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 Jenny Lau
A1 Paolo Mazzotta
A1 Ciara Whelan
A1 Mohamed Abdelaal
A1 Hance Clarke
A1 Andrea D Furlan
A1 Andrew Smith
A1 Amna Husain
A1 Robin Fainsinger
A1 David Hui
A1 Nadiya Sunderji
A1 Camilla Zimmermann
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