Spinal opioids in the home and hospice setting

Area of Science:

• Pharmacology
• Pain Management
• Home Infusion Therapy

Background:

• Outpatient management of spinal opioids presents challenges for home infusion pharmacists.
• These challenges include compounding, Schedule II prescription control, long-term dispensing, reimbursement, and overall opioid management in the home.
• While various spinal opioids exist, preservative-free morphine is preferred for epidural and intrathecal injections.

Purpose of the Study:

• To discuss the challenges and considerations for home infusion pharmacists managing spinal opioids.
• To highlight the safety and efficacy of home administration of spinal opioids.
• To identify areas for future research in home opioid therapy.

Main Methods:

• Review of clinical experience and available literature on spinal opioid use in outpatient settings.
• Discussion of compounding, dispensing, and administration methods for spinal opioids at home.
• Examination of opioid characteristics, including preservative-free formulations and combinations with local anesthetics.

Main Results:

• Preservative-free morphine is the preferred agent for spinal administration, despite commercial availability of other opioids.
• Spinal opioids can be administered via intermittent injection, continuous infusion, or patient-controlled analgesia (PCA) pumps.
• Extensive clinical experience supports the safety and effectiveness of home administration of spinal opioids.

Conclusions:

• Home administration of spinal opioids is a safe and effective method for managing intractable pain.
• Further research is needed regarding the stability, storage, and optimal use of various opioids in the home environment.
• Addressing challenges in compounding, regulation, and reimbursement is crucial for successful outpatient spinal opioid management.