Opioid safety recommendations in adult palliative medicine: a North American Delphi expert consensus

Abstract

ObjectivesDespite the escalating public health emergency related to opioid-related deaths in Canada and the USA, opioids are essential for palliative care (PC) symptom management.Opioid safety is the prevention, identification and management of opioid-related harms. The Delphi technique was used to develop expert consensus recommendations about how to promote opioid safety in adults receiving PC in Canada and the USA.MethodsThrough a Delphi process comprised of two rounds, USA and Canadian panellists in PC, addiction and pain medicine developed expert consensus recommendations. Elected Canadian Society of Palliative Care Physicians (CSPCP) board members then rated how important it is for PC physicians to be aware of each consensus recommendation.They also identified high-priority research areas from the topics that did not achieve consensus in Round 2.ResultsThe panellists (Round 1, n=23; Round 2, n=22) developed a total of 130 recommendations from the two rounds about the following six opioid-safety related domains: (1) General principles; (2) Measures for healthcare institution and PC training and clinical programmes; (3) Patient and caregiver assessments; (4) Prescribing practices; (5) Monitoring; and (6) Patients and caregiver education. Fifty-nine topics did not achieve consensus and were deemed potential areas of research. From these results, CSPCP identified 43 high-priority recommendations and 8 high-priority research areas.ConclusionsUrgent guidance about opioid safety is needed to address the opioid crisis. These consensus recommendations can promote safer opioid use, while recognising the importance of these medications for PC symptom management.

Palliative care interventions for people who use substances during communicable disease outbreaks: a scoping review

“…This review identified non-pharmacologic and pharmacologic recommendations for people who use substances, including opioid prescribing strategies for people on OAT. These recommendations are consistent with expert consensus recommendations about safer opioid prescribing for people receiving palliative care 51 and management of advanced cancer-related pain in people with opioid use disorder. 52 Based on individual circumstances and barriers, care plans should be individualised and adapted to provide high-quality, trauma-informed care that does not exacerbate barriers to care.…”

“…When managing symptoms for people who use substances with life-limiting illnesses, palliative care providers should evaluate risk for non-medical use of opioids, opioid use disorder and opioid-related poisoning. 51 Different opioid prescribing strategies may be required for people who use substances who are at high risk of these opioid-related harms (eg, daily to weekly dispensing of opioids prescribed for symptom management). 51 Healthcare providers should not withhold or discontinue opioids necessary for symptom management or restrict access to services and resources.…”

“… 51 Different opioid prescribing strategies may be required for people who use substances who are at high risk of these opioid-related harms (eg, daily to weekly dispensing of opioids prescribed for symptom management). 51 Healthcare providers should not withhold or discontinue opioids necessary for symptom management or restrict access to services and resources. Health and social harms associated with non-medical opioid use can be reduced by harm reduction strategies, such as needle distribution programmes, supervised consumption sites, naloxone distribution programmes and drug checking services.…”

Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going?

“…[ 25 ]. Finally, opioids can be prescribed as palliative care or for limiting the suffering of patients at the end of life [ 26 , 27 , 28 ]. Despite the possible therapeutic role of opioid medications, the treatment of the above-mentioned diseases with opioids is still under debate for several reasons.…”

Prevalence and management of chronic nonmalignant pain in palliative care populations: A systematic review

“…It is these patients who may potentially benefit from non-pharmacological treatment modalities that are more patient-centered and responsive to psychological and social needs. The increasing concern regarding safety and management of opioid harm in the palliative care context was the topic of a recent Delphi study (Lau et al 2022). Currently, there is limited evidence and guidance for clinicians on the assessment and management of patients with chronic pain who are receiving palliative care.…”