Management of Nonmedical Use of Prescribed Pharmaceutical Fentanyl Products in an Acute Palliative Care Unit: A Case Series

BACKGROUND: The aim of this retrospective study was to describe the course of patients with opioid use disorders (OUD) admitted to an acute palliative care unit (APCU) for managing pain and nonmedical use of prescribed transmucosal fentanyl products. METHODS: Briefly, 11 patients underwent opioid switching and initiation of medications for OUD, primarily using methadone and buprenorphine. RESULTS: In total, 11 patients were included in this series. The clinical protocol, which integrated opioid rotation with the use of adjunctive medications such as olanzapine and ketamine, resulted in a significant reduction in pain and withdrawal symptoms. Methadone and buprenorphine, used to manage pain while avoiding access to fentanyl products and monitoring withdrawal symptoms with subsequent dose tapering, were effective in an APCU providing comprehensive palliative care treatment. CONCLUSION: The proper and flexible use of methadone and buprenorphine in an APCU can help patients who were prescribed fentanyl products improperly.