The Impact of a Jersey Health Campaign on Fentanyl Prescribing after a Cluster of Six Deaths Caused by Fentanyl Patch Abuse and the Subsequent Cessation of Further Fatalities

This Research Poster was presented at the International Association for the Study of Pain (IASP) conference, Monteral, Canada, 2010. Deaths attributed to the illicit extraction and overdose from fentanyl patches have been reported mostly in the USA and Canada and much less in Europe. We report on six deaths attributed to fentanyl patch abuse in the British Channel Island of Jersey between 2004 and 2007. This was a high ratio of deaths per head of population of only 80,000 people. Deaths occurred despite the introduction of the matrix patches in early 2005 and the exclusion of the reservoir patches. Fentanyl blood concentrations of 25 – 400ng/ml were consistent with fatal overdose. In half the cases the fentanyl was prescribed for pain conditions. Subsequent law changes prohibited the prescription of fentanyl patches to known or previous drug addicts other than for organic disease or injury. It became a legal requirement for physicians to inform the Medical Officer of Health of suspected fentanyl abuse. No further deaths occurred. This study aimed to establish whether the local policy produced a change in the prescribing habits amongst local community-based physicians, thus achieving the prevention of further deaths. METHOD Central dispensing records were utilised to extract monthly fentanyl-patch prescription records for all (N=98) prescribing community physicians, including the total number and dose of patches. RESULTS 1) In the year prior to the health campaign a total monthly average of 211241 mcg was prescribed in patch strengths of ≤25mcg. Following the campaign this reduced to a total monthly average of 124082. 2) Analysis of the ≤25mcg patch prescriptions (12 and 25 mcg patches separately) shows both a remarkable increase in the average monthly number of smaller 12mcg patches prescribed (+356%) and a decrease in the 25mcg patches prescribed (-64%) after the policy change. These changes in prescribing led to an overall 63% reduction of the total monthly average mcg of ≤25mcg patches after the policy change (pre=17603; post=6530). 3) Mean monthly mcgs prescribed for patches >25 mcg reduced by 5.73% (Pre = 55185.29; Post = 52022.37) CONCLUSIONS It appears that a change in law and a local health campaign and subsequent altered prescribing habits contributed to preventing further deaths through abuse. An opposite trend for prescribing habits for 12 and 25mcg fentanyl patches, led to a significant reduction in the monthly average (in mcg) overall, and may have prevented further deaths occurring. Additional potential mediators and confounders of the observed change are discussed. Acknowlegments: Mr P McManus (Chief Pharmacist) Dr S Turnbull (Deputy Medical Officer of Health)