• Sander D Borgsteede, Luc Deliens, Wouter W A Zuurmond, François G Schellevis, Dick L Willems, Gerrit Van der Wal, and Jacques Th M van Eijk.
• VU University Medical Center, Department of Public and Occupational Health, EMGO Institute, Amsterdam, The Netherlands. s.borgsteede@vumc.nl
• Pharmacoepidemiol Drug Saf. 2009 Jan 1;18(1):16-23.

PurposeTo examine what pain and adjuvant medication is prescribed in palliative care patients at home in The Netherlands.MethodsIn a nationwide, representative, prospective study in general practice in The Netherlands, prescribed medication was registered in 95 general practices with a listed population of 374 070 patients. The GPs identified those who received palliative care in a retrospective survey of the 2169 patients who died within the 1-year study period. We analysed the analgesics, laxatives and anti-emetics that were prescribed during the last 3 months of life for these patients.ResultsThe response rate of the survey was 74%. 425 patients received palliative care and 73% of them were prescribed pain medication: 55% a non-opioid analgesic (paracetamol, NSAIDs), 21% a weak opioid (tramadol, codeine), and 51% a strong opioid. Relatively more younger than older patients were prescribed strong opioids, and more cancer than non-cancer patients were prescribed an analgesic. During the last 3 months of life, the proportion of patients prescribed a non-opioid or a weak opioid increased gradually. The proportion of patients prescribed a strong opioid increased considerably nearing the patient's death. About one third of the non-cancer patients were prescribed strong opioids, mostly commencing in the last 2 weeks before death. In 48% of all patients with an opioid prescription, the GP did not prescribe a laxative.ConclusionsWeak opioids and laxatives are frequently omitted from pain regimens in palliative care at home in The Netherlands.

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