Problematic opioid use is a growing concern in palliative care. This review examines existing tools for assessing opioid risk in this population. A comprehensive search of bibliographic databases, reference lists, and grey literature (up to January 31, 2020) identified relevant primary studies focusing on adults receiving palliative care and prescription opioids for symptom management in advanced illnesses like cancer, neurodegenerative diseases, or end-stage organ diseases. These studies utilized tools to assess problematic opioid use. Inclusion criteria encompassed various study designs, locations, and languages.
Forty-two observational studies, encompassing 14,431 participants and published between 2009 and 2020, were identified. These studies employed questionnaires (n=32) and urine drug tests (n=21) to evaluate problematic opioid use within palliative care settings. The majority of studies originated in the US (n=38) and focused on outpatient palliative care (n=36).
Several standardized questionnaires were utilized, including:
- CAGE (Cut down, Annoyed, Guilty, and Eye-opener): n=8 studies
- CAGE-AID (CAGE-Adapted to Include Drugs): n=6 studies
- Opioid Risk Tool: n=9 studies
- SOAPP (Screener and Opioid Assessment for Patients with Pain): n=3 studies
- SOAPP-Revised: n=2 studies
- SOAPP-Short Form: n=5 studies
Urine drug testing (UDT) was also a common assessment method, although its implementation varied widely across studies. The frequency of abnormal UDT results ranged significantly, from 8.6% to 70%. This variability highlights the lack of standardized protocols for UDT in palliative care. Surprisingly, only two studies primarily focused on evaluating the psychometric properties of questionnaires specifically for palliative care patients.
This review reveals a significant gap in research regarding validated assessment tools specifically designed for problematic opioid use in palliative care. The reliance on generic tools raises concerns about their accuracy and applicability in this unique patient population. Further research focusing on developing and validating palliative care-specific opioid risk assessment tools is crucial. This will inform clinical practice, improve patient safety, and guide policy development related to opioid use in palliative care. This need for specialized tools underscores the importance of considering the complex interplay of physical, psychological, and social factors influencing opioid use in individuals facing serious illnesses.
