Access to Opioids for Patients with Advanced Disease

Abstract

Pain at the end of life is common in both malignant and non-malignant disease. It is feared by patients, their families and careers, and professionals. Effective pain control can be achieved for the majority of patients at the end of life using a multimodal approach. Pharmacological management relies predominantly on strong opioids. In spite of this, evidence suggests that under treatment of pain is common resulting in unnecessary suffering. Multiple barriers to use of opioids have been identified. Patient barriers include reluctance to report pain and to take analgesics. Professional barriers include inadequate pain assessment and lack of specialist knowledge and confidence in opioid therapy. Fear of side effects including respiratory depression affects patients and professionals alike. The impact of the “opioid epidemic”, with increasing prescribed and illicit opioid use around the world, has also led to increasingly stringent regulation and concern about under prescribing in palliative care. System barriers to use of opioids at the end of life result from limited opioid availability in some countries and also inconsistent and limited access to palliative care. Multiple interventions have been developed to address these barriers, targeted at patients, professionals and systems. There is increasing evidence to suggest that complex interventions combining a number of different approaches are most effective in optimising pain outcomes for patients at the end of life.

Between “opioidophobia” and the opioid crisis: a cross-sectional comparison of opinions on opioid analgesic treatment between palliative care patients with cancer and physicians in Poland

“…Furthermore, the physicians' concern expressed about patients using opioids for purposes other than medical treatment may indicate either a lack of doctors' confidence in the adequacy of their assessment of pain, the low efficacy of opioids for pain management, other opioids' potential for abuse and patients' rapid addiction. These findings are in agreement with prior reviews about incorrect pain assessment and documentation of pain levels, errors in treatment, and limited patient education as major barriers to adequate pain management [37,38].…”

Morphine use for cancer pain: A strong analgesic used only at the end of life? A qualitative study on attitudes and perceptions of morphine in patients with advanced cancer and their caregivers

“…More studies will be required to clarify the impact of increased opioid regulations on opioid access and adequacy of pain control in this specific group of patients. 49,50 Lack of impact of caregivers' views on patients' attitudes toward morphine use. Notably, views of the caregivers did not appear to have a significant impact on patients' attitudes toward future morphine use.…”

Digital Analgesic Comprising a Second-Generation Digital Health System: Increasing Effectiveness by Optimizing the Dosing and Minimizing Side Effects

“…Respiratory depression is a side effect that causes worry and distress in patients and their care givers. 28–30 Aspects related to high risk of misuse are younger age, a history of a substance use disorder, major depression, and psychotropic medications. 31 , 58 , 59 …”