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Opioid Use at the End-of-Life

Opioid Use at the End-Of-Life
ACOI Task Force on Palliative Medicine
ACOI Board of Directors
Adopted: May 14, 2009

Whereas, the dying process for most patients involves symptoms such as pain, dyspnea, anxiety and terminal congestion; and

Whereas, the Study to Understand Prognoses and Preferences or Request for Outcomes and Risks of Treatments (SUPPORT), a landmark study in Journal of American Medical Association (JAMA) in 1995, which changed the face of end-of-life care in America, demonstrated that the majority of patients suffer at the end-of-life; and

Whereas, many physicians have concerns about prescribing, or lack sufficient knowledge to prescribe, opioids for dyspnea at the end-of-life; and

Whereas, many nurses are uncomfortable giving opioids for symptom management at necessary doses at the end-of-life. Now, therefore, be it

Resolved, that the following statements are made to improve symptom management at the end-of-life:

1) Patients have a right to pain control and optimal symptom management at the end-of-life;
2) Opioid dosing (e.g. morphine) may be required at frequent intervals, or on an as needed (prn) basis to control end-of-life symptoms;
3) Nursing should work collaboratively with physicians to adjust opioid dosing to meet patients' goals for care and need for comfort;
4) Opioid management at the end-of-life is an important part of providing comfort to most patients. At the opioid dose often needed for patient comfort, sedation and respiratory depression may occur as an unintended consequence; and
5) Opioid use at the end-of-life is medically, legally and ethically appropriate to control symptoms of pain, dyspnea and anxiety despite any unintended consequences, including respiratory depression and sedation.

References:
1) Palliative Care Pocket Consultant, Oxford International Centre for Palliative Care
2) Evidence-Based Interventions to Improve the Palliative Care of Pain, Dyspnea, and Depression at the End of Life: A Clinical Practice Guideline from the American College of Physicians, Annals of Internal Medicine, 15 January, 2008