Amidst the ongoing opioid crisis, the number of individuals with opioid use disorder is on the rise. Opioid use disorder, a chronic, life-limiting illness, leads to substantial impairment and distress. As the population with opioid use disorder ages, there is a growing need for access to palliative care at the end of their lives.
This study led by Dr. Jenny Lau, the medical director of the Harold and Shirley Lederman Palliative Care Centre at Princess Margaret Cancer Centre, delves into the characteristics of people with opioid use disorder at the end of their lives and investigates the accessibility of palliative care for this demographic.
The research, based on a comprehensive study including information from ICES on 679,840 deaths, revealed that 11,200 of the deceased (1.6%) had opioid use disorder. Individuals with opioid use disorder died at younger ages than those without the disorder (50 years v. 78 years) and were more likely to reside in marginalized neighborhoods.
Comparatively, individuals with opioid use disorder were 16% less likely to receive palliative care than those without the disorder, particular in clinics and at home. This disparity is most likely linked to the high number of individuals with opioid use disorder who die suddenly from drug poisoning and do not have an opportunity to receive palliative care. The most common reasons why physicians provided palliative care for individuals with opioid use disorder were cancer, liver cirrhosis, and sepsis.
Dr. Lau, the lead author of this study, highlights, “The majority of conversations about the opioid crisis focus on the high number of opioid toxicity deaths. The unfortunate reality is that people with opioid use disorder are dying young from other causes as well. If we can improve our understanding of this population and the healthcare that they receive at the end of their lives, we can identify opportunities to intervene and improve their quality of life.”
This research underscores the urgency of addressing the disparities in palliative care provision for individuals with opioid use disorder. By understanding these discrepancies, researchers can pave the way for targeted interventions to ensure equitable end-of-life care for all.
With the proper training in both palliative care and addiction medicine and attention to socioeconomic inequalities, healthcare providers can significantly improve the quality of life for patients with opioid use disorder in their final days.
(L-R) Co-principal Investigators: Dr. Jenny Lau, the medical director of the Harold and Shirley Lederman Palliative Care Centre at Princess Margaret Cancer Centre, and Dr. Sarina Isenberg, chair in mixed methods palliative care research at Bruyère Research Institute, and adjunct scientist, ICES, Ottawa, Ontario.
This work was supported by funding from ICES, which is funded by a grant from the Government of Ontario. This work was also supported by the Ontario Health Data Platform (OHDP), a Province of Ontario initiative to support Ontario’s ongoing response to COVID-19 and its related impacts, and The Princess Margaret Cancer Foundation. This study also received funding from the Canadian Institutes of Health Research and Health Canada’s Health Care Policy and Strategies Program. The views expressed herein do not necessarily represent the views of Health Canada and Canadian Institutes of Health Research.
Jenny Lau reports honoraria from the University of Toronto and travel funding from the Canadian Institutes of Health Research and Health Canada. She is a member of the Global Institute of Psychosocial, Palliative and End-of-Life Care Operations Committee and medical director of the Harold and Shirley Lederman Palliative Care Centre. Additional information on competing interests can be found in the CMAJ publication.
Tara Gomes reports research funding from the Ontario Ministry of Health, the Ontario College of Pharmacists, and the Canadian Agency for Drugs and Technologies in Health; consulting fees from the Auditor General of British Columbia; payment for expert testimony from the Office of the Chief Coroner of Ontario; and travel support from Indigenous Services Canada. She is a Tier 2 Canada Research Chair in Drug Policy Research & Evaluation.
Sarina Isenberg reports travel funding from the American Association of Hospice Palliative Medicine. She is director of the St. Joseph’s Villa Foundation Board of Directors and a member of the Temple Anshe Sholom Succession Planning Committee
Lau J, Scott M, Everett K, Gomes T, Tanuseputro P, Jennings S, Bagnarol R, Zimmermann C, Isenberg S. Association between opioid use disorder and palliative care: a cohort study using linked health administrative data in Ontario, Canada. CMAJ. 2024 April 29. doi: 10.1503/cmaj.231419.