About seven years ago, Elkhart County Coroner John White started finding prescription painkiller patches in people's stomachs.
The patches — usually prescribed for moderate to severe chronic pain — contain fentanyl and they are designed to be worn on the skin for two or three days. But White said local people abusing the patches are chewing or swallowing them in an apparent attempt to get high.
Eleven people have died from eating the patches since 2007, White said. In one case, an individual had frozen the patch, which turns the drug inside to crystals. This person had then melted the crystals, put the drug into a syringe and injected it into the shoulder.
"It was instant death," White said. "They were found dead with the syringe still in their shoulder."
Laurie Whitacre, a pharmacist at a Martin's Super Market in Elkhart, said the patches have "a high abuse potential."
"It is one of those types of medications that people seeking drugs are looking for," she said. "My guess would be that these people (who are eating the patches) are addicted to cocaine or meth or heroin, and they are using the patches to come down from those."
White said that only 60 percent of the people who died from eating the patches actually had a prescription for them.
Whitacre said most people who have a prescription for the patches usually pick up about a month's supply, which is just 10 patches.The patches aren't cheap — without insurance, 10 patches costs about $230.
People typically start out with the low-dose fentanyl patches, Whitacre said, which releases 12 micrograms of fentanyl per hour. The patches go up in dosage, and the highest possible dose is 100 micrograms per hour.
"When (the patches) first came out, they were primarily used for cancer patients, at the end stage of cancer," she said. "They are being used differently now. It appears to be that those patients with chronic, non-cancer pain are taking it for extended periods of time."
Whitacre said that most people using the patches gradually increase the dose as they become more tolerant to the drug. But a person who uses the patch appropriately probably won't get addicted to it, she said.
Misusing the patch by wearing more than one at a time or by ingesting it can cause respiratory failure and death.
"If (the patch) is misused, it will stop the respiration," Whitacre said. "We are very careful to tell patients to remember to take off the previous day's patch."
White said that in the cases he's seen, people who have eaten the fentanyl patch also have other drugs in their systems.
The fentanyl patch abuse is a problem, he said, but more Elkhart County residents are dying from abusing methadone — another prescription painkiller.
Forty-three people in the county have died from a methadone overdose since 2007. In the last four months alone, three people have died, White said. Methadone is a synthetic form of heroin — a drug that's becoming a serious issue locally.
"Heroin has been a significant problem in (nearby counties), but we are just starting to see more of it in Elkhart County," White said.