Background & Aims
Fentanyl is a potent opioid analgesic licensed for the treatment of chronic pain. Chronic pain is highly prevalent in the Northeast of England and is linked to increased prevalence of social deprivation and lower socio-economic prosperity in this geographical region. The Faculty of Pain Medicine (FPM) of United Kingdom (UK) and Public Health England suggest limiting the maximum dose of opioid in management of chronic non cancer pain to be under 120 mg per day of Oral Morphine Equivalence (OME). We looked into the pattern of opioid prescribing, specifically the high dose fentanyl transdermal patches in Newcastle upon Tyne Hospital, a tertiary level university teaching hospital in the North East of England and corelated that with the prescribing pattern in the community in the hospital catchment area of Newcastle and Gateshead .
Methods
We used the Faculty of Pain Medicine (FPM ) of Australia and New Zealand College of Anaesthesiology (ANZCA) Opioid Calculator to calculate the Oral Morphine Equivalence of the transdermal Fentanyl Patches. We Identified the 50, 75 and 100 microgram/ hour strength fentanyl patches to be delivering over and above the the recommended 120 mg OME suggested for management of chronic pain. We looked at identifying the trends of prescribing these higher strengths patches over a 10 year period from 2012 to 2023 with increased level of prescriber’s awareness on the background of landmark findings and recommendations from CDC USA Opioid Guidelines from 2016 and Opioid Aware campaign in the United Kingdom around that time. We looked at the prescribing data using Refine Prescribing Software (rxinfo.thirdparty.nhs.uk) and looked at the community prescribing data from www.openprescribing.net
Results
In year 2014, the hospital dispensed 869 prescriptions of fentanyl 50 microgram/hour patches, during that period in the community those patches were prescribed almost 10 times more ( n= 8277). Similar trend was observed in prescription of 75 microgram/hour and 100 microgram/hour fentanyl patches which were prescribed 8-10 times higher in the community. Actual number of prescription of these patches continued to increase and the dispensing peaked around 2015/2016. Subsequent to that there was noticeable decline in prescription of 50, 75, and 100 mcg per hour strains of fentanyl patches both in the community and in the hospital. This correlated with increased awareness about rational and safe prescribing of opioids with more awareness of CDC USA guidance on rational use of opioids in chronic non cancer pain in 2016. Around the same time there was lunch of Opioid Aware initiative from Public Health England and Faculty of Pain Medicine to raise awareness among the prescribers.
Conclusions
Widespread information related to rational and safe prescribing of opioids had a positive impact on the prescribing patterns of fentanyl patches in this geographical area, both in the community and in the hospital.
With continued increased awareness and prescriber and public education, there would be trend towards limiting these patches and safe prescribing. The maximum dose of OME to 120mg/day would imply all fentanyl patches greater than a 25 microgram patch would exceed this target and therefore should be reviewed and titrated down. The encouraging results can be seen that NuTH and the surrounding primary care setting are working collaboratively to ensure the prescribing trends are in the correct direction.
References
https://fpm.ac.uk/opioids-aware-sitemap
https://www.cdc.gov/opioids/healthcare-professionals/prescribing/guideline/index.html
https://www.nps.org.au/consumers/opioid-medicines