PT  - JOURNAL ARTICLE
AU  - Jenny Lau
AU  - Paolo Mazzotta
AU  - Ciara Whelan
AU  - Mohamed Abdelaal
AU  - Hance Clarke
AU  - Andrea D Furlan
AU  - Andrew Smith
AU  - Amna Husain
AU  - Robin Fainsinger
AU  - David Hui
AU  - Nadiya Sunderji
AU  - Camilla Zimmermann
TI  - Opioid safety recommendations in adult palliative medicine: a North American Delphi expert consensus
AID  - 10.1136/bmjspcare-2021-003178
DP  - 2022 Mar 01
TA  - BMJ Supportive & Palliative Care
PG  - 81--90
VI  - 12
IP  - 1
4099  - http://spcare.bmj.com/content/12/1/81.short
4100  - http://spcare.bmj.com/content/12/1/81.full
SO  - BMJ Support Palliat Care2022 Mar 01; 12
AB  - 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.All data relevant to the study are included in the article or uploaded as supplementary information