Opioid therapy for pain in the last days of life in patients who already take an opioid

For patients with pain in the last days of life who already take an opioid, continue opioid therapy.

For patients who have been taking oral opioids and become unable to swallow, convert regular and breakthrough doses of opioids to appropriate subcutaneous doses of morphine, or another opioid if morphine cannot be used. For information about changing opioids and routes of administration, see Switching opioids in palliative care.

For patients using an opioid transdermal patch, continue topical therapy and prescribe as-required opioid doses by subcutaneous injection for breakthrough pain; see Immediate-release opioid therapy for breakthrough pain in patients who take a regular opioid for dosage principles. If pain is not adequately controlled, give additional regular opioids subcutaneously. Dose calculations in this situation are often complicated—seek specialist palliative care advice.