Division of Palliative Care (Lau, Bagnarol, Zimmermann), Princess Margaret Cancer Centre, University Health Network; Division of Palliative Care (Lau), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Scott, Tanuseputro), Ottawa, Ont.; ICES Central (Everett, Gomes); Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Moms Stop The Harm (Jennings); Division of Palliative Medicine (Zimmermann), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Palliative Care (Isenberg), Department of Medicine, University of Ottawa, Ottawa, Ont.
CMAJ. 2024 Apr 28;196(16):E547-E557. doi: 10.1503/cmaj.231419.
People with opioid use disorder (OUD) are at risk of premature death and can benefit from palliative care. We sought to compare palliative care provision for decedents with and without OUD.
We conducted a cohort study using health administrative databases in Ontario, Canada, to identify people who died between July 1, 2015, and Dec. 31, 2021. The exposure was OUD, defined as having emergency department visits, hospital admissions, or pharmacologic treatments suggestive of OUD within 3 years of death. Our primary outcome was receipt of 1 or more palliative care services during the last 90 days before death. Secondary outcomes included setting, initiation, and intensity of palliative care. We conducted a secondary analysis excluding sudden deaths (e.g., opioid toxicity, injury).
Of 679 840 decedents, 11 200 (1.6%) had OUD. Compared with people without OUD, those with OUD died at a younger age and were more likely to live in neighbourhoods with high marginalization indices. We found people with OUD were less likely to receive palliative care at the end of their lives (adjusted relative risk [RR] 0.84, 95% confidence interval [CI] 0.82-0.86), but this difference did not exist after excluding people who died suddenly (adjusted RR 0.99, 95% CI 0.96-1.01). People with OUD were less likely to receive palliative care in clinics and their homes regardless of cause of death.
Opioid use disorder can be a chronic, life-limiting illness, and people with OUD are less likely to receive palliative care in communities during the 90 days before death. Health care providers should receive training in palliative care and addiction medicine to support people with OUD.
患有阿片类药物使用障碍（OUD）的人有过早死亡的风险，并可以从姑息治疗中受益。我们旨在比较有和没有 OUD 的死者的姑息治疗服务提供情况。
我们使用加拿大安大略省的健康管理数据库进行了一项队列研究，以确定 2015 年 7 月 1 日至 2021 年 12 月 31 日期间死亡的人。暴露因素为 OUD，定义为在死亡前 3 年内有急诊就诊、住院或药物治疗提示 OUD。我们的主要结局是在死亡前的最后 90 天内接受 1 次或多次姑息治疗服务。次要结局包括姑息治疗的场所、开始和强度。我们进行了一项二次分析，排除了突然死亡（例如阿片类药物毒性、损伤）。
在 679840 名死者中，有 11200 人（1.6%）患有 OUD。与没有 OUD 的人相比，患有 OUD 的人死亡年龄更小，并且更有可能居住在边缘化指数较高的社区。我们发现，患有 OUD 的人在生命末期接受姑息治疗的可能性较低（调整后的相对风险 [RR] 0.84，95%置信区间 [CI] 0.82-0.86），但在排除突然死亡的人后，这种差异并不存在（调整后的 RR 0.99，95% CI 0.96-1.01）。无论死因如何，患有 OUD 的人在诊所和家中接受姑息治疗的可能性都较低。
阿片类药物使用障碍可能是一种慢性、限制生命的疾病，患有 OUD 的人在死亡前的 90 天内社区接受姑息治疗的可能性较低。医疗保健提供者应接受姑息治疗和成瘾医学方面的培训，以支持患有 OUD 的人。
