Background Opioids are an essential therapeutic tool in Palliative Care (PC). Several studies have found disparities in the prescription of analgesics based on race or ethnicity. In Latin America (LA), the heterogeneity of PC services and opioid prescription patterns across countries, along with the paucity of robust evidence, accentuates the need for a comprehensive understanding of opioid prescribing practices.

Aim To explore the characteristic of opioid prescribing patterns for PC patients in LA.

Design A systematic review was conducted adhering to PRISMA guidelines.

Data sources Relevant databases, including MEDLINE, EMBASE, PubMed, LILAC, and Scielo, were searched from March to June 2023, incorporating English, Spanish, and Portuguese languages. Observational or experimental studies reflecting opioid prescription patterns in adult PC patients were included. Methodological quality was assessed utilizing the Effective Public Health Practice Project (EPHPP) tool.

Data synthesis/analysis The analysis of the data extracted was analysing using narrative synthesis. The descriptive statistical analysis was conducted utilising SPSS® V28 (IBM) for MACs. A concise overview of the study participants was performed, with categorical variables summarised using frequencies and percentages and continuous variables summarised using means.

Results Of the 2082 records screened, twenty studies from 6 countries, with a total of 15418 patients, were included in the review. Two-thirds of the studies were observational studies (65%), including cohort and cross-sectional studies, and one-third (35%) were experimental studies, including five randomised control trials. Due to considerable inter-study heterogeneity, a meta-analysis was unfeasible. Most studies centered on PC cancer outpatients experiencing pain. Notably, 14309 (92%) patients received opioid treatment. Within the opioid-using cohort, 59% relied on weak opioids, with codeine and tramadol being the most prevalent. Morphine emerged as the most prescribed strong opioid. The average daily morphine equivalence dosage was 65.1 mg/day.

Conclusion This systematic review comprehensively explores opioid prescribing patterns in LA for PC patients. The region exhibits a lower opioid consumption rate compared to global standards, with weak opioids being more prevalent than strong opioids among PC patients, and administered at lower dosages in comparison to developed countries. This review suggest that patients who receive opioid in LA are predominantly cancer patients with pain. Through an analysis of opioid types, dosages, Morphine Equivalent Daily Dose, patient diagnoses, and care settings, this review enhances our current comprehension of opioid prescription practices within the region.