SEVEN GALLONS OF FENTANYL?????!!!??
Cheshire Medical Center in Keene, N.H. is dealing with the loss of SEVEN GALLONS of Fentanyl over a five-month period. Just to remind you, Fentanyl is 50-100 times more potent than Morphine. Even when tiny amounts of Fentanyl are lost in a health system, people panic.
But… Seven gallons?!?!? I just can’t picture that. (Chime in here, anyone in anesthesia.) Plus, how can you go five months without knowing it is missing?
They claim they beefed up security but then had a whole bunch more Fentanyl disappear over the next eight weeks.
The loss of SEVEN GALLONS is being pinned on a…“former nurse who allegedly admitted to taking the solution from the hospital, used it “as a way of coping with the stress of working during the pandemic.” She died unexpectedly March 3.
”Isn’t seven gallons enough narcotic to wipe out an entire city or keep a drug cartel in business for a few years? This doesn’t sound like one nurse dealing with stress. This sounds like a serious criminal cover-up! Obviously, this stuff hit the streets.
The whole quantity is weird. When was the last time you measured injectable drugs using gallons or “bags”?…and…I always love the positive spin of Hospital CEO’s:
“Patient and employee safety are always our first priority, and we have a zero-tolerance policy regarding the diversion of any controlled substance. We remain focused on providing the outstanding care our neighbors and community have come to expect from us.”
Heck, I didn’t even know you could buy a gallon of Fentanyl
Maybe it’s just me, but I find the story rather sloppy.
I don’t care about how many GALLONS of Fentanyl solution are missing, I care about the mass of Fentanyl. How many mcg or mg or how many grams.
I doubt that’s 50 mcg/ml injectable Fentanyl, it’s gallons of a far more dilute solution for epidural use, or maybe IV drip in an ICU.
I tried tracking this down to the New Hampshire nursing board, could not find it in the summary suspension order. All it says in the charges are gallons of Fentanyl solution. Nothing about how much mass of Fentanyl in those bags.
I had to look it up. The patches. Whatever dose of Fentanyl the patch delivers. The delivery, say 50 mcg/hr, x 24 hours x 3 days. The total dose of drug delivered. Double that, that’s how much residual Fentanyl is left in the patches. How are the used patches dosposed? Janssen insert fays flush down toilet. I bet some go in needle boxes, maybe some in trash as well.
I’m amazed there is no diversion in the nursing homes, hospices, someone just pockets the used patches for someone to extract the drug from the gel.
Though for all I know, maybe there is diversion along those lines.
arf, yep been too long! there is diversion in any & nearly every venue where such items are used, including prisons, jails, home health agencies, recycling centers, and on and on.. I have personally seen loving children visiting from several states away come home to tell a parent or sibling good-bye during their final days, & reach under their shirt while hugging them to get the patch placed on the mid-back area. i have seen neighbors come to visit terminally ill hospice pts at home, ask the wife for a drink of water, then run out the door with whatever bottles of pain pills they could grab off the bedside table & take off in their car. I have seen a community pillar’s wife hauled out of the local drugstore by local police due to stealing her doctor’s prescription pad & forging herself a new narcotic Rx while also altering the legitimate Rx the doctor did give her to take her pill amount from 10 to 100. I have seen a 30 something year old son say good-bye to a beloved family member, hug another family member then knock the visiting hospice nurse over in the bathroom doorway to try to get to the residual narcotic tablets being flushed down the john before they got out of reach. you apparently have lived a sheltered life!!
I’m guessing these were pre-packaged bags of Fentanyl for epidural infusion? Postoperative analgesia, obstetric labor and delivery?
If accurate, I’d say it’s not a huge amount of Fentanyl.
I wonder – what do facilities do with the used Fentanyl patches?
The transdermal patches have a significant amount of residual Fentanyl when removed from a patient’s skin. AFAIK the patches are simply thrown away, is that accurate?
At the rural hospital I worked at, stuff like this went into a sealed container and then were incinerated in an onsite hospital incinerator. The sealed containers were kept locked in the pharmacy after collection and the the pharmacist took them to be burned.
Yeah, with ambulatory pain patients one doesn’t know where the stuff ends up. Flush down the toilet? Not in my house. I wouldn’t want plastic patches clogging up my sewer lines! 🙂
I agree about the toilet thing. I read that in the package insert, believe it or not. That’s the party line from the manufacturer.
https://www.janssenlabels.com/package-insert/product-monograph/prescribing-information/DURAGESIC-pi.pdf
And I understand the sealed container thing. I just don’t see what prevents a nurse or medical assistant so motivated, to simply pocket the patch. I checked again, the quantity of Fentanyl in the patch, is twice what was delivered to the patient. The patch contains 2X-Fentanyl. “X” is delivered to the patient over three days, and another “X” is still in the patch when it is removed.
I have no idea if there is diversion in the nursing homes, hospices, home health, etc., but it sure seems to me there is a potential for significant diversion if so motivated.
“She died unexpectedly … “
Not really.
Hmmm…50 mcg/mL is 50 mg/L, bout 4 L/gallon, times seven…about 1.4 grams fentanyl done gone missing. That’s a multi state operation. If that was diverted only to New Hampshire, one-done-and-over for the local junkies. About one mcg. for every man, woman, non-binary and kiddies in the state.
Yeah, I figured it as about 1.3g, which is enough for something like 10,000 50-100µg doses (even more if you’re timid).
So, yeah, sure, it was one nurse with a “little problem.”
More like the entire anesthesia department, and each one with a hollow leg, or a very profitable outside operation.
Hmmm… Maybe the hospital CEO should look into this as a “revenue stream”…
You are making the assumption that the bags contained 50 mcg/my Fentanyl straight out of the vials. Maybe so, but I can’t find that when going back to the State Board documents. I tend to suspect these bags are prepackaged to use as maybe an IV drip in an ICU setting on a ventilator, maybe an epidural drip. Either way, a lower concentration.
Nowhere in any official documents do I see any calculation of the actual mass of Fentany that went astray.
If you can find it, let us know.
or maybe someone should look at the hospital CEO period…
Them anesthesiologists in NH must have a heck of a tolerance…
Cheers, guys!
Now that you mention it – tinyurl.com/zus24ck4
Links to a NY Times article on Bill Farley, a Canadian anesthesiologist. I’ve heard him speak a couple times, long ago. That’s his story. He was functioning while taking fistfuls of Dalmane every couple hours. Anesthesiologists who become addicted can develop a tolerance that might surprise you. i don’t presume to know your specialty of course.
I don’t know, but I’m guessing…..BAGS of Fentanyl? I’m thinking maybe pre-packaged Fentanyl for spinal infusions? Postop, L+D?