79 Strong opioid substitution: a survey of healthcare professionals’ practice

Background Strong opioid substitution to a different route or different opioid is common in palliative care. The dose of the substituted opioid should be an individualised clinical judgement but accurately calculating the equianalgesic dose is a key step in safely prescribing the new opioid. Variations in professional practice had been noted across the region. Aim Within a regional palliative care audit program in the North West of England to; Evaluate the opioid substitution practice of healthcare professionals (HCPs) in hospice, hospital and community settings; Update regional guidelines for opioid substitution. Methods Systematic literature review; HCPs working in palliative care who prescribe or recommend medications. Results 18 articles were identified to inform the updated regional guidelines. 82 HCPs from 24 clinical sites completed an online survey of practice. 100% of respondents (n=78) reported Morphine is their oral strong opioid of choice. 95% (n=73) reported Morphine or Diamorphine is their parenteral strong opioid of choice. Reported conversion ratios compared with equianalgesic ratios recommended by regional guidelines: Morphine oral to Morphine subcutaneous: 95% use 2:1 (vs 2:1 recommended). Morphine oral to Oxycodone oral: 67% use 2:1, 25% use 1.5:1 (vs 1.5:1 recommended). Oxycodone oral to Oxycodone subcutaneous: 71% use 2:1, 26% use 1.5:1 (vs 1.5:1 recommended). Morphine oral to Alfentanil subcutaneous: 59% use 30:1 (vs 30:1 recommended). 35% consult equianalgesic table or guidelines. Conclusion When converting Morphine to Oxycodone or oral Oxycodone to subcutaneous Oxycodone the majority of HCPs used a 2:1 conversion ratio, rather than the 1.5:1 ratio recommended by regional, national and international guidance. This may lead to higher than recommended doses when converting Oxycodone to Morphine, subcutaneous Oxycodone to oral Oxycodone or Oxycodone to Alfentanil. Further work is required with stakeholders across the region to increase awareness of this.