A case of overdose via tattoo

Why are US military personnel prescribed transdermal fentanyl patches?

INTRODUCTION

Transdermal fentanyl is a continuous release opioid delivery system intended for use in opioid-tolerant patients requiring around-the-clock opioid therapy. The purpose of this study is to identify the most common indications for transdermal fentanyl prescriptions in active duty US military personnel, and determine whether these prescriptions meet US Food and Drug Administration (FDA) labelling.

METHODS

Active duty US military personnel initiating transdermal fentanyl therapy with prescriptions filled at Military Health System pharmacies between 2015 and 2019 were identified in the Military Data Repository. Electronic health records were searched for patient demographic information, clinical information and prescription data. A total of 225 patients with complete data were identified.

RESULTS

The most common reason for transdermal fentanyl initiation was chronic non-cancer musculoskeletal pain. Among patients with non-cancer pain, 36% received their initial prescription from an internal medicine/primary care provider, and 35% did not meet published US FDA criteria for opioid tolerance prior to treatment initiation. There was an 81% decrease in patients initiating therapy between 2015 and 2019.

CONCLUSIONS

While a substantial minority of transdermal fentanyl prescriptions to US military personnel did not meet FDA guidelines on appropriate use, the overall number of prescriptions fell dramatically over the study period. This suggests that automated profile review or additional targeted policies to limit transdermal fentanyl prescribing are unnecessary at this time.

Systemic diseases and infections, anecdotal complications and oddities associated with tattooing

Complications associated with tattoos are mostly of cutaneous origin. They include chiefly ink allergy, local infection, benign tumors or malignant lesions and elective localization of various dermatoses. Tattoo-related systemic diseases and infections have more rarely been described, the most common being sarcoidosis and hepatitis C. However, unusual associations have also been reported, even though they may be anecdotal or likely unrelated with the procedure.

Tattoos among athletes: a matter of concern?

Ten to 30% of the population is currently tattooed. This trend does not spare athletes and sports medicine specialists may have to manage tattooed athletes. The purpose of this study was to review the possible issues associated with tattoos among athletes. Overall, tattooed athletes are exposed to the same complications as anyone, mainly healing issues, skin infections and allergic reactions to a tattoo color. Besides, the main pitfall in sports medicine remains invasive gestures such as puncture or infiltration, as they must be avoided at all cost if the tattoo is recent and under healing. Issues associated with imaging are rather limited (artifacts, visible calcification). Burns during magnetic resonance imagining may occur but they are rather rare. Local neuromuscular complications attributable to tattooing are exceptional. Whether tattoos may have a "systemic" impact on the prevalence of unexplained symptoms in athletes (fatigue, distant tendon or musculoskeletal wounds) remain unknown.