The aim of this study was to present how
opioids are used in an
acute pain relief and
palliative care unit (APRPCU), where many patients with difficult
pain conditions are admitted from GPs, home
palliative care programs, oncology departments, other hospitals or emergency units, and other regional places. From a consecutive sample of
cancer patients admitted to an APRPCU for a period of 6 months, patients who had been administered
opioids were included in this survey. Basic information was collected as well as
opioid therapy prescribed at admission and, subsequently, during admission and at time of discharge. Patients were discharged once stabilization of
pain and symptoms were obtained and the treatment was considered to be optimized. One week after being discharged, patients or relatives were contacted by phone to gather information about the availability of
opioids at dosages prescribed at time of discharge. One hundred eighty six of 231 patients were specifically admitted for uncontrolled
pain, with a mean
pain intensity of 6.8 (SD 2.5). The mean dose of oral
morphine equivalents in patients receiving
opioids before admission was 45 mg/day (range 10-500 mg). One hundred seventy five patients (75.7 %) were prescribed around the clock
opioids at admission. About one third of patients changed treatment (
opioid or route). Forty two of 175 (24 %), 27/58 (46.5 %), 10/22 (45.4 %), and 2/4 (50 %) patients were receiving more than 200 mg of oral
morphine equivalents, as maximum dose of the first, second, third, and fourth
opioid prescriptions, respectively. The pattern of
opioids changed, with the highest doses administered with subsequent line options. The mean final dose of
opioids, expressed as oral
morphine equivalents, for all patients was 318 mg/day (SD 798), that is more than six times the doses of pre-admission
opioid doses. One hundred eighty six patients (80.5 %) were prescribed a breakthrough
cancer pain (BTcP) medication at admission. Sixty five patients changed their BTcP prescription, and further 27 patients changed again. Finally, eight patients were prescribed a fourth BTcP medication. Of 46 patients available for interview, the majority of them (n = 39, 84 %) did not have problems with their GPs, who facilitated prescription and availability of
opioids at the dosages prescribed at discharge. For patients with severe distress, APRPCUs may guarantee a high-level support to optimize
pain and symptom intensities providing intensive approach and resolving highly distressing situations in a short time by optimizing the use of
opioids.