Safety of opioid patch initiation in Australian residential aged care

Abstract

Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches. Design: A cross‐sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013. Setting: Sixty residential aged care facilities in New South Wales. Participants: Residents receiving an initial opioid patch during the study period. Main outcome measure: The proportion of residents who were opioid‐naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined. Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid‐naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up‐titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation. Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid‐naive in the 4 weeks before initiation.

Predictors of persistent prescription opioid analgesic use among people without cancer in Australia

“…Notably, a previous study by Gadzhanova et al . evaluating the proportion of residents in care homes for the elderly who were opioid‐naive in the 4 weeks prior to patch initiation, found that of those who were initiated on a fentanyl or buprenorphine patch, 34% and 49% were opioid naive, respectively . Interestingly, in our study, opioid initiation with a transdermal formulation was found to be the strongest predictor of long‐term opioid use, particularly in the 65–84‐year age group.…”

“…However, this prescribing practice is not consistent with current treatment guidelines [4,42,43] that suggest that if an opioid is trialled, it should be trialled at the lowest dose and for the shortest expected duration, and therefore may highlight a discrepancy between guideline recommendations and current practice. Notably, a previous study by Gadzhanova et al evaluating the proportion of residents in care homes for the elderly who were opioid-naive in the 4 weeks prior to patch initiation, found that of those who were initiated on a fentanyl or buprenorphine patch, 34% and 49% were opioid naive, respectively [44]. Interestingly, in our study, opioid initiation with a transdermal formulation was found to be the strongest predictor of long-term opioid use, particularly in the 65-84-year age group.…”

Initiation of strong prescription opioids in Australia: cohort characteristics and factors associated with the type of opioid initiated

“…Although numerous studies have examined the patterns and harms associated with the increasing use of opioids using aggregated data sources , there are limited data focusing on individual‐level patterns of use. Furthermore, less is known about aspects related to the initiation of opioids, with previous studies having only evaluated the initiation of specific opioids . To date, no population‐based Australian studies have examined the initiation of strong opioids collectively in clinical practice.…”

Utilization of transdermal fentanyl in German nursing home residents from 2010 to 2014

“…In our study, patients often received TF, and half of the new TF users in our study had not been regularly treated with opioids in the 180 days prior to patch initiation. The proportion of opioid‐naïve TF users was therefore substantially higher than in studies from the United States and Australia reporting that 36% and 34% of nursing home residents initiating TF, respectively, had not received opioid treatment before . These differences might be attributed to German guidelines giving preference to extended‐release HPOs in both cancer and chronic noncancer pain…”

“…The proportion of opioid-naïve TF users was therefore substantially higher than in studies from the United States and Australia reporting that 36% and 34% of nursing home residents initiating TF, respectively, had not received opioid treatment before. 13,14 These differences might be attributed to German guidelines giving preference to extended-release HPOs in both cancer and chronic noncancer pain. 15,16 In accordance with previous German studies, TF was mainly used in noncancer pain and mostly initiated by a GP.…”