Where do you dispose of used fentanyl patches?
So is it correct that when trying to streamline meds, and begin taper, you change the short acting medication into extended release, then taper the ER?
Yes, if feasible. The recommendation is to consolidate all short and long-acting opioids into a single extended release opioid before beginning the taper.
These resources provide more information:
Murphy L, Babaei-Rad R, Buna D, et al. Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions. Can Pharm J (Ott). 2018;151(2):114-120. Published 2018 Feb 8. doi:10.1177/1715163518754918
NPS MedicineWise: Victoria State Government. Recommendations for Deprescribing or Tapering Opioids. Information for health professionals. May 2016.
Upon the death of a patient at your hospital, what do you do with the patient's home medication that was brought into the hospital, including controlled substances?
Legally, only the patient (or patient’s agent, in the event of a patient passing) may dispose of controlled substance medications. Thus legally, they would be returned to the patient’s family along with information for appropriate disposal.
Are Morphine Milligram Equivalents (MME) age-specific?
No. It is a standard conversion factor for equivalence across drug potency, and does not factor in patient specifics. For this reason, and given the broad range of individual response and level of tolerance, when dose-converting between opioids the end calculated dose should be reduced by the recommended percentage (10-50%, depending on the source) before being prescribed. I am not aware of an age-related difference in the MME cutoffs for increased risk of overdose and other adverse events (i.e. 50 MME and 90 MME).
Even though the MMEs are not age specific, it is important to note that the conversion factor from the CDC to calculate the MMEs includes these very specific words of caution: “These dose conversions are estimated and cannot account for all individual differences in genetics and pharmacokinetics.” Older patients have decreased renal function, liver function, and other variables that impact the pharmacodynamics and pharmacokinetics of medications. Such factors should be considered when addressing MMEs in the older person. This would also apply to any age person who might have different genetics or pharmacokinetics.