Medication misuse and illicit substance use among palliative care patients in German palliative care units– an evaluation from the perspective of palliative care providers

TL;DR

This study explores how German palliative care providers perceive and manage substance misuse among patients, finding that most do not screen for it and see it as a minor issue.

Contribution

The study provides new insights into the attitudes and practices of palliative care providers regarding substance misuse in Germany.

Findings

Most palliative care units do not screen patients for substance use disorders.

A majority of providers do not implement specific measures for addiction problems.

Many providers reported that addictive potential has little influence on their prescribing decisions.

Abstract

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.

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