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

Abstract

Purpose Transdermal fentanyl (TF) is the most commonly used opioid in Germany although it is associated with an increased risk for hypoventilation and potentially life‐threatening respiratory depression if used inappropriately. The objective of this study was to characterize nursing home residents newly receiving TF with regards to (1) patients' conditions at patch initiation, (2) previous analgesic treatment, and (3) the initial TF dose. Methods Using claims data (2010‐2014), we studied a cohort of new nursing home residents aged greater than or equal to 65 years initiating TF. Results TF was the most commonly prescribed opioid in nursing home residents. During their nursing home stay, 8571 persons (median age: 86 years, 79.2% female and 28.6% with a diagnosis of cancer) started TF (6.7% of all residents). Almost half of the new TF users were opioid‐naïve and 56.2% of those who had been treated with opioids in the 180 days before TF initiation had only received low potency opioids such as tilidine/naloxone or tramadol. Opioid‐naïve TF users more often were care dependent and had a higher prevalence of dementia than patients previously treated with opioids. Overall, patients often received anxiolytic/hypnotic (29.7%) or antipsychotic (31.4%) comedication. About 61% of opioid‐naïve users started with the lowest available dose (12.5 μg/h), followed by 32% treated with 25 μg/h. Conclusions TF as a noninvasive treatment option is the first‐choice opioid in German nursing homes. Although initial doses seemed more appropriate than those identified in previous studies, the large proportion of opioid‐naïve patients in this vulnerable population warrants attention, given the limited controllability of the treatment.

Abuse, dependence and withdrawal associated with fentanyl and the role of its (designated) route of administration: an analysis of spontaneous reports from Europe

“…However, the risks for adverse events including fatalities, even when used as prescribed, are not to be underestimated. Critical circumstances in this regard include treatment initiation in opioid-naïve patients, too high (initial) doses or the involvement of other drugs affecting the central nervous system [19,37]. These risks should be kept in mind as should the biological, psychological and social components of pain [38] when considering initiation or continuation with these medications.…”