CSPCP urges physicians to learn about appropriate opioid use in palliative care

(Nov 6, 2017) The CMAJ published a letter from the CSPCP today: “APPEAL TO PHYSICIANS – OPIOIDS HAVE THEIR PLACE – Let’s avoid an unintended tragedy!” http://www.cmaj.ca/content/189/40/E1270/reply#cmaj_el_733573

Please read the letter and share amongst your networks as you see fit.

An excerpt from the letter is below. (Detailed rationale, references, and names of contributors are provided in the full letter)

“A well-known tragedy has occurred with respect to opioids – the crisis of overdose deaths from opioids that were obtained from various legitimate and illegitimate sources. This has necessitated urgent government and public action.

A second, preventable tragedy is beginning to occur as an unintended consequence of the first. The stigma around opioid use has become so strong that patients, families, and health care practitioners are afraid to receive or prescribe them, leaving patients to suffer unnecessarily.

We are referring specifically to palliative care, a context where opioids are sometimes the most appropriate choice for pain and dyspnea management. This is clearly outlined in our August 2016 Position Statement on Access to Opioids for Patients Requiring Palliative Care.

The 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain made recommendations for opioid prescribing in the chronic non-cancer pain population based on a systematic review of the literature specific to that population. The guideline clearly states that exceptions are appropriate under some circumstances, including palliative care and cancer pain.

Unfortunately, many physicians have misunderstood the guideline to apply to all patients, including those appropriately receiving a palliative approach to care. Many physicians have expressed reluctance to prescribe opioids for such patients, even those approaching the end of their lives. Some physicians have stopped ordering opioids altogether. Unaddressed and unnecessary suffering is the result.

The Canadian Society of Palliative Care Physicians believes that patients with palliative needs who require appropriately prescribed opioids to manage symptoms should not have opioids withheld in an attempt to adhere to guidelines that are meant for a different patient population, or due to fear of regulatory oversight.

We encourage practitioners to assess the risk of misuse and diversion in patients receiving a palliative approach to care and to prescribe opioids (and appropriate adjuvant analgesics) in whatever doses are needed to control symptoms, within accepted principles of palliative care, utilizing appropriate monitoring and safe prescribing strategies depending on individual patient risk factors.”

See full letter for rationale, references and contributors.