JMIR Publications

ABSTRACT

Background:

As a potent opioid analgesic, fentanyl transdermal patches (FTDs) have been widely used in patients with moderate to severe pain. However, increasing concerns about the opioid epidemic have made it important to strengthen the rational use and management of FTDs.

Objective:

We used a national insurance claims database from 2014 to 2020 to investigate the trends in the use of FTDs and to assess the potentially inappropriate FTD use in patients with non-cancer pain. Given the high prevalence of chronic pain and opioid use in geriatrics, we compared the patterns of FTD use in working-age and geriatric groups.

Methods:

Patients who were prescribed FTDs at least once a year in an outpatient setting were included, and cancer or pediatric patients were excluded. To identify potentially inappropriate use, we developed evaluation criteria based on recommendations for safe use of prescription opioids in patients with non-cancer pain and assessed each patient’s compliance. The working-age and geriatric groups were compared to evaluate the difference in FTD use, and modified Lorenz curves and Gini coefficients were used to assess the equality of FTD use.

Results:

A total of 5,386 patients and their 19,800 reimbursements were included. The number of patients with FTDs decreased from 58.6 to 53.7 per 100,000 registrants from 2014 to 2020. Meanwhile, the number of reimbursements increased by 7.4% from 203.2 to 218.1 per 100,000 registrants from 2014 to 2020. The working-age patients had an average of 3.9 reimbursements per year, with an average morphine milligram equivalent per day (MME/day) of 64.4 for each reimbursement. The geriatric patients had an average of 3.5 reimbursements per year, and their average MME/day was 47.9. As a result of applying the evaluation criteria, 567(24.5%) working-age patients and 531(17.3 %) geriatric patients were identified as potentially inappropriate FTD users. Among patients with multiple FTD prescriptions, working-age group with potentially inappropriate FTD use had significantly higher estimated MME/day than the geriatric group (p < 0.001). The modified Lorenz curve showed that more than 70% of the total FTDs used in the working-age group were consumed by those with potentially inappropriate FTD use, while geriatric group with potentially inappropriate FTD use accounted for less than 50.0% of the total geriatric patients. The working-age patients also had a higher Gini coefficient than the geriatric group, indicating unequal use of FTDs (0.461 vs. 0.406).

Conclusions:

Although the number of patients receiving FTD prescriptions has decreased during study period, the total amount of FTDs consumed increased, suggesting that caution is warranted. This study also highlights the potential for inappropriate FTD use in working-age patients. Further research is needed to quantify and qualify the risk factors in patients with potentially inappropriate use, given the clinical rationale associated with prescribing FTDs.