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Safety of opioid patch initiation in Australian residential aged care

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Opioid analgesics are recommended for the treatment of cancer pain and for short-term treatment of moderate to severe acute pain.1,2 The number of opioid prescriptions in Australia reimbursed by the Pharmaceutical Benefits Scheme increased from 2.4 million in 2002 to 7.0 million in 2007.3 Much of this increase is probably driven by the increased administration of opioids for chronic non-cancer pain,3,4 but such use remains controversial, especially in older people, as they are more susceptible to adverse drug events.57

Transdermal opioid patches have been designed to provide long-lasting therapy for patients with chronic pain. Two opioids are available for administration via transdermal patches: fentanyl and buprenorphine. Fentanyl patches have a duration of action of 3 days, while buprenorphine patches are active for 7 days.1 In addition to an extended duration of action, transdermal opioids also have a slower onset of action, making them unsuitable for the management of acute pain.1

For chronic, non-cancer pain, Australian guidelines recommend a stepwise approach,…