Fatal Transdermal Fentanyl Patch Overdose in a Child

A previously healthy three-year-old girl was brought into the emergency department by ambulance after being found unresponsive with a family member's fentanyl patch found adherent to her lower back. A head CT scan showed global cerebral edema and the patient progressed to brain death. An initial standard urine drug screen was negative for opiates, however, subsequent specific urine assay testing was found to be positive for fentanyl and norfentanyl. This case highlights the dangers of not properly disposing of used fentanyl patches as they may still contain enough fentanyl to cause respiratory failure and subsequent unintentional death in children. Prescribing physicians and pediatricians should advise care providers that fentanyl patches should be carefully stored, monitored, and disposed of properly in order to prevent accidental exposure to the pediatric population. Furthermore, synthetic opiates such as fentanyl will not read as positive on routine urine drug screens and will require specific urine assays.