- even death.
So of course, now Paula is looking at her sister's death differently. Was she given fentanyl patches that were defective and had been recalled? Why didn't the doctor say something about the danger? Or did he? Or the pharmacist who dispensed the patches? Is it possible patches that had been pulled from the market were still being sold to unsuspecting patients? Who knows? How will anyone ever know?
Beyond the loss of Paula's sister, there are two aspects to this story that upset me.
First -- when the fentanyl was first prescribed for Paula's sister, someone -- Paula, her spouse, a relative, a friend or loved one -- someone should have been asking questions, just as we should do for any new drug prescribed for us. Ask the doctor, ask the pharmacist, and always go online to review the information that's out there.
As I learned when I had a problem a few weeks ago with Avelox (the flouroquinolone I was prescribed that gave me problems) --we can't trust that our doctors are going to know about problems. Nor can we trust the pharmacist will tell us. We can only trust ourselves, or a loved one or advocate to uncover what we need to know. By the way, a good resource is the FDA's Medwatch. See what's been reported there, if anything, first.
The information for fentanyl is out there and easy to find. After checking MedWatch, I googled "fentanyl" and sure enough, problems with the drug, and warnings about side effects and adverse events are listed with each entry, right there on the first page of results.
And here's point #2 -- which will make the hair on the back of your neck stand up. Included in those search results was a broker for manufacturing fentanyl in China and Korea. (Things that make you go, "hmmm..."?)
When I add that what I know about counterfeit and substandard manufacturing of drugs, where they come from, how they make it into our legal drug supply.... I have to ask myself.... Why is it that three different manufacturing companies had the SAME reason to recall those patches, all manufactured within the same time frame? The press releases all say they use different manufacturing companies. Could it be that those manufacturers outsourced to the same contract manufacturer that was not so... oh... diligent about the work it does? Perhaps not even in this country?
So I checked in with the Feds, the Department of Justice -- and sure enough -- it looks like there is a question mark about these drugs and how they were manufactured, stated as "clandestinely manufactured fentanyl." Nothing specific on the DOJ website -- but enough that it should make us all pause.
So that's today's second warning.... if you run into a problem with any drug you are given -- anything that just seems strange about its appearance, or manufacturing defects, or the print on the box or even a drug you've taken for many years that all of a sudden tastes different or is a different color.... take it back to the pharmacy and insist they look at it carefully.
We can't be too careful. Paula has shared her story with us. Perhaps her tragedy can serve as a warning to the rest of us.
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