• Jenny Lau, Mary M Scott, Karl Everett, Tara Gomes, Peter Tanuseputro, Sheila Jennings, Rebecca Bagnarol, Camilla Zimmermann, and Sarina R Isenberg.
• Division of Palliative Care (Lau, Bagnarol, Zimmermann), Princess Margaret Cancer Centre, University Health Network; Division of Palliative Care (Lau), Department of Family and Community Medicine, University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Scott, Tanuseputro), Ottawa, Ont.; ICES Central (Everett, Gomes); Li Ka Shing Knowledge Institute (Gomes), Unity Health; Leslie Dan Faculty of Pharmacy (Gomes), University of Toronto, Toronto, Ont.; Bruyère Research Institute (Tanuseputro, Isenberg), Ottawa, Ont.; Moms Stop The Harm (Jennings); Division of Palliative Medicine (Zimmermann), Department of Medicine, University of Toronto, Toronto, Ont.; Division of Palliative Care (Isenberg), Department of Medicine, University of Ottawa, Ottawa, Ont. Jenny.Lau@uhn.ca.
• CMAJ. 2024 Apr 28; 196 (16): E547E557E547-E557.

BackgroundPeople with opioid use disorder (OUD) are at risk of premature death and can benefit from palliative care. We sought to compare palliative care provision for decedents with and without OUD.MethodsWe conducted a cohort study using health administrative databases in Ontario, Canada, to identify people who died between July 1, 2015, and Dec. 31, 2021. The exposure was OUD, defined as having emergency department visits, hospital admissions, or pharmacologic treatments suggestive of OUD within 3 years of death. Our primary outcome was receipt of 1 or more palliative care services during the last 90 days before death. Secondary outcomes included setting, initiation, and intensity of palliative care. We conducted a secondary analysis excluding sudden deaths (e.g., opioid toxicity, injury).ResultsOf 679 840 decedents, 11 200 (1.6%) had OUD. Compared with people without OUD, those with OUD died at a younger age and were more likely to live in neighbourhoods with high marginalization indices. We found people with OUD were less likely to receive palliative care at the end of their lives (adjusted relative risk [RR] 0.84, 95% confidence interval [CI] 0.82-0.86), but this difference did not exist after excluding people who died suddenly (adjusted RR 0.99, 95% CI 0.96-1.01). People with OUD were less likely to receive palliative care in clinics and their homes regardless of cause of death.InterpretationOpioid use disorder can be a chronic, life-limiting illness, and people with OUD are less likely to receive palliative care in communities during the 90 days before death. Health care providers should receive training in palliative care and addiction medicine to support people with OUD.© 2024 CMA Impact Inc. or its licensors.

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