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Transdermal opioids: are we plastering over the cracks?
  1. Graham Whyte1,
  2. Alison Coackley2,
  3. Paula Powell3,
  4. Littlewood Clare4,
  5. Simpson Steven5 and
  6. Anthony Thompson6
  1. 1Marie Curie Hospice, Liverpool, UK
  2. 2Clatterbridge Centre for Oncology, Wirral, UK
  3. 3Willowbrook Hospice, Prescot, UK
  4. 4St. Helen's and Knowsley NHS Trust, Helen's St. Helen's, UK
  5. 5North Manchester General Hospital, Manchester, UK
  6. 6Willowbrook Hospice, Prescot, UK

Abstract

Introduction Transdermal opioids such as Fentanyl and Buprenorphine are recognised as effective analgesics in the treatment of moderate to severe pain in patients with both malignant and non-malignant disease. However there is evidence to suggest that the knowledge of appropriate indications, pharmacokinetics, and dose equivalencies of transdermal opioids is poor, particularly among non-specialist prescribers. This is supported by drug safety alerts from the Medicines and Healthcare products Regulatory Agency highlighting reports of life threatening adverse effects and even death from unintentional overdoses.

Aim To explore the prescribing patterns of transdermal opioids in palliative care patients in a UK Cancer Network.

Methods A prospective audit was conducted over a 6 month period at 3 different sites. This incorporated palliative care patients in hospice, hospital and community settings. Data was collected following the initial specialist palliative care assessment of patients already prescribed transdermal opioids at the time of referral. Information was recorded relating to the original prescriber, documentation of indications, evidence of toxicity and use of breakthrough medication.

Results A total of 50 case notes were audited. Key findings revealed that indications for the use of transdermal opioids were only documented in 26% of patients. Over a quarter of patients had evidence of adverse effects, mainly opioid toxicity. The toxicity correlated with the strength of the transdermal opioid preparation rather than incorrect prescribing of breakthrough medication. However, results also showed that there appeared to be a lack of understanding as to appropriate doses of breakthrough medication.

Conclusion There are clear situations in which transdermal opioids can be effective and well tolerated alternative step 3 opioids. However these audit results would suggest that there is a need for more education and training particularly among non-specialist prescribers in order to ensure the safe prescribing and administration of transdermal opioids.

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