Literature Review

Assisted ventilation withdrawal in motor neuron disease: updated results BMJ Supportive & Palliative Care; by Lucy Bleazard, Jonathan Palmer, David Wenzel, Thomas Jeffery, and Christina Faull; 3/24/25 Introduction: Patients with ventilator-dependent motor neuron disease (MND) may request withdrawal of their assisted ventilation. Facilitating this process as a healthcare professional (HCP) can be emotionally and practically challenging. The Association for Palliative Medicine (APM) issued guidance to support HCPs and invited anonymised accounts of the withdrawal process to provide an update on the guidance. ... Results: Younger patients tended to need higher doses to achieve adequate symptom management prior to withdrawal. Practices of weaning the ventilator varied significantly between respondents. The median time to death following withdrawal of ventilation was 30 min, with three-quarters of patients dying within 2 hours. Conclusion: This is the largest data set to date regarding the withdrawal of assisted ventilation in MND. This updated analysis reaffirms that a personalised, titrated approach remains appropriate and effective. The revised APM Guidance 2025 incorporates new sections on recommendations for managing the ventilator. [Continue reading ...]

RFK Jr. continues pioid Crisis PHE into its eighth year Inside Health Policy; by Dorothy Mills-Gregg; 3/19/25 HHS Secretary Robert F. Kennedy Jr. recently renewed the department’s longest ongoing public health emergency (PHE) first declared under the first Trump administration: the opioid abuse crisis. While the Centers for Disease Control and Prevention found a 25.5% decrease in overdose deaths in 2024 compared to the previous year, HHS says the opioid PHE needs to be renewed for another 90 days so federal coordination efforts can continue and key flexibilities for HHS will be preserved.Editor's note: How recently have you reviewed your Policies & Procedures for destroying drugs in the patient's home, upon death--in accordance with state laws? For staff education and accountability? For communicating this with family? For assessing possible drug diversion of opioids, with appropriate follow-up actions? Additionally, numerous hospice bereavement programs have been flooded with grief needs of bereaved family members from opioid deaths. Click here for the U.S. Department of Justice's Drug Enforcement Administration - Diversion Control Divsion; more focused, scroll down to their "Home Disposal Methods."

Psychedelics for cancer pain and associated psychological distress: A narrative review of a potential strategyCancer Medicine; Erika Belitzky, Lis Victoria Ravani Carvalho, Melissa Taylor, Cristina Naranjo Ortiz, Laura Baum, David A Fiellin, Maryam B Lustberg; 3/25Cancer pain can ... be exacerbated by anxiety, depression, quality of life challenges, and fear of death and dying, as well as by fear of recurrence or progression. Psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, mescaline, and N,N-dimethyltryptamine (DMT), are under consideration as new pharmacologic strategies for mitigating pain and the distress associated with cancer pain and associated symptom burden. Although published studies are limited, regulatory hurdles have decreased. Many clinical trials are underway to assess further the use of psychedelics and behavioral counseling for patients with cancer and comorbidities such as anxiety or depression. Early results are promising, and additional research is needed to understand efficacy and tolerability in broader cancer populations. 

Daughter indicted for killing mother with morphine in Evans The Augusta Press, Augusta, GA; by Greg Rickabaugh; 2/25/25The daughter of a woman who died in an Evans assisted living home from a fatal dose of morphine has been indicted for malice murder. Rachel Elaine Waters, 41, is expected to surrender this week on murder charges in the death of 74-year-old Marsha Sprayberry Foster, according to Columbia County authorities.An indictment says that Waters administered a lethal dose of morphine on July 12, 2023, while her mother was at the Marshall Pines assisted living on North Belair Road. The cause of death was determined in an autopsy, showing that excessive use of the unprescribed morphine was the reason for her death. Foster had Alzheimer’s disease, and the morphine was reportedly left behind by hospice workers and used by the daughter without authorization.

Kroger partners with Express Scripts to expand pharmacy services Becker's Hospital Review; by Alexandra Murphy; 2/6/25 Cincinnati-based Kroger Health has reached a new agreement with Express Scripts, the pharmacy benefit services arm of Evernorth, to provide access to prescription medications and health services at the Kroger Family of Pharmacies for Express Scripts Customers. Under the new agreement, the Kroger Family of Pharmacies will resume serving customers in Express Scripts' Medicare Part D and Tricare/Department of Defense plans, according to a Feb. 5 Kroger news release. This comes after Kroger ended its contract with Express Scripts in September of 2022, after months of unsuccessful negotiations over a new agreement. 

Opioid painkillers less available to people of color HealthDay News / Coastal Breeze News, Marco Island, FL; 1/30/25 People of color now have less access to prescription opioid painkillers than white patients, an unintended consequence of efforts to stem America’s opioid epidemic. Communities of color have a 40% to 45% lower distribution of commonly prescribed opioids, compared to majority white communities, researchers reported in a study published Jan. 23 in the journal Pain. This could prevent opioid painkillers from reaching those in true need of them, like cancer patients, researchers said. 

[Sweden] The process of pain assessment in people with dementia living in nursing homes: A scoping reviewPalliative Care and Social Practice; Caroline Kreppen Overen, Maria Larsson, Adelheid Hummelvoll Hillestad, Ingela Karlsson, Siren Eriksen; 1/25Studies have documented a pain prevalence in people with dementia living in nursing homes of 35%–43%, but a possible prevalence of 60%–80%. This scoping review provides a comprehensive description of pain assessment in people with dementia living in nursing homes as a process in three steps. Self-reported information is the most appropriate when assessing pain, as symptom experience is subjective and highly personal. However, for people with dementia living in nursing homes, self-reporting represents a challenge due to cognitive impairment, including difficulties with language and communication. People with dementia might express pain with different behavioural expressions or signs, such as agitation, apathy, restlessness or wandering. Numerous observational assessment tools targeting pain in people with dementia have been developed and evaluated and systematic use of standardized observational tools has been recommended.

North Augusta hospice nurse arrested after allegedly using fake prescriptions Aiken Standard, Aiken, SC; by Matthew Christian; 1/22/25 A North Augusta hospice nurse has been arrested after allegedly acquiring prescription drugs with fake prescriptions. South Carolina Bureau of Drug Control agents arrested Amy Elizabeth Strand, 44, on Jan. 17, according to an Aiken County Sheriff's Office booking report. Strand obtained lorazepam 2 mg tablets from the North Augusta Kroger on June 22, 2024, Agent B.A. Stafford said in a warrant. ... To get the pills, Strand called in a fake prescription in the name of a patient under her care, Stafford continued. ... Strand has been charged with three counts of obtaining a controlled substance by fraud and one count of attempting to obtain a controlled substance by fraud. 

[Korea] A prospective, single-cohort, open, multi-center, observational study of sublingual fentanyl for breakthrough cancer pain: Effectiveness, safety, and tolerability in Korean cancer patientsCancer Research and treatment; Youn Seon Choi, Su-Jin Koh, Woo Kyun Bae, Se Hyung Kim, Seong Hoon Shin, So Yeon Oh, Sang Byung Bae, Yaewon Yang, Eun-Kee Song, Yoon Young Cho, Pyung Bok Lee, Ho-Suk Oh, MinYoung Lee, Jin Seok Ahn; 12/24Fentanyl, a highly lipophilic opioid, was developed as a sublingual fentanyl tablet (SFT) for the management of breakthrough cancer pain (BTcP), and its efficacy and safety were confirmed in a randomized, controlled study. In a real-world setting, SFT provides rapid and effective analgesia in BTcP, even at the lowest dose (100 μg), and the safety profile was acceptable.

PBMs secretly profited from opioid crisis: New York Times Becker's Hospital Review; by Alexandra Murphy; 12/17/24 Pharmacy benefit managers were paid by drugmakers, including Purdue Pharma, to keep opioid prescriptions flowing even as overdose deaths soared across the U.S., according to an investigation by The New York Times. The Dec. 17 report highlighted how Express Scripts, CVS Caremark and Optum Rx, which control access to medications for millions of Americans, negotiated deals with opioid manufacturers to prevent restrictions on painkiller prescriptions in exchange for lucrative rebates. Between 2003 and 2012, Purdue Pharma paid PBMs roughly $400 million annually to avoid limits on opioid prescriptions, which included measures that could have curtailed overprescribing, such as requiring additional physician justifications or limiting the number of pills dispensed. Internal documents reviewed by the Times show how the PBMs repeatedly collaborated with opioid manufacturers to influence insurers' decisions and block restrictions.

Official collaboration between IAHPC and INCB ehospice; 11/19/24 The International Association for Hospice and Palliative Care (IAHPC) is pleased to announce that it has signed a Memorandum of Understanding (MoU) with the International Narcotics Control Board (INCB). The purpose of the MoU is “to provide a framework of cooperation and understanding and to facilitate collaboration to further their shared goals and objectives in regard to improving the availability of internationally controlled substances for medical and scientific purposes.” ... The objectives laid out in the MOU include among others, the exchange of research, data, and analysis on an annual basis on controlled medicines and the exploration of possible solutions such as joint activities to make such information available to the international community. These objectives will be achieved through regular dialogues between INCB and the IAHPC.

Too Much, Too Little, Just Right: Optimizing cancer care for older adults The ASCO Post, American Society of Clinical Oncology; by Ramy Sedhom, MD; Bobby Green, MD; and Julia  Frydman, MD, MS; 9/10/24 Imagine walking into a fancy restaurant only to find a menu consisting mostly of kids’ dishes. It would make no sense. Just 25% of restaurant diners are younger than age 12, and they rarely write Yelp reviews. But when it comes to cancer treatment, this is not very far from what we do. The median age for a new cancer diagnosis is 67, and among those who die of cancer each year, 73% are older adults. Yet just one in four clinical trial participants is aged 70 or older. Consequently, guidelines for most new cancer therapies are based on a median age that is significantly younger than the patient population who actually receives these therapies. That’s quite a conundrum. More than half of patients older than age 65 experience toxicity of grade 3 or worse while undergoing standard chemotherapy. ... Palliative Care—For a 40-year-old mother of two young children, the goal of cancer treatment is usually clear: complete remission and long-term survival. But when you ask older patients with cancer about their priorities, a majority regard symptom control, emotional coping, and other quality-of-life measures at least as much as longevity and sometimes more.

The importance of competencies in pain management and palliative care Greenwich Sentinel, Greenwich, CT; by Russell R. Barksdale, Jr.; 8/21/24 ... Competencies, ongoing pharmacological education, regular patient pain assessments, management, and medication adjustments are all crucial processes for healthcare providers in today’s complex medical environment. Regrettably, metabolic and behavioral issues related to pain medications, especially opioids, if not properly managed, poses risk of addiction. Beginning in the late 1990s, the consumption of medical opioids used to treat pain increased in many countries worldwide. Since that time, alarmingly the United States has outpaced every other country in per capita opioid consumption. ... [Click on the title's link to continue reading.]