[Dealing with (no longer) needed narcotics in the outpatient palliative care setting]

For the provision of home care for dying patients the availability of potent pain medication is essential. The aim of this survey directed at community palliative care physicians was to assess and evaluate the current situation of provision and supply of pain medication in the community palliative care setting, including hospices and specialised palliative care teams.

A total of 489 palliative care doctors were identified from registers held by the Practitioners Associations. These professionals received a letter requesting information about the provision of narcotics in ambulatory and community practice. The answers were evaluated and analysed with descriptive statistics.

Of the 489 palliative care specialists, 208 (43%) responded. Almost all of the doctors (99%) considered the availability of a constant supply of narcotics as vital for their practice; 86.3% considered the service provided by public pharmacies as inadequate. Some incidents of flagrant mismanagement were reported. Only 11% of the doctors considered the transfer of narcotics from one patient to the other in hospices and retirement homes via a new narcotics prescription as practicable; 89% of the doctors judged this procedure to lack practicability.

Despite the fact that the need for unrestricted opioid provision in specialised community palliative care is indisputable and recognised, the implementation is nevertheless hindered by a multitude of legal red tape. One solution to the problem would be the legalisation of emergency supplies of narcotics to be held by specialised facilities, such as hospices or specialised palliative care teams. This could, for instance, be implemented via the narcotics requisition form currently used for inpatient supplies in hospitals or for emergency services. Hospices and care homes must be enabled to receive their supplies directly without bureaucratic hindrance and without the need for renewed narcotic prescription.