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are transdermal opioids contraindicated in patients at risk of suicide?

Oppliger, Martine; Mauermann, Eckhard; Ruppen, Wilhelm

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European Journal of Anaesthesiology: January 2017 - Volume 34 - Issue 1 - p 40-41
doi: 10.1097/EJA.0000000000000483
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Editor,

We would like to thank Dr Ruan and colleagues1 for their interest in, and enhancement of, our case report. We would like to respond to their queries with three brief comments. First, the patient presented had been on a fentanyl patch for several weeks prior to her death.2 In this sense at least, the patient was not opioid nontolerant. Second, although we agree that the individual variation of tolerance is substantial, we were also quite surprised that a nonopioid-naïve patient could commit suicide with her standard patch. This may be an effect of the quicker rate of increase in blood concentration by oral ingestion, rather than the absolute concentration. And third, given that chronic pain itself is an independent risk factor for suicide, withholding pain therapy in acute episodes of any sort is probably not a good idea and an aggressive multimodal approach – as emphasised by Ruan and colleagues – is warranted.

Acknowledgements relating to this article

Assistance with the reply: none.

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Conflicts of interest: none.

References

1. Ruan X, Labrie-Brown C, Kaye AD. Are transdermal opioids contraindicated in patients at risk of suicide? Eur J Anaesthesiol 2017; 34:39–40.
2. Oppliger M, Mauermann E, Ruppen W. Reply to: are transdermal opioids contraindicated in patients at risk of suicide? Eur J Anaesthesiol 2016; 33:604–605.
© 2017 European Society of Anaesthesiology