Opioid use and effectiveness of its prescription at discharge in an acute pain relief and palliative care unit

The aim of this study was to present how opioidsare used in an acute pain relief and palliative care unit(APRPCU), where many patients with difficult pain conditionsare admitted from GPs, home palliative care programs,oncology departments, other hospitals or emergency units,and other regional places. From a consecutive sample ofcancer patients admitted to an APRPCU for a period of6 months, patients who had been administered opioids wereincluded in this survey. Basic information was collected aswell as opioid therapy prescribed at admission and, subsequently,during admission and at time of discharge. Patientswere discharged once stabilization of pain and symptomswere obtained and the treatment was considered to be optimized.One week after being discharged, patients or relativeswere contacted by phone to gather information aboutthe availability of opioids at dosages prescribed at time ofdischarge. One hundred eighty six of 231 patients werespecifically admitted for uncontrolled pain, with a meanpain intensity of 6.8 (SD 2.5). The mean dose of oralmorphine equivalents in patients receiving opioids beforeadmission was 45 mg/day (range 10–500 mg). One hundredseventy five patients (75.7 %) were prescribed around theclock opioids at admission. About one third of patientschanged treatment (opioid or route). Forty two of 175(24 %), 27/58 (46.5 %), 10/22 (45.4 %), and 2/4 (50 %)patients were receiving more than 200 mg of oral morphineequivalents, as maximum dose of the first, second, third, andfourth opioid prescriptions, respectively. The pattern ofopioids changed, with the highest doses administered withsubsequent line options. The mean final dose of opioids,expressed as oral morphine equivalents, for all patients was318 mg/day (SD 798), that is more than six times the dosesof pre-admission opioid doses. One hundred eighty sixpatients (80.5 %) were prescribed a breakthrough cancerpain (BTcP) medication at admission. Sixty five patientschanged their BTcP prescription, and further 27 patientschanged again. Finally, eight patients were prescribed afourth BTcP medication. Of 46 patients available for interview,the majority of them (n=39, 84 %) did not haveproblems with their GPs, who facilitated prescription andavailability of opioids at the dosages prescribed at discharge.For patients with severe distress, APRPCUs mayguarantee a high-level support to optimize pain and symptomintensities providing intensive approach and resolvinghighly distressing situations in a short time by optimizingthe use of opioids.