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Is routine screening for substance use disorders useful in palliative care? Results of a prospective observational
Christian Volberg1, Katharina Toussaint2, Jorge Riera-Knorrenschild3
1Marburg University, Department of Anesthesiology and Intensive Care Medicine, University Hospital of Marburg, Baldingerstraße, 35043, Marburg, Germany. christian.volberg@staff.uni-marburg.de.
Background:
Substance use disorders are an increasingly prevalent issue in today's society, and they can be caused by prescription of drugs with addictive potential. Patients with incurable diseases often experience severe symptoms and require medications with the potential to cause dependence. For patients with a predisposition to addiction, this can lead to the development of a substance use disorder, further reducing their quality of life.
Methodology:
Over a period of six months, all patients newly admitted to the palliative care unit were screened for unusual medication use. If the initial survey, which used the 'Short Questionnaire on Medication Use', revealed abnormal results, the WHO-ASSIST V3.0 questionnaire was administered to identify substance use disorders and the extent of dependence.
Results:
A total of 181 patients were admitted to the palliative care unit during the survey period. Of these, the initial screening could not be performed in 119 patients (65.7%) due to accompanying circumstances. Of the 62 patients who were included in the study, 15 (24.2%) had an elevated score on the 'Short Questionnaire on Medication Use'. The WHO-ASSIST V3.0 questionnaire indicated positive consumption of alcohol in 100% of cases, opioids in 86.7% of cases, tobacco in 73.3% of cases, and sedatives and sleeping pills in 53.3% of cases. Most respondents were at moderate risk of dependence, with only one person at high risk of opioid use. However, further treatment for a substance use disorder was not deemed to be clinically relevant for any of the patients.
Conclusion:
This survey found that routinely screening palliative care patients for substance use disorders did not provide any clinically relevant information for further treatment of the examined cohort. Given the high level of stress often experienced by people with incurable diseases, the extent to which screening is helpful or merely an unnecessary burden should be considered. As other surveys have shown that palliative care patients with substance use disorders benefit from treatment, follow-up studies should investigate how to identify patients at risk specifically.
