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

doi:10.5055/jom.2016.0355

Authors

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

DOI:

https://doi.org/10.5055/jom.2016.0355

Keywords:

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

Abstract

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.

Author Biographies

Sydney Morss Dy, MD, MSc

Departments of Health Policy and Management and Medicine, Johns Hopkins University, Baltimore, Maryland

Cynda Hylton Rushton, PhD, RN, FAAN

Berman Institute of Bioethics and School of, Nursing, Johns Hopkins University, Baltimore, Maryland

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