Article Text

Opioid safety recommendations in adult palliative medicine: a North American Delphi expert consensus
  1. Jenny Lau1,2,
  2. Paolo Mazzotta2,3,
  3. Ciara Whelan2,3,
  4. Mohamed Abdelaal1,4,
  5. Hance Clarke5,6,
  6. Andrea D Furlan7,8,9,10,
  7. Andrew Smith10,11,12,
  8. Amna Husain2,3,
  9. Robin Fainsinger13,
  10. David Hui14,
  11. Nadiya Sunderji15,16 and
  12. Camilla Zimmermann1,4,17
  1. 1 Division of Palliative care, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
  2. 2 Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3 Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada
  4. 4 Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  5. 5 Department of Anesthesia, Toronto General Hospital, Toronto, Ontario, Canada
  6. 6 Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
  7. 7 Department of Physiatry, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
  8. 8 Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  9. 9 Institute for Work and Health, Toronto, Ontario, Canada
  10. 10 Toronto Academic Pain Medicine Institute, Toronto, Ontario, Canada
  11. 11 Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  12. 12 Wasser Pain Management Centre, Sinai Health System, Toronto, Ontario, Canada
  13. 13 Division of Palliative Care, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
  14. 14 Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  15. 15 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  16. 16 Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada
  17. 17 Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Paolo Mazzotta, Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Ontario, Canada; pmazzotta1{at}gmail.com; Dr Jenny Lau, Division of Palliative Care, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; jenny.lau{at}uhn.ca

Abstract

Objectives Despite 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.

Methods Through 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.

Results The 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.

Conclusions Urgent 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.

  • cancer
  • chronic conditions
  • clinical decisions
  • education and training
  • pain

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information

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Footnotes

  • Twitter @JelauPC, @drhaclarke, @adfurlan

  • Contributors All authors contributed to the conception or design of the work. JL and PM drafted the work, and all authors revised it critically for important intellectual content. All authors approved the final version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research was funded by the Global Institute of Psychosocial Palliative and End-of-life Care (GIPPEC) Research Collaboration Grant and Temmy Latner Centre for Palliative Care.

  • Competing interests AF developed the Opioid Manager app that is available for sale on iTunes. This app is owned by University Health Network. AF does not receive any profits from the sales of this app.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.