Observational studyJournal of general internal medicine2025
Fentanyl Initiation Rate Following the Requirement for Specialist Approval.
Observational study in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- The positivity rate of opioid drug urine testing in an emergency department between 2016 and 2024, before and after the introduction of fentanyl testing.Substance abuse treatment, prevention, and policy · 2026Article
- Treatment Outcomes in a Specialized Opioid Maintenance Program for Prescription Opioid Use Disorder in Israel.Substance abuse and rehabilitation · 2026Article
- The majority of opioid prescriptions in Israel between 2010 and 2020 involved a small minority of physicians and of patients: policy implications.Israel journal of health policy research · 2025Article
- Prescription opioid use in Israel - the tide has risen, but it's not a tidal wave.Israel journal of health policy research · 2024Article
Corrections and comments
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundHealthcare organizations attempt to address unwarranted fentanyl use, which often leads to increased risk of addiction and overdose.
objectiveTo assess the impact of a requirement for a specialist's approval on fentanyl initiation for non-oncological pain.
designA retrospective cohort study based on observational data.
participantsAll 4.4 million non-oncological members of Clalit Health Services were included, from July 20, 2021, to July 19, 2023. MAIN MEASURES: The rate of fentanyl initiation was assessed before and after the implementation of the requirement for specialist's approval, which was introduced on July 2022, and expanded 6 months later for continued use. A sub-group analysis by age group was performed, and patient characteristics and indications were assessed. We also compared total opioid dispensation in the 6th and 12th months after the implementation with the predicted rate based on pre-implementation rates. KEY
resultsFentanyl initiation rate in the year before the requirement was 711 per million capita, which decreased following the requirement by - 81% (95% CI: - 77%; - 85%). The decrease attenuated with age. The prevalence of diagnosis with substance abuse disorders at the time of fentanyl initiation decreased from 6 to 3%. In the 6th and 12th months after the requirement was implemented, the morphine milligram equivalent (MME) from dispensation of total opioids was lower than predicted based on pre-implementation rates by 7% and 26%, respectively.
conclusionsRequiring specialist approval for fentanyl initiation for non-oncological chronic pain was associated with a decrease in fentanyl prescription initiations, especially among non-elderly patients. A decrease also occurred gradually in total opioid dispensations, further decreasing following the extension of the requirement to continuous fentanyl. The requirement for specialist approval upon fentanyl initiation and continuous fentanyl may present an effective tool for limiting the use of fentanyl and total opioids in healthcare systems.
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