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End-of-life care in illicit drug users: mapping medication use
  1. Phoebe Ulrick1,
  2. Stacey Panozzo1,2,3,
  3. David Marco1,4,
  4. Anna Collins1,2 and
  5. Jennifer Philip1,2,3
  1. 1 Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
  2. 2 Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
  3. 3 Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Parkville, Victoria, Australia
  4. 4 Centre for Palliative Care, St Vincent's Hospital, Fitzroy, Victoria, Australia
  1. Correspondence to Dr Stacey Panozzo, Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, VIC 3065, Australia; stacey.panozzo{at}


Background While clinical wisdom has long provided suggested guidance around caring for people who use illicit drugs (referred to as PWUD) at the end of life, there is striking paucity of empirical evidence underpinning these practices. Understanding medications and doses required to manage symptoms at the end of life is essential to provide effective end-of-life care for these patients. This study aimed to examine the type and dose of medications prescribed to hospitalised patients who use illicit drugs at the end of life, compared with patients without previous or current illicit drug use.

Method A retrospective medical record review was conducted on consecutive patient deaths between 2012 and 2017 at a metropolitan hospital. PWUD were identified using the International Classification of Diseases 10th Revision codes for illicit drug use. Daily dosage of opioids, benzodiazepines and antipsychotics was documented for the last 3 days of life and compared with a matched comparator group.

Results PWUD patients (n=55) received higher doses of opioids, midazolam and antipsychotics than comparator patients (n=55) for each day, significant for opioids in the last 24 hours (p=0.01). PWUD patients received a significantly higher total opioid dose (median=480.0 mg vs 255.0 mg) and midazolam (median=15.0 mg vs 5.0 mg) (both p<0.05). Rates of dose escalation did not differ.

Conclusions Results suggest that PWUD require greater doses of symptom-controlling medications, particularly opioids and midazolam, at the end of life but that rates of dose escalation do not differ greatly. This study provides a foundation for future research to inform clinical guidelines for this cohort of palliative care patients.

  • symptoms and symptom management
  • terminal care
  • hospital care
  • pain

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  • Contributors JP and AC were responsible for the conception of the study. PU, DM and SP collected and analysed the data. Data were interpreted by JP, PU, DM and SP and confirmed by all authors. All authors were involved in drafting and critically appraising the manuscript before providing final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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