Relationship between palliative care and location of death among people with opioid use disorder: a retrospective cohort study

Objective — People with opioid use disorder are at high risk of serious comorbidities, more likely to die from all major diseases, and their end-of-life needs remain poorly understood. We aimed to examine the relationship between receipt of palliative care across settings and the location of death among individuals with opioid use disorder.

Methods — We employed a population-level cohort study using health administrative databases. Our cohort was adults with opioid use disorder in Ontario, Canada, who died between July 2015 and December 2021 (N = 11,200). Our exposure was receipt of palliative care within three years prior to the last 90 days of life (inpatient-only, outpatient, or none (reference)). Our primary outcome was the location of death in the community versus institution (reference).

Results — Among our decedent cohort, 5636 (50.3%) received no palliative care before their last 90 days of life, and among those who received it, only 1846 (33.2%) received any outpatient palliative care and 3718 (66.8%) received inpatient-only palliative care. After covariate adjustment, receiving inpatient-only palliative care (vs no palliative care) was associated with a 6% (RR 0.94; 95% CI 0.91, 0.98) decrease in the likelihood of community death, whereas there was no relationship between outpatient palliative care and location of death.

Conclusions — The association of palliative care with the location of death for people with opioid use disorder varies by setting of care. Further research is required to understand if community deaths are aligned with preferences and whether additional factors contribute to their likelihood.