Recently-implemented program reduces fentanyl patch dispensing but doesn’t improve outcomes, study finds

By Ana Gajic

Fentanyl patch-for-patch programs, which require patients who receive a re-fill for their fentanyl patches to return their used patches before receiving new ones, may be an effective tool in a multi-layered strategy to combat the opioid crisis, suggests a recent study led by St. Michael’s Hospital and ICES.

The study, published in the International Journal of Drug Policy, assessed the impact of early voluntary fentanyl patch-for-patch (P4P) programs introduced across 21 counties across Ontario. Researchers found that the implementation of these programs reduced the rate of patch dispensing, but did not impact rates of other dispensed opioids, opioid-related hospital visits or opioid-related deaths. This practice has now become law in Ontario.

“The voluntary program didn’t increase or reduce harms – that shows us that while this program may have reduced the volume of prescribed fentanyl in the community, it is not a solution to the overdose crisis by itself,” said Dr. Mina Tadrous, a Scientist at ICES and the Ontario Drug Policy Research Network (ODPRN) which is based out of St. Michael’s.

Fentanyl patches retain significant amounts of the drug after use. Therefore there is opportunity for misuse of these patches as the drug can be extracted from the patch after initial medicinal use. A patch-for-patch program ensures that patients who have fentanyl patch prescriptions return used patches in order to receive new ones. This reduces the likelihood of people selling or mishandling used patches.

The team of researchers found that 12 months after the program implementation, fentanyl patch dispensing rates decreased by 16 per cent. After 24 months, the dispensing rates decreased by 32 per cent, said Dr. Tadrous, who worked with the research team at St. Michael’s at the time of this study and now works at Women’s College Hospital. Non-fentanyl opioid dispensing rates were not impacted by the program, suggesting that people didn’t switch to accessing alternative opioids, and there was no significant change in the amount of opioid-related hospital visits or deaths.

Evaluating drug policies to understand whether they impact people the way they intended to, and don’t cause unintended consequences is part of the ODPRN’s mission. Their work aims to rapidly respond to, guide, and inform policymakers’ decisions with scientifically sound evidence.

“We hope that this study will help inform policy makers around the world considering these types of programs as part of their approach to addressing opioid prescribing and opioid-related harm,” said Dr. Tara Gomes, scientist at the Li Ka Shing Knowledge Institute at St. Michael’s, the ODPRN and ICES. “The finding that changes in prescribing did not reduce opioid-related harm is important. It suggests that harm reduction policies and provision of safe opioid supplies may be important strategies in reducing harm in the current opioid environment in North America.”

This paper is an example of how St. Michael’s Hospital is making Ontario Healthier, Wealthier, Smarter.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.