Diving With Pain Patch

[JLittle44]

In PCB a few weeks ago, the divemaster asked if I had a pain patch under my knee brace. They were talking about a supposed incident where in a diver had a pain patch on his back. According to them, at depth the 12hr patch was compressed and delivered all the meds in one dive causing a heart attack killing the diver after he was back on the boat.

The whole thing just screamed urban myth. Still, it doesn't seem completely out of the realm of possibility. Anybody else hear about this? One of the ladies onboard was pretty nervous about her birth control patch after that story was told.

[ROBERTO REYES]

Be careful at depth and the Viagra patch.

[jaws75]

sounds lame to me.... Why would the meds desolve only in their body and not the water....

[frogman]

That's a very interesting proposition.

The most common "pain patch" is Duragesic-a fentanyl, controlled release transdermal patch. Fentanyl is a very POTENT opioid (much stronger than morphine or ever heroin). It is used for chronic pain and at higher doses for anesthesia in surgery (yeah, it is that strong).
Well, I looked at the PDR for its full prescribing information. The active drug(fentanyl) is mixed with alcohol in a reservoir withing the patch. The drug permeates through the sticky membrane slowly into the skin. Theoretically, if the extrinsic pressure (hydrostatic pressure) increases, it could deliver higher doses which would cause respiratory suppression (stop breathing) :sleep: . Not a heart attack, but I am sure with a bit of nitrogen toxicity not a good thing while diving. I did NOT see a precaution for diving on the prescribing info but there was a precaution for driving, operating heavy machinery etc (like consuming alcohol :beer: :beer: :beer: ). In addition, higher temperature could increase delivery of the drug (hot baths and possibly our 86 F summer water temps). It would be interesting to contact the maker (Ortho-McNeil) to get their opinion.

I am not sure what are the issues with implantable pain pumps or contraceptive patches. However, if someone has such severe pain that they require STRONG medication, why should they be diving anyway? You are asking for trouble.
Bottom line is that if you are planning to dive, take the "pain patch" of.

[Swimsuit]

i can't say i ever asked about a change in the dose delivered when i was on the contraceptive patch, but i know i dove with it & that i am still not a mother (THANK GOD!)

[stevemc1]

I am a Paramedic and recently we have had a few OD cases in our area with pain patches. Teenage kids get them from grandparents med box and put them in their mouth and die. One kid had 2 in his mouth when found. We have also had cases where people that have pain patches leave one or 2 old patches on, or have a home health nurse put a new one on with the old ones still on. No deaths but it could happen. Just really doped out. It makes sense that water pressure could push it into skin at a faster rate and cause problems. Maybe a smoker could put on a nico patch and stop smoking quicker!

[Tunaking]

At least you would die feeling no pain :D

[diverik]

Dove all weekend on the nicotteen patch in the middle grounds. Besides having to duct tape it to me I had no problems.

[stevemc1]

I was just joking about the nico patch!

[Scubado]

Dove all weekend on the nicotteen patch in the middle grounds. Besides having to duct tape it to me I had no problems.
:lol: :thumps:

[GRIM REEFER]

well that sounds like more fun than sucking all the juice out
of the fentanyl patch. But the lollipops are still my fav. :D

[Rolo]

I don't believe it's a stretch to take the dive master at their word. Usual deaths from "pain patches" are likely due to respiratory depression as Frogman mentioned. The most common pain patch is the Fentanyl patches or Duragesic. However, there are other pain patches used that deliver anti-inflamatory agents such as Ketoprofen or Indomethacin. Not sure if these are the ones you were using. Placing it behind the knee does not mean that the delivery of the drug will remain locally, at least not for the Fentanyl patches. These drugs are released systemically throughout the body.

If you call OMJ, you'll likely be told that you should absolutely NOT use these patches while diving. This drug is indicated for severe pain, in many cases such as pain related to cancer or palliative treatment. If you felt good enough to dive, I doubt you need to be using this drug, assuming it's the "pain patch" you are referring to.

There is however been some in Vitro data where the patch was placed at 2.5 atm of pressure and it resulted in a significant increase in the release of the active compound from the drug matrix within the patch. The patch is designed to release the drug over a long period of time (48-72 hours), an immediate release will likely kill most folks, unless you are a heavy herion addict and already have some tolerance in place. This is why you have seen countless deaths with agents such as these as folks will chew them to get an immediate high, which in turn will give them an immediate trip to the undertaker.

Hope that helped.

[JLittle44]

I If you felt good enough to dive, I doubt you need to be using this drug, assuming it's the "pain patch" you are referring to.

I've never used one, and certainly didn't need one. Just had a brace on and the DM asked if I was using one. They told the story later and I thought it was interesting.

[TuckerSnocat]

The fact that someone dies and is wearing a patch doesn't mean that the patch is the cause. Drugs that come in patches take a long time to get the meds through the skin - fentanyl patches don't even start to work until they've been on for twelve hours - it also takes twelve hours for it to wear off once you take the patch off. Unless you defeat the "through the skin process" by ingesting, shooting up etc I don't buy the sudden release leading to death bit. We've used transdermal meds for a long time (ie scopolamine for nausea) so I think we'd know if drug delivery was affected significantly by diving. More likely the victim (who must have had significant health issues to be wearing the patch in the first place) died for other reasons. Diving while using narcotics of any type sounds like a bad plan though.

Russell (ER Doc)

"stupid is as stupid does...."