This case report discusses the clinical presentation and management of a patient presenting to substance misuse services reporting chewing fentanyl patches in addition to wearing them transdermally. The patient was successfully titrated onto methadone 30 mg. Only one previously reported case of an individual chewing fentanyl patches was found in the literature; no case reports were found where treatment involved titrating the patient onto methadone. The pharmacology and illicit use of fentanyl are also considered.