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The following is a summary of “Use of Opioids in an Acute Palliative Care Unit to Re-assess Prescriptions,” published in the March 2025 issue of Pain and Therapy by Mercadante et al. 

Researchers conducted a retrospective study to re-evaluate opioid prescriptions in an acute palliative care unit (APCU) 12 years after a prior audit.  

They analyzed consecutive individuals with advanced cancer admitted to the APCU for 5 months due to uncontrolled pain. Data on opioid use and administration routes before admission, during hospitalization, and at discharge were recorded. Opioid type, dosage, and administration routes were adjusted based on clinical needs for optimal benefit and individualized treatment. The opioid escalation index was calculated in milligrams (OEImg) and percentage (OEI%).  

The results showed that 113 individuals were assessed. Mean pain intensity decreased from 6.4 (SD 1.8) at admission to 2.3 (SD 1.4) at discharge (P < 0.0005). Among those receiving opioids before admission, the mean oral morphine equivalent (OME) dose was 128 mg/day (SD 120), with no significant difference between admission and discharge. A second opioid or route was prescribed for 61 individuals, while 20 received a third. The mean opioid escalation index was 9.3% (SD 22.5) for OEI% and 4.0 mg/day (SD 24.1) for OEImg. Few had a breakthrough pain prescription at admission. Intravenous morphine was commonly used initially, later replaced by oral morphine and fentanyl at discharge.  

Investigators concluded that the intensive and careful use of opioids in the APCU allowed for the achievement of adequate analgesia in all examined patients within a short time without increasing OME. 

Source: link.springer.com/article/10.1007/s40122-025-00728-4