Early palliative care and the opioid crisis: ten pragmatic steps towards a more rational use of opioids

Ann Palliat Med. 2019 Sep;8(4):490-497. doi: 10.21037/apm.2019.08.01. Epub 2019 Aug 16.

Abstract

In palliative care, opioids and other controlled drugs are among the most commonly used and important medications. Opioids are associated with significant risk of dependence and misuse. In many developed countries, there is an epidemic of prescription opioid misuse and overdose deaths. Palliative care has a critical role educating patients about the safe use of opioids, providing universal screening and close monitoring, and prescribing opioids appropriately balancing the risks and benefits. This is particularly important in the era of early palliative care, when patients have much longer survival and potentially greater risk of misuse while on chronic opioid therapy. Here, we provided a critical appraisal of opioid use in the context of opioid crisis and early palliative care. We also present a pragmatic 10-step approach for the judicious use of opioids.

Keywords: pain management; Opioid crisis; cancer pain; early palliative care.

Publication types

  • Review

MeSH terms

  • Analgesics, Opioid / therapeutic use*
  • Cancer Pain / prevention & control
  • Humans
  • Interprofessional Relations
  • Opioid Epidemic
  • Opioid-Related Disorders / prevention & control*
  • Pain Management
  • Palliative Care / methods*
  • Patient Education as Topic
  • Risk Factors
  • Unnecessary Procedures

Substances

  • Analgesics, Opioid