Opioid Use in the Last Year of Life Among Medicare Beneficiaries With Advanced Illnesses A Retrospective Cohort Study

The presence of refractory dyspnea is often associated with illness progression to advanced stages. Opioid medications are the first-line pharmacological treatment for the palliation of refractory dyspnea, and indication for this intervention could signal the need for palliative care or hospice. The aims of this study were to describe opioid use and enrollment in hospice care among Medicare beneficiaries with heart failure, chronic obstructive pulmonary disease, or lung cancer during their last year of life. Using Medicare data, we conducted a retrospective cohort study of beneficiaries with heart failure, chronic obstructive pulmonary disease, or lung cancer who died in 2009. Slightly more than one-third of the 110 218 decedents used an opioid medication during the last year of life. Beneficiaries with lung cancer had the most opioid and hospice use. Hospice was initiated in the last month of life, whereas opioids were first prescribed 9 to 12 months before death. Findings suggest that the symptoms experienced by this population in the last year of life may not be well managed. The introduction of an opioid medication to manage refractory dyspnea could be used as an indicator to begin discussions about palliative care or hospice among patients with advanced illnesses.