RT Journal Article SR Electronic T1 Opioid safety recommendations in adult palliative medicine: a North American Delphi expert consensus JF BMJ Supportive & Palliative Care JO BMJ Support Palliat Care FD British Medical Journal Publishing Group SP 81 OP 90 DO 10.1136/bmjspcare-2021-003178 VO 12 IS 1 A1 Lau, Jenny A1 Mazzotta, Paolo A1 Whelan, Ciara A1 Abdelaal, Mohamed A1 Clarke, Hance A1 Furlan, Andrea D A1 Smith, Andrew A1 Husain, Amna A1 Fainsinger, Robin A1 Hui, David A1 Sunderji, Nadiya A1 Zimmermann, Camilla YR 2022 UL http://spcare.bmj.com/content/12/1/81.abstract 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