Opioid patches: what to tell patients about safe use and disposal

Why this matters

Fentanyl and buprenorphine patches deliver a strong opioid through the skin over several days. The MHRA has repeatedly warned about serious and fatal harm from accidental exposure, especially in children, and from patches used in ways that speed up absorption. Pharmacy technicians often hand these out and reinforce the pharmacist's counselling. This briefing covers the points that matter most.

What the dispensing team needs to know

• A patch that has been worn still contains a large amount of medicine. If a used patch sticks to a child, or is chewed or swallowed, it can be fatal.
• Heat increases how much medicine passes through the skin. Hot baths, heat pads, electric blankets, sunbathing and a high temperature from illness can all cause an overdose from a patch that was fine before.
• Patches are changed on a fixed schedule set by the prescriber. The old patch must come off before the new one goes on. Two patches at once is a common cause of overdose.
• Fentanyl patches are not for people who have not been taking regular opioids already. The pharmacist checks this on a first prescription.
• Fentanyl patches are Schedule 2 controlled drugs and buprenorphine patches are Schedule 3, so the usual controlled drug requirements apply in the pharmacy.

What to say at handout

1. Put the new patch on clean, dry, unbroken skin. Avoid touching the sticky side and wash your hands afterwards.
2. Take the old patch off first. Fold it in half so the sticky sides stick together, put it back in its sachet if there is one, and put it in the bin out of reach of children and pets.
3. Keep patches, new and used, where children cannot see or reach them.
4. Avoid heat on the patch: no hot baths, heat pads, electric blankets or sunbeds. If you get a fever, tell someone.
5. Know the signs of too much opioid: extreme drowsiness, confusion, slow or shallow breathing. That is a 999 call.
6. Do not cut a patch unless the pharmacist has told you it is safe for that product.

Refer to the pharmacist

• A first prescription for a patch, or a change in strength
• A patient or carer who says the patch is not working, or asks about applying extra patches
• Any mention of children in the household who might reach the patches
• A patient who has been unwell with a fever, or who mentions feeling unusually drowsy
• Patches being returned. Used patches count as controlled drug waste and must be handled under your SOP

PPets learning connection

Controlled drugs, counselling and safety alerts are covered in the Level 3 Diploma. This briefing pairs well with our controlled drug records scenario.

Record this as CPD

Registered pharmacy technicians can use this article towards GPhC revalidation, as an unplanned CPD entry or as the starting point for a reflective account. Pharmacy assistants and trainees can use it as evidence of reflective practice. Note down three things:

1. What you learned from this article
2. How you have applied it, or will apply it, in your own role
3. The benefit to the people who use your pharmacy's services

Sources and further reading

• MHRA Drug Safety Update: transdermal fentanyl patches, accidental exposure (October 2018)
• MHRA Drug Safety Update: fentanyl patches for non-cancer pain, not for opioid-naive patients
• MHRA patient sheet: fentanyl skin patches, how to use and dispose of them safely

Related from PPets

• Level 3 Diploma for pharmacy technicians
• Medicines counselling

This article is for general educational purposes only. It is not legal advice, professional regulatory advice or clinical advice about an individual patient. Always follow your pharmacy's SOPs and check current official guidance and product information.

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