Association Between Opioid-Related Health Harms And Palliative Care: A Cohort Study

Outcomes 1. Participants will have a better understanding of how access to and receipt of palliative care differs among individuals experiencing opioid-related health harm compared to the general decedent population.2. Participants will be familiar with how administrative health data can be used to answer population-level questions about palliative care access, receipt, and delivery. Key Message Using administrative health databases in Ontario, Canada from 2015 to 2018, we compared palliative care provision for decedents with and without opioid-related health harms (OHH) that are suggestive of opioid use disorder (OUD). Patients with OHH were less likely to receive palliative care in community settings, but more likely to receive it in acute care. Background People with opioid use disorder (OUD) are at high risk of premature death and can likely benefit from palliative care. We aimed to compare palliative care provision for decedents with and without opioid-related health harms (OHH) that are suggestive of opioid use disorder (OUD). Methods This cohort study used health administrative databases in Ontario, Canada, to identify people who died between July 1, 2015 and December 31, 2018. Our exposure was OHH, which was defined as emergency department visits, hospitalizations and/or pharmacologic treatments suggestive of OUD within three years of death. The primary outcome was receipt of palliative care within the last 90 days of life, calculated using modified Poisson regression, adjusted for age, sex, rurality, immigrant status, marginalization indices, comorbidities and substance use. Secondary outcomes included setting, initiation and intensity of palliative care. Results Of 323,727 decedents, 2,732 (0.84%) had a history of OHH. Compared to patients without OHH, those with OHH died at a younger age from non-sudden death causes (58.1 vs. 78.2 years; StD 1.33) and were more likely to live in neighbourhoods associated with lowest income quintile (37.0% vs. 22.6%; StD 0.32). Compared to those without OHH, patients with OHH had similar likelihood of receiving any palliative care at the end of life (RR 0.99, 95% CI 0.97-1.02); however, palliative care intensity was lower for patients with OHH (RR 0.91, 95% CI 0.86-0.96). Patients with OHH were less likely to receive palliative care in community settings, but more likely to receive palliative care in acute care settings. Conclusion Patients with OHH suggestive of OUD experience socioeconomic inequities, receive fewer palliative care visits, and access palliative care primarily in acute care settings. Palliative care providers in acute care hospitals should assist with identification and management of structural vulnerability and substance use disorders. Keywords Scientific Research / Disease specific management