Abstract

Aim: The worldwide opioid crisis in recent decades has appropriately brought about much stricter rules and regulations concerning opioid use. Oral opioids remain first line unless other routes, subcutaneous or intravenous opioid are required in certain circumstances. Methods: Hospitals now have strict guidelines for how, where and by whom intravenous opioids are administered. In Palliative Care these opioid policies do not impact on our routine work but on rare occasions the intravenous route may become priority. Service providers need to know when mandatory intravenous opioid policy may require to be overridden. Results: Rare cases outline how, alerting to measures required if a strict policy has to be bypassed; it is implemented correctly; rapidly to insure patient’s comfort and continuity of relief; it does not put other staff in danger of breaching their scope of practice. Involvement of senior managers, is pivotal to allay fears of breaching their strict policy. Conclusions: Once all agree patient’s comfort requires a once off break in policy, collaboration to achieve best outcome for the patient is pivotal. New developments in opioid drug delivery systems deserve a mention to insure awareness of new options for our patients. The technological evolution of orally disintegrating opioid tablets, ‘Oradispera’ that; rapidly dissolve once placed on the tongue; do not require swallowing is invigorating as routes of opioid drugs delivery is a daily issue in our prescribing decisions. Policies on opioids are imperative and strict, but if a rare scenario occurs, we are required to explore, educate and override the policy if it empowers the best comfort in dying patients. Upto-date knowledge of new developments in opioid routes of delivery and old knowledge combined with new of the pharmacology of opioids is also essential as with any debate. “Problems are not stop signs, they are guidelines” Robert Schuller.

Keywords

overriding policy, opioid policies