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Safety of opioid patch initiation in Australian residential aged care

Svetla Gadzhanova, Elizabeth E Roughead and Lisa G Pont
Med J Aust 2015; 203 (7): 298. || doi: 10.5694/mja15.00174

Summary

Objective: To explore opioid use by aged care facility residents before and after initiation of transdermal opioid patches.

Design: A cross-sectional cohort study, analysing pharmacy data on individual patient supply between 1 July 2008 and 30 September 2013.

Setting: Sixty residential aged care facilities in New South Wales.

Participants: Residents receiving an initial opioid patch during the study period.

Main outcome measure: The proportion of residents who were opioid-naive in the 4 weeks prior to patch initiation was determined. In addition, the patch strength at initiation and the daily dose of transdermal patches and of additional opioids 1 month after initiation were determined.

Results: An opioid patch was initiated in 596 of 5297 residents (11.3%: 2.6% fentanyl, 8.7% buprenorphine) in the 60 residential aged care facilities. The mean age at initiation was 87 years, and 74% of the recipients were women. The proportion of recipients who were opioid-naive before patch initiation was 34% for fentanyl and 49% for buprenorphine. Most were initiated at the lowest available patch strength, and the dose was up-titrated after initiation. Around 15% of fentanyl users and 10% of buprenorphine users needed additional regular opioids after patch initiation.

Conclusions: The results suggest some inappropriate initiation of opioid patches in Australian residential aged care facilities. Contrary to best practice, a third of residents initiated on fentanyl patches were opioid-naive in the 4 weeks before initiation.

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  • Svetla Gadzhanova1
  • Elizabeth E Roughead2
  • Lisa G Pont3

  • 1 University of South Australia, Adelaide, SA
  • 2 University of South Australia, Adelaide, SA
  • 3 Macquarie University, Sydney, NSW


Acknowledgements: 

We acknowledge Mr Gerard Stevens, managing director of Webstercare, for his contribution to data collection and provision.

Competing interests:

No relevant disclosures.

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