Abstract
•Measure the impact of parenteral opioid shortage on the opioid prescriptions by the inpatient palliative care (PC).•Compare the pain control of patients before and after parenteral opioid shortage (POS). Recent POS has the potential to impact cancer pain management in hospitalized patients. This study aims to compare changes in the opioid prescriptions by the inpatient PC team before and after the institution first reported the POS. We reviewed and compared the electronic health records of 386 consecutive eligible consultations seen by the inpatient PC team equally in 1 month before and after the announcement of POS on February 8, 2018. The eligibility criteria include (1) cancer diagnosis, (2) ≥18 years of age, (3) taking opioid medication at the time of consultation, and (4) having at least two consecutive visits with the PC team. Patient demographics, cancer type, opioid type, route, and dose defined as the morphine equivalent daily dose were assessed. Pain control was assessed based on the documentation for each follow-up by the PC team. After POS, parenteral opioids (patient-controlled analgesia, and intravenous breakthrough) were less used by the referring oncology teams [before POS 109/311 (35%) vs. after POS 56/311 (18%) (P=<.001)], while non-parenteral opioids (extended release, transdermal, and oral breakthrough) were more used [before POS 202/311 (65%) vs. after POS 258/311 (82%) P=<.001]. Similar changes associated with POS were indicated by the PC team [parenteral opioids 159/338 (47%) vs. 96/338 (29%) (P=<.001); non-parenteral opioids 179/338 (53%) and 240/228 (71%)]. At first PC follow-up, significantly less proportion of patients achieved better pain control after POS [119/193 (62%) vs. 144/193 (75%) (P=.006)]. However, at the second PC follow-up, the proportion of pain improvement was similar in both cohorts. There is a significant change in opioid routes associated with POS. POS was associated with worse analgesia.
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