Exploring Palliative Care for Individuals with Opioid Use Disorder: A Scoping Review

Objective: In the rapidly evolving climate of opioid use, this scoping review sought to map the factors affecting access to and experience of palliative care (PC) among those with opioid use disorder (OUD). Methods: This scoping review was developed using JBI Scoping Review and Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) criteria. Academic literature searches were performed using PubMed, Web of Science and the Canadian Business & Current Affairs databases. Full-text, peer-reviewed articles published in English or French were searched from January 1, 2010, to present. Thematic analysis was used to examine data extracted in the context of the research question. Results: Twenty-one primary research articles representing 680,992 participants were included. Studies from the United States, Australia, The Netherlands and Canada that focused on PC services from the perspective of the individual, their care partners and health care providers were reviewed. Results were synthesized into three broad themes (person-level, health care provision, and system level), which were broken into ten subthemes (pain management needs, social needs, clinician confidence/expertise, risk of problematic use, fragmented care, prescribing opioid agonist therapy, guidelines and models of care, impact of stigma, policy/legislative limitations and other system limitations). Conclusions: While the PC needs of individuals living with OUD are similar to those without OUD, the PC experiences are very different. Overall, individuals with OUD had less access to PC, the care they received was fragmented and uncoordinated, and pain management needs were unmet. We identified how stigma, prescribing practices, and other considerations also negatively affected PC experiences.