http://goo.gl/9w1QP1
If you had to guess what long acting opioid is most commonly started on in nursing home patients, which one would you guess? A new study released last week in JAGS shocked me. The answer to this question was a fentanyl patch. Even more shocking, many of those started on this medication were never prescribed any opioids prior to being started on a patch.
What they found was eye opening:
I have some worry about a blanket statement against the use of long acting opioids without starting a short acting agent first, I do feel that starting a fentanyl patch in an opioid naïve patient is dangerous. My only hope is that the study didn't capture opioid prescriptions that were outside of the Medicare Part D benefit, which is possible but unlikely to account for all of their findings.
- One out of ten nursing home residents (9%) were never on a short acting agent in the previous 60 days prior to starting a long acting opioid.
- The most-common initial long-acting opioids was a fentanyl patch, accounting for about half of all long acting opioids for both opioid-naïve and non-naïve patients.
- For those opioid-naïve patients put on fentanyl patches, 27% were placed on a 12 mcg/h patch. 38% were placed on a 25mcg/h patch, and the rest were placed on 50mcg/h or more of a patch.
I have some worry about a blanket statement against the use of long acting opioids without starting a short acting agent first, I do feel that starting a fentanyl patch in an opioid naïve patient is dangerous. My only hope is that the study didn't capture opioid prescriptions that were outside of the Medicare Part D benefit, which is possible but unlikely to account for all of their findings.