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Original research
Why are US military personnel prescribed transdermal fentanyl patches?
  1. Hailey Murray1,
  2. A N Gregoriou1,
  3. A Lepore1,
  4. G J Booth2,3,
  5. A H Goldman4,
  6. M L Allen5 and
  7. G C Balazs4
  1. 1 Eastern Virginia Medical School, Norfolk, Virginia, USA
  2. 2 Department of Anesthesiology & Pain Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  3. 3 Naval Biotechnology Group, Portsmouth, Virginia, USA
  4. 4 Bone & Joint Sports Medicine Institute, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  5. 5 Pharmacy Department, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  1. Correspondence to Dr G C Balazs, Department of Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, 23708, USA; gcbalazs{at}gmail.com

Abstract

Introduction Transdermal fentanyl is a continuous release opioid delivery system intended for use in opioid-tolerant patients requiring around-the-clock opioid therapy. The purpose of this study is to identify the most common indications for transdermal fentanyl prescriptions in active duty US military personnel, and determine whether these prescriptions meet US Food and Drug Administration (FDA) labelling.

Methods Active duty US military personnel initiating transdermal fentanyl therapy with prescriptions filled at Military Health System pharmacies between 2015 and 2019 were identified in the Military Data Repository. Electronic health records were searched for patient demographic information, clinical information and prescription data. A total of 225 patients with complete data were identified.

Results The most common reason for transdermal fentanyl initiation was chronic non-cancer musculoskeletal pain. Among patients with non-cancer pain, 36% received their initial prescription from an internal medicine/primary care provider, and 35% did not meet published US FDA criteria for opioid tolerance prior to treatment initiation. There was an 81% decrease in patients initiating therapy between 2015 and 2019.

Conclusions While a substantial minority of transdermal fentanyl prescriptions to US military personnel did not meet FDA guidelines on appropriate use, the overall number of prescriptions fell dramatically over the study period. This suggests that automated profile review or additional targeted policies to limit transdermal fentanyl prescribing are unnecessary at this time.

  • pain management
  • musculoskeletal disorders
  • oncology

Data availability statement

Data are available upon reasonable request. Not applicable.

https://doi.org/10.1136/bmjmilitary-2021-001894

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    Data availability statement

    Data are available upon reasonable request. Not applicable.

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    Footnotes

    • Contributors HM assisted with data collection, data analysis, editing of the manuscript and approved the final version. ANG assisted with data collection, data analysis, editing of the manuscript and approved the final version. AL assisted with data collection, data analysis, editing of the manuscript and approved the final version. GJB assisted with project design, data analysis, manuscript editing and approved the final version. AHG assisted with project design, data analysis, manuscript editing and approved the final version. MLA assisted with background information, data analysis, manuscript and approved the final version. GCB was primarily responsible for the conduct of the study, and assisted with data collection, data analysis, manuscript drafting and approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer The views expressed in this article reflect the results of research conducted by the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.