Why Are You So Scared? Managing Risk and Safe Prescribing of Opioids in Hospice and Palliative Medicine (FR454)

Abstract

•Integrate formal risk assessment for substance use disorder when considering or using ongoing opioid therapy.•Implement strategies for safe and appropriate pain management for the patient with serious illness of all risk levels. Epidemic undertreatment of pain, the growing use of opioids for nonmedical purposes, and media attention on opioid misuse have had clinical implications for patients with serious illness. Undertreatment of pain affects ALL patient populations with varied diagnoses. Opioid prescriptions have increased, but they are not necessarily getting to the seriously ill patients with palliative care needs. The implication for patients with cancer and/or serious illness is that they are too often undertreated due to clinician and/or patient fears. While there is an epidemic of pain, use of prescription pain relievers for nonmedical purposes (without a prescription) is now the second most common form of substance use disorder. Since 1999, prescription opioid overdoses, as a proportion of all deaths, have risen by 265% in men and by more than 400% in women. In 2015, there were more than 16,000 prescription painkiller deaths, and 2 million people reported using prescription opioids nonmedically for the first time. This presentation will help hospice and palliative care clinicians to utilize formal risk assessment, recognize at-risk behaviors, risk stratify patients, distinguish substance use disorder from undertreatment of pain, and develop management strategies for all patients with serious illness, regardless of risk level.