Opioid patch - handling prone for errors: A 91-year old female pain patient was switched to transdermal fentanyl (MATRIFEN etc.). After several days without problems, her homecare service did not remove the old patch when changing the patch. During a visit to the hairdresser she suddenly experienced dyspnoea, palpitations, dizziness, nausea and anxiety, when the two patches which were attached in the supraclavicular region were heated by the stream of air from the hairdryer. When she tried to stand up, the old lady's collapsed. She only recovered hours after removing the patches. The NETZWERK report (14.163) cleary demonstrated that handling of opioid containing patches is fault-prone. Adverse effects can also persist even after removal of the patches because of drug absorption from the skin depot (a-t 2005; 36: 27-9). Sustained-release oral morphine (M-BETA etc.) is regarded as the standard for pain, but prolonged-release transdermal opioids are now being prescribed increasingly for non-tumour-related severe chronic pain. Overall, transdermal preparations are obviously being used more often, but because these are difficult to control, they appear advisable only when the opioid requirement is stable and when it is not possible to take them orally. We advise specially against transdermal buprenorphine (TRANSTEC). In 2005 over half of the prescribed daily doses of strong opioids were for patches containing fentanyl or buprenorphine - with additional costs of up to 200 million Euro compared to equivalent, but cheaper oral morphine preparations. The statutory German Sickness Founds had to pay out over 300 million Euro for DUROGESIC, the highest-selling preparation on their prescription list (BÖGER, R.H., SCHMIDT, G. in: SCHWABE, U., PAFFRATH, D. [eds.]: "Arzneiverordnungs-Report [Drug prescribing report] 2006" Springer, Heidelberg 2007, page 273-80, 1023/ati d).