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BMJ Mil Health. October 8, 2021: bmjmilitary-2021-001894. doi: 10.1136 / bmjmilitary-2021-001894. Online ahead of print.
INTRODUCTION: Transdermal fentanyl is a continuous release opioid delivery system for use in opioid tolerant patients requiring 24 hour opioid therapy. The aim of this study is to identify the most significant indications. current prescriptions for transdermal fentanyl in active-duty United States military personnel, and to determine whether those prescriptions comply with the United States Food and Drug Administration (FDA) labeling.
METHODS: Active-duty U.S. military personnel initiating fentanyl transdermal therapy with prescriptions filled at military health system pharmacies between 2015 and 2019 have been identified in the Military Data Repository. Electronic health records were searched for patient demographic information, clinical information, and prescribing data. A total of 225 patients with complete data were identified.
RESULTS: The most common reason for initiation of transdermal fentanyl was chronic non-cancerous musculoskeletal pain. Of the patients with non-cancer pain, 36% received their initial prescription from an internal physician / primary care provider, and 35% did not meet the published U.S. FDA criteria for opioid tolerance prior to beginning of treatment. There was an 81% decrease in the number of patients starting treatment between 2015 and 2019.
CONCLUSIONS: While a substantial minority of prescriptions for transdermal fentanyl to US military personnel did not meet FDA guidelines on appropriate use, the total number of prescriptions dropped dramatically over the study period. This suggests that automated review of profiles or additional targeted policies to limit the prescribing of transdermal fentanyl are unnecessary at this time.
PMID: 34625516 | DOI: 10.1136 / bmjmilitaire-2021-001894