Research shows that people with an opioid use disorder are less likely to receive palliative care at the end of life

Compared to people without an opioid use disorder, those with an opioid use disorder were less likely to receive palliative care in clinics and in their homes, and to die at a younger age from causes other than opioid use, according to new research published in Journal of the Canadian Medical Association.

“Most of the conversation about the opioid crisis focuses on the high number of deaths from opioid poisoning. The unfortunate reality is that people with opioid use disorder also die young from other causes,” says author Dr. Jenny Lau, medical director of the Harold and Shirley Lederman Palliative Care Center at Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario.

“If we can improve our understanding of this population and the health care they receive at the end of life, we can identify opportunities to intervene and improve their quality of life.”

The ongoing opioid crisis is increasing the number of people with opioid use disorder. Opioid use disorder can be a chronic, life-limiting illness that causes significant disability and anxiety. As the population with opioid use disorders ages, more and more people will need access to palliative care at the end of life. This study describes the characteristics of people with opioid use disorder at the end of life and examines whether they receive palliative care.

In this large study with information from ICES on 679,840 deaths, 11,200 of the deaths (1.6%) had an opioid use disorder. People with an opioid use disorder died at a younger age than people without an opioid use disorder (50 years vs. 78 years) and were more likely to live in marginalized neighborhoods.

Compared to people without an opioid use disorder, people with an opioid use disorder were 16% less likely to receive palliative care. This finding is most likely related to the high number of people with opioid use disorder who die suddenly from drug poisoning. The most common reasons physicians provided palliative care to people with opioid use disorder were cancer, liver cirrhosis, and sepsis.

“Although most people in Canada want to die at home, people with opioid use disorder may have limited social support, limited finances and unstable housing, which can lead to difficulties accessing palliative care in the community and challenges for healthcare providers to provide this care ” says co-author Dr. Sarina Isenberg, Chair of Mixed Methods Palliative Care Research at the Bruyère Research Institute, and Adjunct Scientist, ICES, Ottawa, Ontario.

“Our findings highlight the importance of health care providers receiving training in both palliative care and addiction medicine to better support patients with opioid use disorder as they approach the end of life.”