• Joanne Droney, Jeremy Levy, and Columba Quigley.
• Palliative Medicine, Royal Marsden Hospital, London.
• J Opioid Manag. 2007 Nov 1; 3 (6): 309-16.

UnlabelledOpioids are commonly used in both cancer and noncancer pain. Many patients who require opioids have renal impairment. This can adversely influence the safety of opioids in these patients.ObjectivesThe objectives of this study were to (1) determine which opioids are most commonly prescribed in patients with renal impairment, (2) to identify differences in prescribing practices between two groups of physicians, and (3) to determine how renal impairment was recognized in this setting.Design And ParticipantsA questionnaire postal survey was sent out to renal and palliative medicine consultants in U.K. and Ireland. One hundred and seventy-eight (30.5 percent) questionnaires were completed.ResultsA larger proportion of renal than palliative medicine physicians prescribed morphine in patients with renal impairment. A significant number of physicians did not adjust doses of morphine or codeine. Palliative medicine physicians were more likely to prescribe opioids other than morphine, with the exception offentanyl which was widely used by both groups. Renal physicians were more likely to base their choice of opioid on glomerular filtration rate while palliative medicine physicians were more likely to be influenced by serum creatinine.ConclusionsConsensus guidelines drawing on expertise from both palliative and renal physicians are needed to promote safer use of opioids in this vulnerable patient group.

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