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.

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

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