Safety of fentanyl initiation according to past opioid exposure among patients newly prescribed fentanyl patches

Friesen, Kevin J.; Woelk, Cornelius J.; Bugden, Shawn

doi:10.1503/cmaj.150961

Cited by 25 publications

(20 citation statements)

References 14 publications

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“…Of opioid‐tolerant‐only episodes of extended‐release oxycodone, 44% met the primary definition of tolerance and 56% met the secondary tolerance definition (≥30‐mg oxycodone equivalents/day in any 7 days in the 30 days prior to the index date). In Manitoba, Canada, Friesen and colleagues examined pre‐fentanyl opioid exposure among new users of the fentanyl patch from April 2001 through March 2013 . The safety of prior opioid exposure—ie, the tolerance cut‐offs—varied by product strength, based on the manufacturer's monograph.…”

Section: Discussionmentioning

confidence: 99%

Assessment of prior opioid tolerance among new users of fentanyl transdermal system in FDA's Sentinel System

Cocoros

Larochelle

Popovic

et al. 2018

Pharmacoepidemiology and Drug

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Purpose Fentanyl transdermal system (FTS) is intended only for patients with prior opioid tolerance. The purpose of this study is to identify the proportion of new FTS users who had evidence of prior opioid tolerance, by dosage strength, in FDA's Sentinel System. Methods We identified new FTS episodes (183‐day washout) from 2009 through 2013. Members were <65 years and enrolled in medical and pharmacy coverage for 183 days prior to initial FTS dispensing (index). We assessed the proportion of users with prior tolerance stratified by dosage strength of FTS using four definitions of opioid tolerance: ≥30‐mg oxycodone equivalents/day in each of 7 consecutive days immediately prior to index; ≥30‐mg oxycodone equivalents/day for any 7 days in the 30 days prior to index (secondary); any dose in each of 7 days in the 7 consecutive days immediately prior to index (tertiary); and any dose for any 7 days in the 30 days prior to index (quaternary). Results Of 44 450 episodes of 25 mcg/hr FTS, 37% met the primary definition, and 77% met the quaternary definition. Of 3507 episodes of 100 mcg/hr FTS, 57% and 74% met the primary and quaternary definitions, respectively. Those aged 25 to 34 years had the highest proportion of episodes with prior tolerance; those aged 55 to 64 accounted for more of the episodes overall. Conclusions In Sentinel, many new users of FTS did not have evidence of prior opioid tolerance by the primary definition, ie, the product label definition, which is the minimum standard for the lowest FTS dose (12 mcg/hr), especially at the highest strength (100 mcg/hr). Validation of this metric is warranted, but our findings suggest the need for further prescriber education regarding appropriate prescribing of FTS.

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Section: Discussionmentioning

confidence: 99%

Assessment of prior opioid tolerance among new users of fentanyl transdermal system in FDA's Sentinel System

Cocoros

Larochelle

Popovic

et al. 2018

Pharmacoepidemiology and Drug

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“…Patients exposed to at least 60 MME daily for at least 7 out of 14 days prior to the index date were defined as opioid tolerant . Claims‐based identification of opioid tolerance was based on FDA drug labels, and we used an algorithm similar to those used in prior publications on opioid tolerance . We conducted multiple sensitivity analyses (described below) to consider the robustness of our findings under different assumptions.…”

Section: Methodsmentioning

confidence: 99%

Opioid tolerance and clinically recognized opioid poisoning among patients prescribed extended‐release long‐acting opioids

Young

Lund

Dasgupta

et al. 2018

Pharmacoepidemiology and Drug

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“…2 However, this guidance is often not followed, as clearly shown by Friesen and colleagues in a linked research article. 3 Many guidelines exist for the use of opioids in treating chronic pain. Most recommend a stepped approach to dosing, starting with a low dosage and escalating based on careful re assessment.…”

mentioning

confidence: 99%

“…Included were patients 65 years of age and older, a group with high rates of comorbid disease that could amplify the consequences of the drug's respiratory depressant effects. Even more alarming is the authors' finding that 26.3% of prescriptions for transdermal fentanyl were to fully opioid-naive patients, 3 which represents a critical prescribing error and system failure.…”

mentioning

confidence: 99%

Consequences of unsafe prescribing of transdermal fentanyl

Lucyk

Nelson

2016

CMAJ

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Safety of fentanyl initiation according to past opioid exposure among patients newly prescribed fentanyl patches

Cited by 25 publications

References 14 publications

Assessment of prior opioid tolerance among new users of fentanyl transdermal system in FDA's Sentinel System

Assessment of prior opioid tolerance among new users of fentanyl transdermal system in FDA's Sentinel System

Opioid tolerance and clinically recognized opioid poisoning among patients prescribed extended‐release long‐acting opioids

Consequences of unsafe prescribing of transdermal fentanyl

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