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Is Euthanasia acceptable within Palliative care and opiate prescribing? -…
Is Euthanasia acceptable within Palliative care and opiate prescribing?
Doctors that specialise in pain have observed that over time the principles used in prescribing for acute pain and pain at the end of life have been applied to the field of chronic pain, despite a lack of evidence of effectiveness and the potential for harm.
https://www.england.nhs.uk/south/info-professional/safe-use-of-controlled-drugs/opioids/#:~:text=Learn%20about%20the%20harms%20of%20opioids%20for%20long-term%20pain%20and
Doctors and medical professionals should provide a self-management plan to patients.
When developing an individualised, documented self‑management plan, provide it in an accessible format for the person and consider including:
the plan's start and review dates
the conditions being managed
a description of medicines being taken under the plan (including the timing)
a list of the medicines that may be self‑administered under the plan and their permitted frequency of use, including any strength or dose restrictions and how long a medicine may be taken for
known drug allergies and reactions to medicines or their ingredients, and the type of reaction experienced.
arrangements for the person to report suspected or known adverse reactions to medicines
circumstances in which the person should refer to, or seek advice from, a health professional
the individual responsibilities of the health professional and the person
any other instructions the person needs to safely and effectively self‑manage their medicines.
The NICE ( national institute for health and care excellence) There recommendations suggest to
Offer a person-centered assessment to those presenting with chronic pain (chronic primary pain, chronic secondary pain, or both), to identify factors contributing to the pain and how the pain affects the person's life.
Organisations should determine locally the most appropriate health professional to carry out a structured medication review, based on their knowledge and skills, including all of the following:
technical knowledge of processes for managing medicines
therapeutic knowledge on medicines use
effective communication skills.
During a structured medication review, take into account:
the person's, and their family members or carers where appropriate, views and understanding about their medicines
the person's, and their family members' or carers' where appropriate, concerns, questions or problems with the medicines
all prescribed, over-the-counter and complementary medicines that the person is taking or using, and what these are for
how safe the medicines are, how well they work for the person, how appropriate they are, and whether their use is in line with national guidance
whether the person has had or has any risk factors for developing adverse drug reactions
Starting strong opioids – titrating the dose
When starting treatment with strong opioids, offer patients with advanced and progressive disease regular oral sustained-release or oral immediate-release morphine (depending on patient preference), with rescue doses of oral immediate-release morphine for breakthrough pain.
OPIODS
Opiods prescribed for end of life care
For patients with no renal or hepatic comorbidities, offer a typical total daily starting dose schedule of 20 mg to 30 mg of oral morphine (for example, 10 mg to 15 mg oral sustained-release morphine twice daily), plus 5 mg oral immediate-release morphine for rescue doses during the titration phase.
A change of breathing pattern can occur in the last few hours before a patient is due to die
nausea may occur when starting strong opioid treatment or at dose increase, but that it is likely to be transient.
Adjust the dose until a good balance exists between acceptable pain control and side effects. If this balance is not reached after a few dose adjustments, seek specialist advice. Offer patients frequent review, particularly in the titration phase.
END OF LIFE OPIOD USAGE
Seek specialist advice before prescribing strong opioids for patients with moderate to severe renal or hepatic impairment.