Fentanyl Patch Prescription Risky for More than Half of Current Users
Fentanyl is strong opioid with the power 100 times that of morphine. A new analysis questions at risk populations are being properly assessed.
Previous exposure and/or use of an opioid is important safety requirement for patients that are about to use fentanyl.
Medical News reports that a study published shows that 50% of new prescriptions are still for people without the necessary previous opioid exposure.
Usually, the transdermal patch delivers fentanyl continuously over a span of 3 days. This patch was available in 25-, 50-, 75-, and 100- μg/h. In 2008, a 12- μg/h patch was introduced mainly for dose adjustment.
Those who have previously used an opioid of 60 mg of morphine a day for a week or more are recommended with a 25 μg/h fentanyl patch.
Potential Consequences of Fentanyl
The consequences of fentanyl are very serious and risky. Some of the adverse effects include:
- Central nervous system depression
- Dangerously low blood pressure and heart rate
- Difficulty breathing
From 1996-2015, 284 deaths have been linked with fentanyl patches, which were reported in Canada. Many of these deaths were linked to use of them in the early stages.
These deaths and adverse events related to fentanyl use prompted a doctor to look at safety issues surrounding the patch.
Study Conducted Regarding Fentanyl
According to Medical Device Daily, researchers wanted to evaluate how the multiple warnings and safety bulletins regarding fentanyl prescription have impacted fentanyl related risk and assess the level of risk in the population.
The research team examined fentanyl patch prescription over a span of 12 years, using data for 11,063 patients.
They found that 74% of cases the users’ previous exposure to opioids was insufficient and 18% of first-time patients started with the 50 μg/h, not the recommended 25 μg/h.
During this 12-year period, prescription practices had improved significantly. The unsafe prescribing rate of fentanyl had fell from 87% to 50%. It was safer to prescribe fentanyl in women and those under 65 years of age.
Even with this decrease in unsafe prescribing, 15.7% of patients were still receiving fentanyl patches without any exposure to opioids and half of all fentanyl patch prescriptions still remained unsafe.
Patients older than 65-years-old experienced higher levels of unsafe fentanyl initiation than younger patients. This was worsened by the fact that absorption and metabolism change with age.
Implications of the Study
The researchers noted that considerable attention has been placed into making the prescriber more aware of the need to ensure adequate opioid tolerance before prescribing fentanyl patches. Specific attention needs to be placed on older patients who are at the greatest risk of adverse outcomes.
Limitations in the study included that it only looked at prescriptions obtained in the Manitoba area. However, other studies conducted in the US and Europe have reported similar results.
Additionally, physician errors in prescribing fentanyl patches stem from the lack of familiarity with the delivery system. This shows the need for more prescriber education to reduce adverse events and risks.
Prescribers are able to reduce the risk of patients by ensuring that they have sufficient opioid tolerance before the patient starts using the fentanyl patch.