Unused opioids following palliative care for children at home: A missed opportunity for opioid stewardship?

Context: Opioids are often a key component of compassionate end-of-life care for children at home. However, after a child dies, unused opioids pose a risk for misuse or diversion, thereby contributing to the ongoing opioid crisis.

Objectives: This exploratory study aimed to identify the prevalence and context of unused opioids in bereaved families' homes to inform interventions to remove medications in a compassionate and timely manner.

Methods: Bereaved families whose child received palliative care from a tertiary hospital in Ontario, Canada, were invited to participate in an online survey if: (1) their child died at home between January 2020 and July 2024 (no less than 3 months prior to study commencement), (2) they had an email address on file, and (3) they did not require an English interpreter.

Results: Of 121 eligible families, 45 (37.2%) completed the survey. Thirty-four respondents (75.6%) reported having unused opioids in their home at the time of their child's death, with 5 (14.7%) still in possession of opioids at the time of survey completion. Twenty-nine of 34 families (85.3%) disposed of all unused opioids, with 10 (34.4%) taking longer than a month to do so. Eighteen (62.1%) used a pharmacy 'take-back' program, the recommended disposal method.

Conclusion: At the time of their child's death, most families who responded to an online survey had unused opioids in their home, some of which remained in the home for an extended period, posing a risk for misuse. Disposal methods varied, revealing the need for a clear, streamlined process for safe disposal.