Dispensing of fentanyl and tapentadol in community pharmacy: Therapeutic adherence in non-cancer pain

Introduction: In recent years there has been an increase on prescription and dispensation of opioids and high prevalence of patients with chronic non-oncological pain. Main objective; evaluate the pharmacotherapy adherence of patients with non-cancer pain treated with fentanyl or tapentadol.

Material/ Methods: Observational, descriptive and transverse study performed by 139 community pharmacists. Target population: people over 18 years old that come to community pharmacy with a prescription of fentanyl or tapentadol. The collected variables were age, sex, pathology, chronic/acute character, indication, reason of pain, dispensed active principles (knowledge of posology, administration, possible adverse reactions), adherence (Haynes-Sackett Test), pain intensity (Visual Analog Scale), and the pharmacist’s intervention.

Haynes-Sackett test was used to measure the adherence, which allows detecting non-adherent patients, knowing the difficulties related with the use fentanyl or tapentadol and offering recommendations to improve the use of these treatments and minimize the problems of lack of adherence.

The pain evaluation was carried out only in continuation care treatment; determining the average value using the VAS pain measuring system.

Results: The adherence analysis using Haynes-Sackett showed 358 patients (87.1%) without difficulties to take/put on treatment while 53 patients (12.9%) did present difficulties, of which 77% were older than 70 years old and 79% were women.

The main reasons for the non-adherence in the studied population were: being dependent people, having difficulties in the placement and having adhesion problems with fentanyl patches.

The average pain measure evaluation in the studied patients was 6.1 points in VAS; 44.5% of patients presented VAS values above 6 points, for the non-adherent patients the average VAS value was 6.6 while for the adherent patients was 6.

In patients with chronic treatment, the 41% had controlled pain, 53% presented an improvement in their functional capacity and the 57% had improved their quality life.

Adverse reactions were manifested in the 37.9% of the continuation care treatments. The main adverse reaction was the constipation, present in the 23.6% of the patients with chronic treatments.

53.9% of the patients answered affirmative to be under Assistance Pharmaceutical Professional Service of boarding chronic pain.

Conclusions: Most of patients were adherent. The main reason for non-adherence was to be a dependent person.

VAS average value was 6 points and patients did not reach to an adequate pain control, although they recognize a better functional capacity and quality of life. Almost 40% of the continuation care treatments manifested adverse reactions.

Half of the patients demanded Assistance Pharmaceutical Professional Service in pain.