Danger lurks for kids who discover used medicine patches

Parents, grandparents, and anyone else wearing a medicine patch all need to be extra cautious when they're around children and pets. Everyone's familiar with medicine bottle labels that warn, "Keep out of reach of children" when medications are stored. But not many think of that when it comes to medication patches they've already worn. Yet, all too often we learn about tragedies where kids have been exposed medicine patches that fell off a family member or that they find in a trash can, discarded after use.

Some potentially dangerous medicines come in patches that you attach to your skin. Examples include nicotine patches to help people quit smoking, drugs for motion sickness like scopolamine, and drugs for pain, like the narcotic fentanyl. Lidocaine, a local anesthetic that's used for nerve pain for patients who've had shingles, also comes in a patch and contains potentially lethal amounts of drug if accidentally ingested. Patches are designed to give a constant amount of medicine over a certain period of time, usually several days. New patches contain lots of medicine, but used patches can still contain medicine after you take them off. So both new and used patches can be dangerous if kids or small animals somehow find them and apply or ingest them.

Earlier this month, one of the pharmacy technicians I work with alerted me to a report she'd just received through our reporting program from a doctor who wanted us to put out a warning after an accidental ingestion of a used medicine patch nearly caused an 8-month-old baby's death. At home, the child found a once lost fentanyl patch and placed it into his mouth where it became affixed to the roof of his mouth (called the palate). Later a grandparent thought he looked sleepy so the baby was placed into his crib for a nap.

The grandparent caring for the child was not aware that the baby had somehow found and ingested a used fentanyl patch. After sometime, the caregiver heard "gurgling" sounds coming from the child's crib. The child was lifted from the crib and was flaccid. His lips were blue, indicating that he wasn't breathing well. CPR was administered, 911 was called, and the child was transported to the emergency room for treatment, where the patch was noticed and removed from his mouth. A reversal drug called naloxone was administered in the ED, and the baby's breathing, which had slowed to dangerous levels, rebounded within minutes. Fortunately the patient awakened and became more alert although a second dose of naloxone was required 30 minutes later. The patient was admitted to the ICU for further treatment and observation. While he was unconscious, the baby breathed in some particles from his mouth causing aspiration pneumonia (lung inflammation.) The patient was treated with antibiotics and thankfully did fine thereafter.

This is certainly not the first time we've heard about kids somehow finding medicine patches and pets find them too. I wrote about this problem last August after we received reports about a child who died from being exposed to a fentanyl patch. His Mom told us that her 4-year-old found a discarded patch retrieved from the trash, or opened a wrapper from a box of stored patches, and applied one to his body. His heartbroken mother found him dead on the floor of a bedroom near an overturned trashcan. We also heard about a child who was accidentally exposed to a patch that fell off a family member, and another who removed a patch while his grandmother was sleeping and applied it to himself. Fortunately, in those cases, the children were not seriously injured.

Although the cases above involve fentanyl, any drug that is applied as a patch can be dangerous to kids. Kids sometimes find patches that were being disposed of. In addition to finding lost patches, in a previous blog I mentioned how children love to put on stickers, Band-Aids, tattoos, and the like. They think of medicine patches in that way and this too has been a factor in some tragic overdoses. Children might also mimic adults after seeing them apply a patch.

Follow these suggestions for safe patch use to better protect children, pets. First, be sure to store them safely. Keep new patches far away from the reach or discovery of children. A high, locked cabinet would be best. Dispose of patches safely too. As a precaution, this medicine is one of just a few medicines that the US Food and Drug Administration says must be flushed down the toilet for disposal. Or, fold the sticky sides together and place them in a sturdy container, preferably with a child-resistant cap. Be sure the opening is big enough for a folded patch to go in but small enough that a child's hand cannot. A washed-out bottle with a child-resistant cap may work well. You could also ask your pharmacist for a large empty bottle or prescription vial with a child-resistant cap. Or look in the drugstore for "sharps containers" that diabetics use for their insulin needles. Some of these can even be mailed back to the container company for free when they are ready for disposal (visit here for one example). Whatever container you use to dispose of patches, remove it from your home frequently. The more used patches available to someone, the more seriously they can be harmed.

Finally, if you are wearing a patch while caring for children, please keep track of where the patch is located on your body at all times to make sure it hasn't fallen off. While patches have adhesive backings that usually work well, they don't always hold to skin. So check for it soon after you wake up to make sure it hasn't come off in the bed while you were sleeping. Check in the bathroom after a shower and, during the day, check regularly for its presence under clothing or stuck to it.

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