Open Access Open Access  Restricted Access Subscription or Fee Access

A more balanced approach to opioid use and management is also needed in end-of-life care

Sydney Morss Dy, MD, MSc, Cynda Hylton Rushton, PhD, RN, FAAN


Significant pain and suffering are frequent at the end-of-life, and opioids are often essential for relief. Although opioids must be readily available when appropriate, particularly for unbearable physical pain, some of the same issues causing current reconsideration of aggressive opioid guidelines for chronic pain1 also apply at the end of life. These patients may be given opioids when other potentially beneficial treatments should be tried first or for reasons other than physical pain, prescribed excessive doses, and insufficiently counseled or supported. Opioids are easy to start but challenging to discontinue and can cause dependence and psychosocial consequences, and vulnerability at end-of-life may increase risk of and burden from harms and side effects. These patients and their families usually also have multifactorial suffering requiring multidisciplinary teams and approaches other than or in addition to opioids.


opioid, end-of-life care, management, pain

Full Text:



Nelson LS, Juurlink DN, Perrone J: Addressing the Opioid Epidemic. JAMA. 2015;314(14):1453-1454. doi: 10.1001/ jama.2015.12397 [doi].

Teno JM, Freedman VA, Kasper JD, et al: Is Care for the Dying Improving in the United States? J Palliat Med. 2015; 18(8): 662-666. doi: 10.1089/jpm.2015.0039 [doi].

Cassel EJ: The nature of suffering and the goals of medicine. N Engl J Med. 1982; 306(11): 639-645. doi: 10.1056/NEJM 198203183061104 [doi].

Lanning R: “Death doesn’t come like it does in the movies:” What my mother’s last days taught me about our right to die. 2015. Available at: Accessed October 25, 2016.

Hospice & Palliative Nurses Association. HPNA Position Statement: The Ethics of Opioid Use at End of Life. Available at Accessed June 18, 2016.

American Society for Pain Management Nursing. American Society for Pain Management Nursing Position Statement Pain Management at the End of Life. 2013. Available at:, Accessed June 20, 2016.

Dowell D, Haegerich TM, Chou R: CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016. MMWR Recomm Rep 2016; 65: 1–49. DOI:



  • There are currently no refbacks.