Peculiarities of prescribing and use of opioids in palliative care mobile teams

Abstract

Despite the widespread recognition of the importance of opioid analgesics for the treatment of moderate to severe pain in oncology and in the palliative care in many countries the adequate pain relief and availability of opioids for medical purposes is still a problem. To analyze prescribing and use of opioids for palliative patients, the data of 43 patients treated by mobile palliative care teams in Western Ukraine have been collected. The results obtained have been compared with international guidelines of pain relief and use of opioids in palliative care. It was determined that 60.5% of patients consumed opioids for 44 days on average; more than half of cancer patients received morphine, usually at the end of life. Opiods prescribed for pain relief were: tramadol – to 48.8% patients, morphine or omnopon – to 39.5%; nalbuphine – to 9.3%; promedol – to 7.3%. Only one third of the patients administered opioids orally. Morphine drugs were received by 54.8% of cancer patients, an average daily consumption of morphine was 26.17 mg and the average duration of administration 9.82 days. Most patients received morphine and omnopon 2 or 3 times a day. Prescriptions of morphine started with a single injection of 10 mg of injection morphine (or 11.5 mg in the case of omnopon injection). A limited range of opioids and peculiarities of providing these medicines to patients in Ukraine restricted the application of pain relief in accordance with international guidelines: prescribing oral forms of opioids at first; introduction of opioids at fixed intervals of time; titrating the dose.