Factors associated with opioid dispensation for patients with COPD and lung cancer in the last year of life: A retrospective analysis.
BACKGROUND
For patients in late stages of chronic obstructive pulmonary disease (COPD), dyspnea is often refractory to conventional treatment. We know little about the use of opioids in ameliorating dyspnea in this population. In this study we explored factors associated with opioid dispensation within the last year of life and differences in opioid dispensation for persons with lung cancer or COPD.


METHODS
In this retrospective cohort study we used administrative health data gained from 1,035 residents of Saskatchewan, Canada to examine patterns of community opioid dispensation in the last year of life. Factors associated with opioid use were determined using multiple logistic regression.


RESULTS
When compared with those with lung cancer, fewer patients with COPD were given opioids within the last week of life; the last month of life, and the last 3 months of life. After adjusting for relevant predictors, patients with lung cancer were more than twice as likely as those with COPD to fill prescriptions for the following: morphine (odds ratio [OR] 2.36, 95% confidence interval [CI]: 1.52-3.67); hydromorphone (OR 2.69, 95% CI: 1.53-4.72); transdermal fentanyl (OR 2.25, 95% CI: 1.28-3.98); or any of these opioids (OR 2.61, 95% CI: 1.80-3.80).


CONCLUSIONS
These opioids are dispensed only for a small proportion of patients with COPD at the end of their lives. Future researchers could explore the efficacy and safety of opioid use for patients with advanced COPD, and whether their limited use is justified.
Goodridge
Donna
D
University of Saskatchewan, Saskatoon, Canada. donna.goodridge@usask.ca <donna.goodridge@usask.ca>
Lawson
Josh
J
Rocker
Graeme
G
Marciniuk
Darcy
D
Rennie
Donna
D
D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology*; D008297:Male; D010166:Palliative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012189:Retrospective Studies; D012525:Saskatchewan; D019452:Terminally Ill
D000701:Analgesics, Opioid
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