Eersink Jannis, Maul Julian, Heuser Nils, Morin Astrid, Gschnell Martin, Volberg Christian
Department of Anaesthesiology & Intensive Care Medicine, Philipps University of Marburg, Marburg, Germany.
Department of Dermatology and Allergology, Faculty of Medicine, Philipps University of Marburg, Marburg, Germany.
Addict Sci Clin Pract. 2025 Mar 31;20(1):32. doi: 10.1186/s13722-025-00560-3.
Palliative care focuses on controlling symptoms and improving the patient's quality of life. To achieve this, medications with addictive potential are often used. There have been various case reports of substance misuse in palliative care. This study aims to explore how practitioners perceive the issue and management of substance misuse in palliative care patients.
Following an extensive literature review, a 23-question questionnaire was developed to assess attitudes and practices related to substance misuse in palliative care and distributed to all German palliative care units (PCUs) listed on the website of the German Society for Palliative Medicine (n = 334).
A total of 116 responses from PCUs (34.7%) were included in the analysis. Of these, 49.1% estimated that approximately 1-5% of their patients suffer from medication-related substance misuse. Most respondents (72.4%) assumed that 1-5% of their patients use illicit substances. In addition, 62.9% of the PCUs do not screen their patients for substance use disorders, while only 0.9% report doing so regularly. In the case of addiction problems, 55.2% of the PCUs do not implement any specific measures. Most respondents described their approach to prescribing medications with potential for substance misuse as liberal (71.6%) or very liberal (12.9%). Furthermore, 78.4% reported that the addictive potential of a medication has little or no influence on their prescribing decisions. Finally, 67.2% of participants expressed a desire for more education about addiction in palliative care.
The data collected in our study indicate that, from the perspective of palliative care professionals, substance use disorders are not perceived as a significant problem for patients receiving inpatient palliative care. However, we found that most PCUs do not screen their patients for substance misuse, suggesting that most practitioners may not have a comprehensive view of the actual number of dependent patients. Further research is therefore needed to obtain reliable data on the number of patients with substance use disorders in palliative care and to determine the point at which substance misuse is caused by medical prescription.
姑息治疗专注于控制症状并改善患者生活质量。为实现这一目标，常使用具有成瘾潜力的药物。已有多例关于姑息治疗中药物滥用的病例报告。本研究旨在探讨从业者如何看待姑息治疗患者中药物滥用问题及管理方法。
在广泛的文献综述之后，设计了一份包含23个问题的问卷，以评估与姑息治疗中药物滥用相关的态度和做法，并分发给德国姑息医学协会网站上列出的所有德国姑息治疗单位（PCU）（n = 334）。
分析纳入了来自PCU的116份回复（34.7%）。其中，49.1%估计其约1 - 5%的患者存在与药物相关的药物滥用问题。大多数受访者（72.4%）认为其1 - 5%的患者使用非法药物。此外，62.9%的PCU不对患者进行药物使用障碍筛查，而只有0.9%报告定期进行筛查。在成瘾问题方面，55.2%的PCU未采取任何具体措施。大多数受访者将其开具具有药物滥用潜力药物的方法描述为宽松（71.6%）或非常宽松（12.9%）。此外，78.4%报告称药物的成瘾潜力对其处方决定影响很小或没有影响。最后，67.2%的参与者表示希望获得更多关于姑息治疗中成瘾问题的教育。
我们研究收集的数据表明，从姑息治疗专业人员的角度来看，药物使用障碍对于接受住院姑息治疗的患者而言并非被视为重大问题。然而，我们发现大多数PCU不对患者进行药物滥用筛查，这表明大多数从业者可能对依赖患者的实际数量没有全面认识。因此，需要进一步研究以获取关于姑息治疗中药物使用障碍患者数量的可靠数据，并确定药物滥用由医疗处方导致的临界点。
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