Opioid use at end of life does not hasten death

NEW YORK (Reuters Health) - Effective use of opioids to control pain around the time of death does not appear to hasten death, contrary to general beliefs.

"Hospice providers, families, and patients should not be afraid of opioid drugs because of the belief that their use to control pain shortens life," Dr. Russell K. Portenoy, of the Beth Israel Medical Center, New York, told Reuters Health.

He and colleagues examined the relationship between opioid use and survival using data from the National Hospice Outcomes Project (NHOP), a prospective, longitudinal cohort study involving 13 U.S. hospice programs.

Of 1,306 patients analyzed, 725 received opioids and had at least one dose change before death. The average patient age 76.6 years, the average length of hospice stay was 30 days and the average number of days between final opioid dose change and death was 12 day.

Data analysis showed that a "slightly shorter survival was independently associated with a higher dose of the opioid and also with a cancer diagnosis, being unresponsive, and having lower pain scores," Portenoy told Reuters Health.

"All of these factors, however, accounted for very little (<10 percent) of the differences in time to death among all the patients," he said. "In short, opioid therapy by itself contributes very little to the time before death occurs in hospice programs."

"Opioid drugs," Portenoy concludes, "can be used aggressively at the end of life to relieve pain and suffering, and this use should not be constrained by inappropriate fear of serious consequences like earlier death."

SOURCE: The Journal of Pain and Symptom Management, December 2006.