WASHINGTON — Army Master Sgt. Harold Kinamon entered a military hospital
in Ohio for routine respiratory surgery to help him sleep better. The operation,
in October 2005, progressed smoothly. He went home with nothing more than a raw
throat and a painkiller contained in an adhesive patch on his skin.
That night, Kinamon, 41, died in his sleep — killed by an overdose of the drug
delivered through the patch.
What made his death even more tragic was that the dangers of using skin patches
to administer the particular painkiller he received, an opium-like drug called
fentanyl, were clearly understood at the time. Only three months earlier, the
Food and Drug Administration — responding to a rash of similar deaths — had
issued a strong warning: Although beneficial under appropriate conditions,
fentanyl patches should be used with great caution, and not for postoperative
pain relief.
But Kinamon's death reflects more than an individual misfortune. Health care
providers nationwide are still not getting the message as fentanyl patches
continue to be implicated in scores of deaths.
Failure to solve the problem is all the more serious because the use of
medicinal patches is spreading to other drugs — painkillers, birth control drugs
and medications for children with attention deficit disorder.
Drug-safety experts are urging the FDA to re-examine the whole issue of
medicinal patches. One primary problem seems to be how to get the right dose of
a drug through a patch for different patients under differing conditions.
The appeal of the patches over more traditional methods of administering
medications is clear: Unlike injections, they don't hurt. Unlike pills, they
don't have to be swallowed.
Those advantages are real, medical experts say, but they are not the whole
story.
Sales of Ortho Evra, the first birth-control patch, plunged last year after the
FDA cautioned that it exposed women to higher levels of a hormone linked to
dangerous blood clots than did oral contraceptives.
