Perceptions on the use of opioids in COVID-19: Survey among members of the german association for palliative medicine (DGP)

Background: Opioids efficiently alleviate pain and dyspnea. However, guidelines on symptom management with opioids differ which may lead to an uncertainty concerning opioid indication and ethical implication among medical staff, especially when caring for COVID-19 patients. Aims: We aimed to examine the perception of members of the German Association for Palliative Medicine (DGP) concerning the administration of morphine as the gold standard opioid for symptom control within and outside of a palliative care (PC) setting, including care for COVID-19 patients. Methods: DGP members received an anonymized online questionnaire (Survey Monkey®), containing questions regarding their perception of symptom management with morphine in general, and in particular concerning COVID-19 patients. Participants were asked to rate their perception within and outside of a PC setting. Results: N=506 of 6129 DGP members participated. DGP physicians and nurses perceived handling of morphine as 'certain and confident'(98%) and 'clearly regulated' within PC (95%), but rated these items significantly lower for outside PC (48%/38%). When caring for COVID-19 patients, handling of morphine was even less often rated 'certain and confident'(26%) or 'clearly regulated' (23%) for outside PC. Dyspnea (99%/52%), relief of the dying process (62%/37%), restlessness (30%/15%) and fear/panic (27%/13%) were more frequently rated as general indications for morphine within versus outside PC. Most participants (89%) wished to involve palliative care consultation teams. Conclusions: DGP members perceived substantial uncertainty in the handling of morphine for medical fields outside PC. Uniform interdisciplinary guidelines for symptom control, more education and involvement of a PC consultation team should be increasingly considered in the future.