National utilization of transdermal fentanyl among community-dwelling older people in Finland

The use of opioids has increased rapidly in Europe and North America, and older people may be susceptible to opioid-related adverse drug events. The Finnish National Agency for Medicines has recommended that oral opioids be considered the first-line treatment when a strong opioid is required for severe pain.

The objective of this study was to investigate and describe the age-, indication-, sex-, and geographic-specific utilization of transdermal fentanyl among older people residing in noninstitutional settings in Finland.

Reimbursement data for fentanyl, morphine, oxycodone, and hydromorphone were extracted from the Finnish National Prescription Register for 2008. Age-specific population data were used to calculate the annual prevalence of opioid use for malignant and nonmalignant pain for patients aged < or = 64, 65 to 69, 70 to 74, 75 to 79, 80 to 84, 85 to 89, 90 to 94, 95 to 99, and >99 years. The annual prevalence of transdermal fentanyl use was also calculated separately for each of the 21 hospital districts in Finland.

Reimbursement for transdermal fentanyl was paid to 2746 people for malignant pain and 6223 people for nonmalignant pain. The annual prevalence of transdermal fentanyl use for nonmalignant pain was lowest among men aged < or = 64 years (2.2 users/10,000 men) and highest among women >99 years (539.2 users/10,000 women). The annual prevalence of transdermal fentanyl use was >47 times higher than that of morphine for nonmalignant pain among people aged 85 to 89 years and >97 times higher than that of morphine among people aged 90 to 94 years. A greater than 4-fold variation in the annual prevalence of transdermal fentanyl use was reported among the 21 hospital districts in Finland (range, 9.5-40.6/10,000 inhabitants).

The prevalence of transdermal fentanyl use was higher than that of morphine, oxycodone, and hydromorphone among people aged > or = 80 years residing in noninstitutional settings in Finland. The variation in use between hospital districts suggests that organizational culture may have a strong impact on prescribing practices. Our data highlight the need for further education regarding the appropriate use of opioids among older people.