Opioid Prescribing Patterns Before and After an Inpatient Palliative Care Consultation

• Published in: American journal of hospice & palliative medicine 2020-09, Vol.37 (9), p.738-742
• Main Authors: Al-Shahri, Mohammad Zafir, Abdullah, Abdulrahman, Alansari, Ameena, Sroor, Mahmoud
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - therapeutic use; Drug Administration Routes; Drug Prescriptions - statistics & numerical data; Female; Humans; Inpatients; Male; Middle Aged; Palliative Care - statistics & numerical data; Practice Patterns, Physicians' - statistics & numerical data; Referral and Consultation; Retrospective Studies; Saudi Arabia; Young Adult
• ISSN: 1049-9091; 1938-2715
• DOI: 10.1177/1049909119897260

Background: To the best of our knowledge, the change in opioid prescription patterns upon referral to a palliative care team (PCT) was not previously investigated in the Middle East. Objective: This study aimed to explore the change in the pattern of opioid prescription and the pain scores before and after referring inpatients to a PCT. Methods: We conducted a retrospective review of patients’ records including all inpatients ≥15 years newly referred to the PCT over a period of 21 months at King Faisal Specialist Hospital and Research Center, Riyadh. Results: Of 631 patients, 52.3% were females, the median age was 54 years, and 96.7% had cancer. The proportion of patients on opioids before referral (83.4%) increased to 93.3% in the postreferral period, P < .0001. Patients receiving opioids on a regular basis increased from 31.9% before referral to 49.9% after referral to the PCT, P < .0001. Morphine was the most commonly prescribed opioid on a regular basis pre- and postreferral. Upon referral, the administration of opioids through the subcutaneous route increased from 3.7% to 10.9%, P < .0001. On average, pain scores were reduced by 1 point on a 0 to 10 numeric scale within 48 hours of seeing a patient by the PCT, P < .0001. Conclusion: Patients referred to a PCT are likely to get their opioid prescription optimized and pain scores improved shortly after the PCT involvement. Patients with cancer-related pain requiring opioids should be referred to a PCT as early as possible.