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Opioids in terminal care

Pain control with opioids in palliative care does not significantly shorten life, according to a US study.

It has been noted that a perception that they shorten life may limit the use of strong opioids for palliative care patients with severe pain. Although pain is common in this setting and the benefits of these drugs is widely accepted, the fear that their adverse effects may hasten death is a factor that may lead to underuse.

A large cohort study was carried out to determine the relationship between opioid use and survival in a hospice population.

Data were available for 1,306 patients, of whom 1,163 received an opioid. Of these, 725 (55.5% of total) had at least one dose change. The analysis showed that survival from dose change was related to a wide range of factors, all of which were only weakly related and none of which explained more than 10% of the variance. Final opioid dose was a factor, but so were severity of pain, cancer diagnosis and being unresponsive. There was no relationship between receiving a higher dose and survival.

On the basis of this analysis, the authors conclude that effective use of opioids does not significantly affect survival time in patients with terminal illness.

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